Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis

European Journal of Clinical Nutrition volume 60, pages 163–171 (2006)Cite this article

Abstract

Objective:

To examine the impact of HIV coinfection, socioeconomic status (SES) and severity of tuberculosis (TB) on the body composition and anthropometric status of adults with pulmonary TB.

Design:

Cross-sectional study.

Setting:

Five TB clinics in Dar es Salaam, Tanzania.

Subjects:

A total of 2231 adult men and women diagnosed with pulmonary TB, prior to the initiation of anti-TB therapy.

Methods:

We compared the distribution of anthropometric characteristics including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin-fold (TSF), and arm muscle circumference (AMC) by HIV status, SES characteristics, and indicators of TB severity (bacillary density in sputum and Karnofsky performance score). Similar comparisons were carried out with body composition variables from bioelectrical impedance analysis and albumin concentrations, in a subsample of 731 subjects.

Results:

In multivariate analysis, HIV infection was significantly associated with lower MUAC and AMC in both men and women, but not with BMI or TSF. Compared to HIV-uninfected women, those who were HIV infected had lower body cell mass (BCM) (adjusted difference=−0.85 kg, P=0.04), intracellular water (−0.68 l, P=0.04), and phase angle (−0.52, P=0.02). Albumin concentrations were significantly lower in both men and women infected with HIV. Among HIV-infected men, CD4 cell counts <200/mm3 were related to lower intracellular water, BCM, fat-free mass and phase angle. Independent of HIV infection, BMI and MUAC were positively related to SES indicators and the Karnofsky performance score; and inversely related to bacillary density.

Conclusions:

HIV infection is associated with indicators of low lean body mass in adults with TB; socioeconomic factors and TB severity are important correlates of wasting, independent of HIV.

Sponsorship:

The National Institute of Allergy and Infectious Diseases (UO1 AI 45441-01).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Bovet P, Ross AG, Gervasoni JP, Mkamba M, Mtasiwa DM, Lengeler C et al. (2002). Distribution of blood pressure, body mass index and smoking habits in the urban population of Dar es Salaam, Tanzania, and associations with socioeconomic status. Int J Epidemiol 31, 240–247.

    Article  Google Scholar 

  • Ellis KJ (2000). Human body composition: in vivo methods. Physiol Rev 80, 649–680.

    Article  CAS  Google Scholar 

  • Forrester JE, Spiegelman D, Tchetgen E, Knox TA, Gorbach SL (2002). Weight loss and body-composition changes in men and women infected with HIV. Am J Clin Nutr 76, 1428–1434.

    Article  CAS  Google Scholar 

  • Harries AD, Nkhoma WA, Thompson PJ, Nyangulu DS, Wirima JJ (1988). Nutritional status in Malawian patients with pulmonary tuberculosis and response to chemotherapy. Eur J Clin Nutr 42, 445–450.

    CAS  PubMed  Google Scholar 

  • Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH (1948). The use of nitrogen mustards in the palliative treatment of cancer. Cancer 1, 634–656.

    Article  Google Scholar 

  • Kennedy N, Ramsay A, Uiso L, Gutmann J, Ngowi FI, Gillespie SH (1996). Nutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania. Trans R Soc Trop Med Hyg 90, 162–166.

    Article  CAS  Google Scholar 

  • Kotler DP, Burastero S, Wang J, Pierson Jr RN (1996). Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease. Am J Clin Nutr 64, 489S–497S.

    Article  CAS  Google Scholar 

  • Kotler DP, Thea DM, Heo M, Allison DB, Engelson ES, Wang J et al. (1999). Relative influences of sex, race, environment, and HIV infection on body composition in adults. Am J Clin Nutr 69, 432–439.

    Article  CAS  Google Scholar 

  • Kotler DP, Tierney AR, Wang J, Pierson Jr RN (1989). Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr 50, 444–447.

    Article  CAS  Google Scholar 

  • Lohman TG, Roche AF, Martorell RE (1988). Anthropometric Standardization Reference Manual. Human Kinetics Books: Champaign, IL.

    Google Scholar 

  • Macallan DC, McNurlan MA, Kurpad AV, de Souza G, Shetty PS, Calder AG et al. (1998). Whole body protein metabolism in human pulmonary tuberculosis and undernutrition: evidence for anabolic block in tuberculosis. Clin Sci (London) 94, 321–331.

    Article  CAS  Google Scholar 

  • Macdonald B, Johns T, Gray-Donald K, Receveur O (2004). Ecuadorian Andean women's nutrition varies with age and socioeconomic status. Food Nutr Bull 25, 239–247.

    Article  Google Scholar 

  • Madebo T, Lindtjorn B, Aukrust P, Berge RK (2003). Circulating antioxidants and lipid peroxidation products in untreated tuberculosis patients in Ethiopia. Am J Clin Nutr 78, 117–122.

    Article  CAS  Google Scholar 

  • Mulligan K, Tai VW, Schambelan M (1997). Cross-sectional and longitudinal evaluation of body composition in men with HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol 15, 43–48.

    Article  CAS  Google Scholar 

  • Niyongabo T, Henzel D, Idi M, Nimubona S, Gikoro E, Melchior JC et al. (1999). Tuberculosis, human immunodeficiency virus infection, and malnutrition in Burundi. Nutrition 15, 289–293.

    Article  CAS  Google Scholar 

  • Niyongabo T, Mlika-Cabanne N, Barihuta T, Henzel D, Aubry P, Larauze B (1994). Malnutrition, tuberculosis and HIV infection in Burundi. AIDS 8, 851–852.

