成人抗结核治疗期间的宏量营养素摄入与身体组成变化

　　美国埃默里大学莱尼研究生院

　　美国埃默里大学医学院

　　美国国家结核病与肺部疾病中心

　　美国埃默里大学罗琳斯公共卫生学院

　　结核患者的宏量营养素摄入高于对照组，但是结核所致消耗显然更大。由于结核患者宏量营养素摄入随着时间推移而增加，体重指数也同步增加，故身体组成比例维持不变。不过，尽管宏量营养素摄入增加，多药耐药结核患者与药物敏感结核患者相比，体重和非脂肪体重随着时间推移持续降低。因此，多药耐药结核对于宏量营养素摄入合成代谢不足，可能反映了结核的分解代谢作用。

Clin Nutr. 2016 Feb;35(1):205-12.

Macronutrient intake and body composition changes during anti-tuberculosis therapy in adults.

Frediani JK, Sanikidze E, Kipiani M, Tukvadze N, Hebbar G, Ramakrishnan U, Jones DP, Easley KA, Shenvi N, Kempker RR, Tangpricha V, Blumberg HM, Ziegler TR.

Laney Graduate School, Emory University, Atlanta, GA 30322, United States; Emory University School of Medicine, Atlanta, GA 30322, United States; National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia; Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States.

BACKGROUND: Malnutrition is common in patients with active tuberculosis (TB), yet little information is available on serial dietary intake or body composition in TB disease.

OBJECTIVE: To evaluate macronutrient intake and body composition in individuals with newly diagnosed TB over time.

DESIGN: Adults with active pulmonary TB (n = 191; 23 with multidrug resistant TB (MDR-TB) and 36 culture-negative household contacts (controls) enrolled in a clinical trial of high-dose cholecalciferol (vitamin D3) were studied. Macronutrient intake was determined at baseline, 8 and 16 weeks. Serial body composition was assessed by body mass index (BMI; kg/m(2)) and bioelectrical impedance analysis (BIA) to estimate fat mass and fat-free mass. Descriptive statistics, repeated measures ANOVA for changes over time and linear regression were used.

RESULTS: At baseline, mean daily energy, protein, fat and carbohydrate (CHO) intakes were significantly higher, and body weight, BMI, fat-free mass and fat mass were significantly lower, between TB subjects and controls. These remained significant after adjusting for age, gender, employment status and smoking. In all TB subjects, baseline mean daily intakes of energy, fat and protein were adequate when compared to the US Dietary Reference Intakes and protein significantly increased over time (p < 0.0001). Body weight, BMI, and fat and fat-free mass increased over time. MDR-TB patients exhibited lower body weight and fat-free mass over time, despite similar daily intake of kcal, protein, and fat.

CONCLUSIONS: Macronutrient intake was higher in TB patients than controls, but TB-induced wasting was evident. As macronutrient intake of TB subjects increased over time, there was a parallel increase in BMI, while body composition proportions were maintained. However, individuals with MDR-TB demonstrated concomitantly decreased body weight and fat-free mass over time versus drug-sensitive TB patients, despite increased macronutrient intake. Thus, MDR-TB appears to blunt anabolism to macronutrient intake, likely reflecting the catabolic effects of TB.

KEYWORDS: Body composition; Diet; Macronutrient; Tuberculosis

PMID: 25753551

PMCID: PMC4550569

DOI: 10.1016/j.clnu.2015.02.007