Department of Nutrition, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ogi-machi, Kita-ku, Osaka-city, Osaka, 530-8480, Japan.
Graduate School of Human Science and Environment, University of Hyogo, 1-1-12 Shinzaike-honcho, Himeji city, Hyogo, 670-0092, Japan.
BMC Pulm Med. 2022 Aug 15;22(1):315. doi: 10.1186/s12890-022-02109-5.
In women, slender body habitus has been reported to be one of the predisposing factors underlying the development and poor prognosis of non-tuberculous mycobacterial lung disease (NTM-LD). Given the lack of nutritional data contributing to treatment strategies, we aimed to clarify the nutritional status of female patients with NTM-LD and its association with disease severity.
In this single-center observational study, we enrolled 81 female outpatients with NTM-LD. Data on healthy women of similar ages were selected from our previous survey data and categorized as controls. First, we compared anthropometric and dietary survey data between patients and controls. Second, after the patients were categorized into relatively mild (mild, n = 40) and relatively severe groups (severe, n = 41) based on pulmonary X-ray-image finding scores, body composition, nutritional intake, and biochemical markers were compared between the groups. To identify nutritional factors associated with disease severity, logistic regression analyses were performed.
Compared with controls, patients with NTM-LD had significantly lower energy intake, body mass index, body fat, and skeletal muscle mass (all p < 0.001). Compared with the mild group, the severe group had significantly lower skeletal muscle mass (p = 0.037), albumin (p = 0.029), transthyretin (prealbumin) (p = 0.002), retinol-binding protein (p = 0.011), and hemoglobin (p = 0.001); however, no between-group differences were observed in energy or nutrient intake. Logistic analyses revealed that transthyretin (p = 0.025) and hemoglobin (p = 0.003) levels were independent factors associated with disease severity.
This is the first study to comprehensively report the association between NTM-LD severity and nutritional status, including body composition, nutrient intake, and biomarkers. The results suggest that initiating nutritional therapy from the mild stage of the disease to prevent undernutrition is warranted.
在女性中，苗条的体型被认为是非结核分枝杆菌肺病（NTM-LD）发展和预后不良的一个潜在因素。鉴于缺乏有助于治疗策略的营养数据，我们旨在阐明 NTM-LD 女性患者的营养状况及其与疾病严重程度的关系。
在这项单中心观察性研究中，我们纳入了 81 名女性 NTM-LD 门诊患者。从我们之前的调查数据中选择了年龄相似的健康女性作为对照。首先，我们比较了患者和对照的人体测量和饮食调查数据。其次，根据肺部 X 射线图像发现评分，将患者分为相对轻度（轻度，n=40）和相对重度（重度，n=41）两组，比较两组的身体成分、营养摄入和生化标志物。为了确定与疾病严重程度相关的营养因素，我们进行了逻辑回归分析。
与对照组相比，NTM-LD 患者的能量摄入、体重指数、体脂肪和骨骼肌质量显著较低（均 p<0.001）。与轻度组相比，重度组的骨骼肌质量（p=0.037）、白蛋白（p=0.029）、转甲状腺素（前白蛋白）（p=0.002）、视黄醇结合蛋白（p=0.011）和血红蛋白（p=0.001）显著较低；然而，两组之间的能量或营养素摄入没有差异。逻辑分析表明，转甲状腺素（p=0.025）和血红蛋白（p=0.003）水平是与疾病严重程度相关的独立因素。
这是第一项全面报告 NTM-LD 严重程度与营养状况之间关系的研究，包括身体成分、营养素摄入和生物标志物。结果表明，从疾病的轻度阶段开始进行营养治疗以预防营养不良是有必要的。
