Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
BMC Infect Dis. 2019 Jul 16;19(1):627. doi: 10.1186/s12879-019-4244-4.
Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction.
We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI.
Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant.
BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
营养不良和糖尿病是活动性结核病（TB）的风险因素，也是潜伏性 TB 感染（LTBI）的可能风险因素，并且可能相互作用，从而改变它们对这些结果的影响。迄今为止，研究尚未探讨这种相互作用。
我们于 2014 年至 2018 年在印度本地治里和泰米尔纳德邦的基层医疗中心招募了 919 名新诊断的活动性 TB 患者和 1113 名家庭接触者。在横断面分析中，我们使用广义估计方程来衡量体重指数（BMI）和糖尿病对两个结局（活动性 TB 和 LTBI）的相加和相乘交互作用。
在超重或肥胖的成年人中，糖尿病患者活动性 TB 的患病率比非糖尿病患者高 12 倍，在正常体重成年人中高 2.5 倍，在体重不足的成年人中则没有差异（交互作用 P<0.0001）。糖尿病与每 100 名超重或肥胖参与者中增加 50 例活动性 TB 病例、每 100 名正常体重参与者中增加 56 例和每 100 名体重不足参与者中增加 17 例（交互作用 P<0.0001）有关。在 BMI 类别中，筛查 2.3-3.8 例活动性 TB 患者即可发现 1 例高血糖患者。糖尿病与 LTBI 患病率无关，且 BMI*糖尿病交互作用不显著。
BMI 和糖尿病与新诊断的活动性 TB 相关，但与 LTBI 无关。糖尿病使超重和肥胖成年人中活动性 TB 的风险最大，而糖尿病相关的活动性 TB 负担在正常和超重或肥胖成年人中相似。所有活动性 TB 患者中都普遍存在高血糖。这些发现强调了在印度进行双向糖尿病-活动性 TB 筛查的重要性。
