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Open Access Research article

Wasting among Uganda men with pulmonary tuberculosis is associated with linear regain in lean tissue mass during and after treatment in contrast to women with wasting who regain fat tissue mass: prospective cohort study

Ezekiel Mupere13*, LaShaunda Malone2, Sarah Zalwango3, Alphonse Okwera3, Mary Nsereko3, Daniel J Tisch4, Isabel M Parraga5, Catherine M Stein24, Roy Mugerwa36, W Henry Boom2, Harriet K Mayanja36, Christopher C Whalen7 and Tuberculosis Research Unit at Case Western Reserve University

Author Affiliations

1 Department of Paediatrics & Child Health College of Health Sciences, Makerere University Kampala, Kampala, Uganda

2 Tuberculosis Research Unit, Case Western Reserve University, Cleveland, USA

3 Uganda-Case Western Reserve Research Collaboration, Kampala, Uganda

4 Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, USA

5 Department of Nutrition, Case Western Reserve University, Cleveland, USA

6 Department of Internal Medicine College of Health Sciences, Makerere University, Kampala, Uganda

7 Department of Epidemiology & Biostatistics College of Public Health, University of Georgia Athens, Athens, USA

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BMC Infectious Diseases 2014, 14:24  doi:10.1186/1471-2334-14-24

Published: 13 January 2014

Abstract

Background

Nutritional changes during and after tuberculosis treatment have not been well described. We therefore determined the effect of wasting on rate of mean change in lean tissue and fat mass as measured by bioelectrical impedance analysis (BIA), and mean change in body mass index (BMI) during and after tuberculosis treatment.

Methods

In a prospective cohort study of 717 adult patients, BMI and height-normalized indices of lean tissue (LMI) and fat mass (FMI) as measured by BIA were assessed at baseline, 3, 12, and 24 months.

Results

Men with wasting at baseline regained LMI at a greater rate than FMI (4.55 kg/m2 (95% confidence interval (CI): 1.26, 7.83 versus 3.16 (95% CI: 0.80, 5.52)) per month, respectively during initial tuberculosis therapy. In contrast, women with wasting regained FMI at greater rate than LMI (3.55 kg/m2 (95% CI: 0.40, 6.70) versus 2.07 (95% CI: -0.74, 4.88)), respectively. Men with wasting regained BMI at a rate of 6.45 kg/m2 (95% CI: 3.02, 9.87) in the first three months whereas women, had a rate of 3.30 kg/m2 (95% CI: -0.11, 6.72). There were minimal changes in body composition after month 3 and during months 12 to 24.

Conclusion

Wasted tuberculosis patients regain weight with treatment but the type of gain differs by gender and patients may remain underweight after the initial phase of treatment.

Keywords:
Tuberculosis; HIV; Wasting; Lean tissue mass index; Fat mass index; Body mass index; Gender