World Health Organization, Stop TB Department, Geneva, Switzerland.
Int J Epidemiol. 2010 Feb;39(1):149-55. doi: 10.1093/ije/dyp308. Epub 2009 Oct 9.
Low weight for height is an established risk factor for tuberculosis (TB), and recent studies suggest that overweight is a protective factor. No previous systematic review has been done to explore the consistency and establish the gradient of this apparent 'dose-response' relationship.
A systematic literature review was carried out to identify cohort studies that collected data on weight and height at baseline and that used a diagnosis of active TB as the study outcome. Weight-for-height measures used in the original studies were transformed into body mass index (BMI). Exponential trend lines were fitted to each data set.
Six studies were included. In all of them, there was a log-linear inverse relationship between TB incidence and BMI, within the BMI range 18.5-30 kg/m(2). The average slope gave a reduction in TB incidence of 13.8% [95% confidence interval 13.4-14.2] per unit increase in BMI. The dose-response relationship was less certain at BMI <18.5 and >30 kg/m(2).
There is a strong and consistent log-linear relationship between TB incidence and BMI across a variety of settings with different levels of TB burden. More research is required to test the relationship at very low and very high BMI levels, to establish the biological mechanism linking BMI with risk of TB and to establish the potential impact on the global TB epidemic of changing nutritional status of populations.
身高体重偏低是结核病（TB）的既定风险因素，最近的研究表明超重是一种保护因素。目前尚未有系统综述来探讨这种明显的“剂量-反应”关系的一致性并确定其梯度。
系统检索了队列研究文献，这些研究在基线时收集了体重和身高数据，并将活动性结核病的诊断作为研究结果。原始研究中使用的体重身高指标被转化为身体质量指数（BMI）。对每个数据集拟合指数趋势线。
共纳入 6 项研究。在所有研究中，TB 发病率与 BMI 之间存在对数线性反比关系，BMI 范围在 18.5-30 kg/m²。平均斜率表明 BMI 每增加 1 个单位，TB 发病率降低 13.8%[95%置信区间 13.4-14.2]。BMI<18.5 和>30 kg/m²时，这种剂量-反应关系不太确定。
在具有不同结核病负担水平的各种环境中，TB 发病率与 BMI 之间存在强烈而一致的对数线性关系。需要进一步研究以检验非常低和非常高 BMI 水平下的关系，以确定 BMI 与结核病风险之间的生物学机制，并确定人群营养状况变化对全球结核病流行的潜在影响。
