Body Wasting Among Tuberculosis Patients in Urban Uganda

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Mupere, Ezekiel
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Case Western Reserve University
Background although body wasting is a cardinal feature of tuberculosis, its etiology and management is poorly understood; and its assessment is overlooked in research and in clinical practice. Objective We established whether body wasting modifies survival and body composition changes during and after tuberculosis treatment; whether HIV modifies dietary intake among tuberculosis patients; whether dietary intake differs by wasting and severity of disease status; and whether dietary intake influences body composition. Methods Retrospective cohort and cross-sectional designs were employed. Height-normalized body mass (BMI), fat-free mass (FFMI), and fat mass (FMI) indices and 24-hour dietary intake recall were measured. Results Body wasting was associated with reduced survival and the effect differed by gender. FFMI was found to be a predictor of survival among women whereas BMI was among men. Wasting was associated with substantial linear increase in FFMI, FMI, and BMI during the first three months but the rate of increase differed by gender and not HIV status. Changes in body composition among men were affected by initial FFMI and BMI, whereas among women by FMI. There were minimal changes in body composition after month 3 and during the one year period after month 12 regardless of the initial body composition, gender, and HIV status. Dietary intake in the study population was monotonous, rich in carbohydrates and deficient in nutrients. Dietary intake at the time of diagnosis was influenced by severity of tuberculosis disease, but not HIV status and in the absence of tuberculosis was influenced by gender. Prediction of body composition by energy and protein intake differed by gender. Energy intake was an important predictor of body composition among women whereas appetite was among men. Conclusion Results provide theoretical framework to provide targeted nutritional intervention to patients presenting with wasting and patients of female gender. National programs should integrate nutritional health education in the management of tuberculosis. Nutritional assessment should involve establishment of body composition to identify patients that may be at risk of poor survival. Further evaluation is needed to understand changes in dietary intake overtime and its impact on body composition.
A thesis submitted in fulfillment of the requirements of the degree of Doctor of Philosophy Department of Epidemiology and Biostatistics, Case Western Reserve University.
Body Wasting , Tuberculosis Patients
Mupere, Ezekiel, 2010. Body Wasting Among Tuberculosis Patients in Urban Uganda