Author ORCID Identifier

https://orcid.org/0000-0002-8210-3032

Date of Award

8-8-2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Christine E. Stauber

Second Advisor

Matthew J Magee

Third Advisor

Henry M Blumberg

Fourth Advisor

Russell R Kempker

Fifth Advisor

Riuyan Luo

Abstract

The relationship of low BMI and an increase in BMI with TB treatment outcomes is not well characterized. Assessing adiposity distribution in addition to BMI may improve the characterization of the metabolic status of patients with TB. This dissertation aimed to determine the association of body composition with TB treatment outcomes among patients with TB.

Study 1 aimed to assess the association of baseline BMI with TB treatment outcomes among adult patients with drug-resistant TB. We also examined whether these associations differed by baseline glycemic status. We used log-binomial models to estimate risk ratios (RR). Compared to individuals with normal BMI, patients with BMI2 were significantly more likely to remain sputum culture positive after two months of treatment (aRR=1.25; 95%CI: 1.06-1.49). The risk of non-conversion by month two was significantly higher among patients with low BMI and hyperglycemia than those with normal BMI and euglycemia (RR=1.54, 95% CI:1.23-1.92). The risk of poor TB treatment outcomes was significantly higher among patients with normal/high BMI and hyperglycemia than those with normal BMI and euglycemia (RR=1.28, 95% CI: 1.03-1.59).

Study 2 assessed whether lack of weight gain during the initial months of treatment was associated with all-cause mortality. We used competing-risk Cox proportional hazard models to estimate hazard ratios (HR). Among adults with normal baseline BMI, weight loss compared to weight gain was associated with an increased risk of death during TB treatment (aHR=5.0; 95%CI 1.2, 19.9). Among adults with low baseline BMI, no change in BMI compared to an increase in BMI was associated with an increased rate of all-cause post-TB mortality (aHR=6.1; 95% CI: 1.5, 24.5).

Study 3 aimed to determine the association between adiposity distribution (fat mass (FM)/fat-free mass (FFM)) and the prevalence of metabolic disorders among patients with drug-sensitive TB. We used multinomial logistic models to estimate odds ratios (OR). Initial high FM/FFM was significantly associated with hyperglycemia (aOR: 16.2; 95% CI: 1.5, 92.7).

This dissertation studies provide valuable information that can be used to prioritize the development of targeted interventions that simultaneously address weight, adipose distribution, and metabolic disease among people with TB.

DOI

https://doi.org/10.57709/35706300

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