Body Mass Index, Diabetes, and Risk of Tuberculosis: A Retrospective Cohort Study

Hayoung Choi; Jung Eun Yoo; Kyungdo Han; Wonsuk Choi; Sang Youl Rhee; Hyun Lee; Dong Wook Shin

doi:10.3389/fnut.2021.739766

Body Mass Index, Diabetes, and Risk of Tuberculosis: A Retrospective Cohort Study

Front Nutr. 2021 Dec 1:8:739766. doi: 10.3389/fnut.2021.739766. eCollection 2021.

Authors

Hayoung Choi¹, Jung Eun Yoo², Kyungdo Han³, Wonsuk Choi⁴, Sang Youl Rhee⁵, Hyun Lee⁶, Dong Wook Shin^{7

8}

Affiliations

¹ Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
² Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea.
³ Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.
⁴ Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea.
⁵ Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, South Korea.
⁶ Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
⁷ Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁸ Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea.

Abstract

Although both diabetes mellitus (DM) and underweight are associated with increased risk of tuberculosis (TB), there are limited data evaluating TB risk while considering two factors simultaneously-body mass index (BMI) and DM. A retrospective cohort study was performed with 10,087,903 participants of the Korean National Health Screening Program in 2009. The cohort was followed up to the date of TB incidence, death, or until December 31, 2018. We compared the incidence and risk of TB according to BMI category and DM. During the 7.3-year follow-up duration, the incidence of TB was 0.92 per 1,000 person-years in the normal weight without DM, 2.26 in the normal weight with DM, 1.80 in the underweight without DM, and 5.35 in the underweight with DM. Compared to the normal weight without DM, the normal weight with DM, the underweight without DM, and the underweight with DM showed a 1.51-fold (95% CI, 1.46-1.57), a 2.21-fold (95% CI, 2.14-2.28), and a 3.24-fold (95% CI, 2.95-3.56) increased risk of TB, respectively. However, compared to the normal weight without DM, the severely obese without DM and those with DM showed a 0.37 (95% CI, 0.36-0.38) and a 0.42 (95% CI, 0.36-0.48)-fold decreased risk of TB, respectively. There was no significant joint effect of BMI and DM on the risk of incident TB in the overall population; a synergistic effect of underweight and DM was evident in participants <65 years of age, current smokers, and heavy drinkers. In conclusion, being underweight or DM individually increases the risk of incident TB. Based on our study results, a focused screening of incident TB in patients with DM may be beneficial.

Keywords: body mass index; diabetes mellitus; epidemiology; nutritional status; tuberculosis.