Skip to main content
    • Aa
    • Aa

Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients

  • L. J. PODEWILS (a1), T. HOLTZ (a1), V. RIEKSTINA (a2), V. SKRIPCONOKA (a2), E. ZAROVSKA (a2), G. KIRVELAITE (a2), E. KREIGERE (a2) and V. LEIMANE (a2)...

Despite the adoption of strategies to prevent and treat multidrug-resistant tuberculosis (MDR-TB) over the past decade, Latvia continues to have one of the highest rates of MDR-TB in the world. It is important to identify modifiable factors that may impact on MDR-TB patient outcomes. A study was conducted to elucidate the association between nutritional status and clinical presentation, clinical course, and mortality in 995 adult patients treated for MDR-TB from 2000 to 2004. Twenty percent of patients were underweight, defined as a body mass index <18·5, at the time of diagnosis. These patients were significantly more likely to have clinical evidence of advanced disease, and had a greater risk of experiencing ⩾3 side-effects [adjusted odds ratio 1·5, 95% confidence interval (CI) 1·1–2·1] and death (adjusted hazard ratio 1·9, 95% CI 1·1–3·5) compared to patients who were normal or overweight. Interventions aimed at these high-risk patients, including nutritional supplementation as an adjunct to anti-TB therapy, should be considered and evaluated by TB programmes.

Corresponding author
*Author for correspondence: L. J. Podewils, Epidemiologist, International Research and Programs Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-10, Atlanta, GA 30333, USA. (Email:
Hide All
1.WHO. Global tuberculosis control: surveillance, planning, financing: WHO Report 2008. Geneva, World Health Organization, 2008 (WHO/HTM/TB/2008.393).
2.Scrimshaw NS. Symposium: Nutrition and infection, prologue and progress since 1968. Historical concepts of interactions, synergism, and antagonism between nutrition and infection. Journal of Nutrition 2003; 133: 316S321S.
3.Davis AL. A historical perspective on tuberculosis and its control. In Reichman LB, Hershfield ES, eds. Tuberculosis: A Comprehensive International Approach, 2nd edn. New York: Marcel Dekker Inc. 2000, pp. 249.
4.Macallan DC. Malnutrition in tuberculosis. Diagnostic Microbiology and Infectious Disease 1999; 34: 153157.
5.van Lettow M, Fawzi WW, Semba RD. Triple trouble: The role of malnutrition in tuberculosis and human immunodeficiency virus co-infection. Nutrition Reviews 2003; 61: 8190.
6.Khan A, et al. Lack of weight gain and relapse risk in a large tuberculosis treatment trial. American Journal of Respiratory and Critical Care Medicine 2006; 174: 344348.
7.Zacharia R, et al. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Transactions of the Royal Society of Tropical Medicine and Hygiene 2002; 96: 14.
8.WHO. The International Classification of adult underweight, overweight and obesity according to BMI ( Accessed 28 February 2008.
9.WHO. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.361).
10.den Boon S, et al. Comparison of symptoms and treatment outcomes between actively and passively detected tuberculosis cases: the additional value of active case finding. Epidemiology and Infection 2008; 136: 13421349.
11.Ramakrishnan CV, et al. The role of diet in the treatment of pulmonary tuberculosis. An evaluation in a controlled chemotherapy study in home and sanatorium patients in south India. Bulletin of the World Health Organization 1961; 25: 339359.
12.Santha T, et al. Risk factors associated with default, failure, and death among tuberculosis patients treated in DOTS programme in Tiruvallur District, South India, 2000. International Journal of Tuberculosis and Lung Disease 2002; 6: 780788.
13.Karyadi E, et al. Poor micronutrient status of active pulmonary tuberculosis patients in Indonesia. Journal of Nutrition 2000; 130: 29532958.
14.Abba K, et al. Nutritional supplements for people being treated for active tuberculosis. Cochrane Database of Systematic Reviews 2008; Issue no. 4, Art no. CD006086.
15.Martins N, et al. Food incentives to improve completion of tuberculosis treatment: randomized controlled trial in Dili, Timor-Leste. British Medical Journal 2009; 339: b4248.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 31 *
Loading metrics...

Abstract views

Total abstract views: 265 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th October 2017. This data will be updated every 24 hours.