HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
PLoS One. 2011;6(6):e21161. doi: 10.1371/journal.pone.0021161. Epub 2011 Jun 21.
Diabetes prevalence and body mass index reflect the nutritional profile of populations but have opposing effects on tuberculosis risk. Interactions between diabetes and BMI could help or hinder TB control in growing, aging, urbanizing populations.
We compiled data describing temporal changes in BMI, diabetes prevalence and population age structure in rural and urban areas for men and women in countries with high (India) and low (Rep. Korea) TB burdens. Using published data on the risks of TB associated with these factors, we calculated expected changes in TB incidence between 1998 and 2008. In India, TB incidence cases would have increased (28% from 1.7 m to 2.1 m) faster than population size (22%) because of adverse effects of aging, urbanization, changing BMI and rising diabetes prevalence, generating an increase in TB incidence per capita of 5.5% in 10 years. In India, general nutritional improvements were offset by a fall in BMI among the majority of men who live in rural areas. The growing prevalence of diabetes in India increased the annual number of TB cases in people with diabetes by 46% between 1998 and 2008. In Korea, by contrast, the number of TB cases increased more slowly (6.1% from 40,200 to 42,800) than population size (14%) because of positive effects of urbanization, increasing BMI and falling diabetes prevalence. Consequently, TB incidence per capita fell by 7.8% in 10 years. Rapid population aging was the most significant adverse effect in Korea.
Nutritional and demographic changes had stronger adverse effects on TB in high-incidence India than in lower-incidence Korea. The unfavourable effects in both countries can be overcome by early drug treatment but, if left unchecked, could lead to an accelerating rise in TB incidence. The prevention and management of risk factors for TB would reinforce TB control by chemotherapy.
糖尿病患病率和体重指数反映了人群的营养状况，但对结核病风险有相反的影响。糖尿病和 BMI 之间的相互作用可能有助于或阻碍在人口增长、老龄化和城市化的国家中控制结核病。
我们汇编了描述高（印度）和低（韩国）结核病负担国家城乡地区 BMI、糖尿病患病率和人口年龄结构随时间变化的数据。利用关于这些因素与结核病风险相关的已发表数据，我们计算了 1998 年至 2008 年期间结核病发病率的预期变化。在印度，由于老龄化、城市化、BMI 变化和糖尿病患病率上升的不利影响，结核病发病率的增长速度（从 170 万增加到 210 万，增长 28%）将快于人口增长速度（增长 22%），这将导致人均结核病发病率在 10 年内增加 5.5%。在印度，大多数居住在农村地区的男性 BMI 下降，抵消了一般营养改善的影响。糖尿病在印度的患病率不断上升，使 1998 年至 2008 年间糖尿病患者的结核病年发病数增加了 46%。相比之下，在韩国，由于城市化、BMI 增加和糖尿病患病率下降的积极影响，结核病病例的数量增长速度较慢（从 40200 例增加到 42800 例，增长 6.1%），比人口增长速度（增长 14%）慢。因此，人均结核病发病率在 10 年内下降了 7.8%。人口快速老龄化是韩国最显著的不利影响。
营养和人口变化对高发病率的印度的结核病产生了比低发病率的韩国更不利的影响。两国的不利影响可以通过早期药物治疗来克服，但如果不加以控制，可能会导致结核病发病率加速上升。预防和管理结核病的危险因素将通过化疗来加强结核病控制。
