Nutritional status in patients with active pulmonary tuberculosis and new nutritional risk screening model for active tuberculosis: a national, multicenter, cross-sectional study in China

Wei Chen; Qin Ding; Sheng-Kang Zhang; Zhao-Wei Tong; Fei Ren; Chun-Mei Hu; Shi-Fang Su; Xiao-Hong Kan; Hanjuan Cao; Rong Li; Gang Fang; Xin-Zhi Guo; Xiao-Hong Chen; Gu-Qing Zhu; Qian Yao; Hai-Yan Luo; Han-Mei Tang; Jian-Yan Lin; Luca Bertolaccini; Lin Fan

doi:10.21037/jtd-23-623

Nutritional status in patients with active pulmonary tuberculosis and new nutritional risk screening model for active tuberculosis: a national, multicenter, cross-sectional study in China

J Thorac Dis. 2023 May 30;15(5):2779-2799. doi: 10.21037/jtd-23-623. Epub 2023 May 25.

Authors

Wei Chen^#¹, Qin Ding^#¹, Sheng-Kang Zhang^#², Zhao-Wei Tong^#³, Fei Ren^#⁴, Chun-Mei Hu^#⁵, Shi-Fang Su^#⁶, Xiao-Hong Kan^#⁷, Hanjuan Cao², Rong Li⁴, Gang Fang⁵, Xin-Zhi Guo⁸, Xiao-Hong Chen⁹, Gu-Qing Zhu⁶, Qian Yao⁶, Hai-Yan Luo⁶, Han-Mei Tang², Jian-Yan Lin¹⁰, Luca Bertolaccini¹¹, Lin Fan¹²

Affiliations

¹ Nutritional Department, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
² Nutritional Department, Hunan Chest Hospital, Changsha, China.
³ Department of Infectious Diseases, Huzhou Center Hospital, Huzhou, China.
⁴ Department of Tuberculosis, Xi'an Chest Hospital, Xi'an, China.
⁵ Department of Tuberculosis, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China.
⁶ Nutritional Department, Chongqing Public Health Medical Center, Chongqing, China.
⁷ Department of Tuberculosis, Anhui Chest Hospital, Hefei, China.
⁸ Department of Tuberculosis, the Hospital of Henan Province Infectious Diseases, Zhengzhou, China.
⁹ Department of Tuberculosis, the Pulmonary Hospital of Fuzhou in Fujian Province (the Tuberculosis Control and Prevention Hospital of Fuzhou in Fujian Province), Fuzhou, China.
¹⁰ Department of Tuberculosis, The Fourth People's Hospital of Nanning, Nanning, China.
¹¹ Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
¹² Department of Tuberculosis, Shanghai Clinical Research Center for Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinical Research Center for Tuberculosis, Shanghai, China.

^# Contributed equally.

Abstract

Background: Tuberculosis (TB) remains a significant challenge for public health and is closely associated with malnutrition; however, few studies have attempted to screen malnutrition among TB patients. The study aimed to evaluate the nutrition status and build a new nutritional screening model for active TB.

Methods: A retrospective, multicenter, large cross-sectional study was conducted in China from 1 January 2020 to 31 December 2021. All included patients diagnosed with active pulmonary TB (PTB) were evaluated both by Nutrition Risk Screening 2002 (NRS 2002) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Univariate and multivariate analyses were conducted to screen the risk factors associated with malnutrition, and a new screening risk model, mainly for TB patients, was constructed.

Results: A total of 14,941 cases meeting the inclusion criteria were entered into the final analysis. The malnutrition risk rate among PTB patients in China was 55.86% and 42.70%, according to the NRS 2002 and GLIM, respectively. The inconsistency rate between the two methods was 24.77%. A total of 11 clinical factors, including elderly, low body mass index (BMI), decreased lymphocyte cells, taking immunosuppressive agents, co-pleural TB, diabetes mellitus (DM), human immunodeficiency virus (HIV), severe pneumonia, decreased food intake within a week, weight loss and dialysis were identified as independent risk factors of malnutrition based on multivariate analyses. A new nutritional risk screening model was constructed for TB patients with a diagnostic sensitivity of 97.6% and specificity of 93.1%.

Conclusions: Active TB patients have severe malnutrition status according to screening by the NRS 2002 and GLIM criteria. The new screening model is recommended for PTB patients as it is more closely tailored to the characteristics of TB.

Keywords: Global Leadership Initiative on Malnutrition (GLIM); Nutrition Risk Screening 2002 (NRS 2002); Nutritional risk; malnutrition; model.