Frediani Jennifer K, Sanikidze Ekaterina, Kipiani Maia, Tukvadze Nestani, Hebbar Gautam, Ramakrishnan Usha, Jones Dean P, Easley Kirk A, Shenvi Neeta, Kempker Russell R, Tangpricha Vin, Blumberg Henry M, Ziegler Thomas R
Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Graduate Program, Laney Graduate School, Emory University, Atlanta, GA 30322, United States; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States; Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia.
Clin Nutr. 2016 Feb;35(1):205-212. doi: 10.1016/j.clnu.2015.02.007. Epub 2015 Feb 26.
Malnutrition is common in patients with active tuberculosis (TB), yet little information is available on serial dietary intake or body composition in TB disease.
To evaluate macronutrient intake and body composition in individuals with newly diagnosed TB over time.
Adults with active pulmonary TB (n = 191; 23 with multidrug resistant TB (MDR-TB) and 36 culture-negative household contacts (controls) enrolled in a clinical trial of high-dose cholecalciferol (vitamin D3) were studied. Macronutrient intake was determined at baseline, 8 and 16 weeks. Serial body composition was assessed by body mass index (BMI; kg/m(2)) and bioelectrical impedance analysis (BIA) to estimate fat mass and fat-free mass. Descriptive statistics, repeated measures ANOVA for changes over time and linear regression were used.
At baseline, mean daily energy, protein, fat and carbohydrate (CHO) intakes were significantly higher, and body weight, BMI, fat-free mass and fat mass were significantly lower, between TB subjects and controls. These remained significant after adjusting for age, gender, employment status and smoking. In all TB subjects, baseline mean daily intakes of energy, fat and protein were adequate when compared to the US Dietary Reference Intakes and protein significantly increased over time (p < 0.0001). Body weight, BMI, and fat and fat-free mass increased over time. MDR-TB patients exhibited lower body weight and fat-free mass over time, despite similar daily intake of kcal, protein, and fat.
Macronutrient intake was higher in TB patients than controls, but TB-induced wasting was evident. As macronutrient intake of TB subjects increased over time, there was a parallel increase in BMI, while body composition proportions were maintained. However, individuals with MDR-TB demonstrated concomitantly decreased body weight and fat-free mass over time versus drug-sensitive TB patients, despite increased macronutrient intake. Thus, MDR-TB appears to blunt anabolism to macronutrient intake, likely reflecting the catabolic effects of TB.
营养不良在活动性肺结核（TB）患者中很常见，但关于结核病患者的系列饮食摄入量或身体组成的信息却很少。
评估新诊断结核病患者随时间推移的常量营养素摄入量和身体组成。
对参与高剂量胆钙化醇（维生素D3）临床试验的191例活动性肺结核成人患者（其中23例为耐多药结核病（MDR-TB）患者，36例培养阴性的家庭接触者（对照））进行了研究。在基线、第8周和第16周测定常量营养素摄入量。通过体重指数（BMI；kg/m²）和生物电阻抗分析（BIA）评估系列身体组成，以估计脂肪量和去脂体重。使用描述性统计、重复测量方差分析来分析随时间的变化以及线性回归。
在基线时，结核病患者与对照组相比，平均每日能量、蛋白质、脂肪和碳水化合物（CHO）摄入量显著更高，而体重、BMI、去脂体重和脂肪量显著更低。在调整年龄、性别、就业状况和吸烟因素后，这些差异仍然显著。与美国膳食参考摄入量相比，所有结核病患者的基线平均每日能量、脂肪和蛋白质摄入量充足，且蛋白质摄入量随时间显著增加（p < 0.0001）。体重、BMI以及脂肪量和去脂体重随时间增加。尽管MDR-TB患者每日千卡、蛋白质和脂肪摄入量相似，但随时间推移其体重和去脂体重较低。
结核病患者的常量营养素摄入量高于对照组，但结核病引起的消瘦明显。随着结核病患者常量营养素摄入量随时间增加，BMI平行增加，同时身体组成比例保持不变。然而，与药物敏感结核病患者相比，MDR-TB患者随时间推移体重和去脂体重同时下降，尽管常量营养素摄入量增加。因此，MDR-TB似乎削弱了对常量营养素摄入的合成代谢作用，这可能反映了结核病的分解代谢效应。