    Article  CAS  Google Scholar 

  • Onwubalili JK (1988). Malnutrition among tuberculosis patients in Harrow, England. Eur J Clin Nutr 42, 363–366.

    CAS  PubMed  Google Scholar 

  • Ott M, Fischer H, Polat H, Helm EB, Frenz M, Caspary WF et al. (1995). Bioelectrical impedance analysis as a predictor of survival in patients with human immunodeficiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 9, 20–25.

    Article  CAS  Google Scholar 

  • Paton NI, Castello-Branco LR, Jennings G, Ortigao-de-Sampaio MB, Elia M, Costa S et al. (1999). Impact of tuberculosis on the body composition of HIV-infected men in Brazil. J Acquir Immune Defic Syndr Hum Retrovirol 20, 265–271.

    Article  CAS  Google Scholar 

  • Paton NI, Chua YK, Earnest A, Chee CB (2004). Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Am J Clin Nutr 80, 460–465.

    Article  CAS  Google Scholar 

  • Range N, Ipuge YA, O'Brien RJ, Egwaga SM, Mfinanga SG, Chonde TM et al. (2001). Trend in HIV prevalence among tuberculosis patients in Tanzania, 1991–1998. Int J Tuberc Lung Dis 5, 405–412.

    CAS  Google Scholar 

  • Scalcini M, Occenac R, Manfreda J, Long R (1991). Pulmonary tuberculosis, human immunodeficiency virus type-1 and malnutrition. Bull Int Union Tuberc Lung Dis 66, 37–41.

    CAS  PubMed  Google Scholar 

  • Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H et al. (2003). Inequities among the very poor: health care for children in rural southern Tanzania. Lancet 361, 561–566.

    Article  Google Scholar 

  • Schwenk A, Beisenherz A, Romer K, Kremer G, Salzberger B, Elia M (2000). Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment. Am J Clin Nutr 72, 496–501.

    Article  CAS  Google Scholar 

  • Shah S, Whalen C, Kotler DP, Mayanja H, Namale A, Melikian G et al. (2001). Severity of human immunodeficiency virus infection is associated with decreased phase angle, fat mass and body cell mass in adults with pulmonary tuberculosis infection in Uganda. J Nutr 131, 2843–2847.

    Article  CAS  Google Scholar 

  • Suttmann U, Ockenga J, Selberg O, Hoogestraat L, Deicher H, Muller MJ (1995). Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. J Acquir Immune Defic Syndr Hum Retrovirol 8, 239–246.

    Article  CAS  Google Scholar 

  • Tang AM, Forrester J, Spiegelman D, Knox TA, Tchetgen E, Gorbach SL (2002). Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 31, 230–236.

    Article  Google Scholar 

  • Urassa W, Matunda S, Bredberg Raden U, Mhalu F, Biberfeld G (1994). Evaluation of the WHO human immune deficiency virus (HIV) antibody testing strategy for the diagnosis of HIV infection. Clin Diagn Virol 2, 1–6.

    Article  CAS  Google Scholar 

  • Van Lettow M, Kumwenda JJ, Harries AD, Whalen CC, Taha TE, Kumwenda N et al. (2004). Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis 8, 211–217.

    CAS  PubMed  Google Scholar 

  • Villamor E, Msamanga G, Spiegelman D, Coley J, Hunter DJ, Peterson KE et al. (2002). HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy. Eur J Clin Nutr 56, 415–424.

    Article  CAS  Google Scholar 

  • White H (1980). A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica 48, 817–830.

    Article  Google Scholar 

  • World Health Organization (1998). Laboratory Services in Tuberculosis Control – Part II: Microscopy. World Health Organization: Geneva.

  • World Health Organization (2004). Global Tuberculosis Control: Surveillance, Planning, Financing. WHO Report 2004: Geneva.

  • World Health Organization Expert Committee on Physical Status (1995). Physical Status: The Use and Interpretation of Anthropometry. World Health Oranization: Geneva.

  • Zachariah R, Spielmann MP, Harries AD, Salaniponi FM (2002). Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg 96, 291–294.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the study participants, and the study coordinator, supervisors, nurses, and laboratory technicians who made this research possible. This study was supported by the National Institute of Allergy and Infectious Diseases (UO1 AI 45441-01) of the United States of America.

Author information

Authors and Affiliations

  1. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    E Villamor, E Saathoff & W W Fawzi

  2. Department of Internal Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

    F Mugusi

  3. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    R J Bosch

  4. Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA

    R J Bosch

  5. Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

    W Urassa

  6. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    W W Fawzi

Authors
  1. E Villamor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E Saathoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F Mugusi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R J Bosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W Urassa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W W Fawzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Villamor.

Additional information

Guarantor: E Villamor.

Contributors: WWF, FM, WU, and EV contributed to the study design. EV and ES participated in the study implementation and field supervision. RJB participated in statistical data analyses. EV carried out the data analyses, interpreted the results, and wrote the initial draft of the manuscript. All authors participated in data interpretation and contributed to the final version of the manuscript. WWF and FM are Principal Investigators of the study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Villamor, E., Saathoff, E., Mugusi, F. et al. Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis. Eur J Clin Nutr 60, 163–171 (2006). https://doi.org/10.1038/sj.ejcn.1602281

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602281

Keywords

This article is cited by

Search

Advanced search

Quick links