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Weight Changes During Tuberculosis Treatment and Associated Factors: A Historical Cohort Study in Golestan Province, Iran (2020)
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Mohammad Reza Honarvar1    , Mahsa Ghaffari2 , Naser Behnampour *3 |
1- Assistant Professor of Nutritional Sciences, Health Management and Social Development Research Center, Department of Nutritional Sciences, School of Health, Golestan University of Medical Sciences, Gorgan, Iran.
2- General Physician, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
3- Assistant Professor of Biostatistics, Health Management and Social Development Research Centre, Department of Biostatistics and Epidemiology, School of Health, Golestan University of Medical Sciences, Gorgan, Iran. , behnampour@goums.ac.ir |
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Keywords: Tuberculosis [MeSH], Tuberculosis, Pulmonary [MeSH], Tuberculosis, Extrapulmonary [MeSH], Body Weight Changes [MeSH]
Article ID: Vol27-38 |
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Type of Study: Original Articles |
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Abstract: (83 Views) |
Extended Abstract
Introduction
Tuberculosis (TB), caused by a bacterium called Mycobacterium TB, is the most prevalent infectious disease leading to mortality worldwide.
Despite all measures and initiatives implemented through effective preventive and therapeutic programs, TB remains one of the most challenging diseases regarding diagnosis, treatment, and control globally, and specifically within Iran. Various factors contribute to the failure of treatment and control efforts, including the emergence of drug resistance, diagnostic delays, migration, poverty, ethnicity, gender, malnutrition, and tobacco use and substance dependence. Weight loss and malnutrition are frequently observed in TB patients at the time of diagnosis. Furthermore, malnutrition increases the risk of developing TB. Body weight changes have been identified as a potential predictive marker for TB treatment outcomes, particularly in drug-susceptible cases.
Wight loss due to malnutrition has a direct, bidirectional relationship with TB and serves as a determinant risk factor. Wight loss is observed in 55% of the annual TB incidence cases. Malnourished TB patients often enter a synergistic cycle of disease progression and nutritional decline. However, treatment outcomes for these patients improve significantly with nutritional intervention. Various factors, including associated comorbidities, lifestyle habits, drug side effects, and socioeconomic status, can influence weight gain during the treatment course. Weight changes during the treatment course serve as a critical indicator of nutritional status. Concurrent assessment of the various elements influencing weight change contributes to the optimization of patients' nutritional well-being and the enhancement of clinical outcomes. Specifically, a weight loss of 2 kg during the first month of treatment is identified as a potential risk factor for drug toxicity. Consequently, monitoring patient weight can function as a supportive and cost-effective metric for predicting TB treatment outcomes.
Numerous retrospective cohort studies have demonstrated that weight changes during TB treatment can serve as predictors of treatment outcomes. Patients with successful outcomes (cure) typically have exhibited weight gain, whereas those with unsuccessful outcomes (treatment failure or mortality) have experienced weight loss or negligible weight gain. Accordingly, patients’ body weight changes have been identified as a potential prognostic marker for TB treatment outcomes, particularly in drug-susceptible cases. Given the clinical manifestations of the disease and the paucity of global and domestic research-specifically in Iran and Golestan province-regarding weight changes, this study was conducted to evaluate weight changes during TB treatment and its associated factors.
Methods
This historical cohort study was conducted based on data retrieved from the TB Registry System of Golestan Province. The study population comprised all patients diagnosed with TB at health centers across Golestan Province in 2020. Out of 400 referred patients, complete and analyzable data were available for 348 individuals (178 males and 170 females). Patient information was treated with strict confidentiality.
The inclusion criteria comprised patients diagnosed with TB, including smear-positive, smear-negative, and extra-pulmonary TB cases, whose complete medical records were documented in the TB Registry System. The sole exclusion criterion was human immunodeficiency virus (HIV) coinfection.
Data including age, gender, type of TB, pre- and post-treatment weight, place of residence (urban or rural), and treatment outcomes were extracted from patients’ medical records in the TB Register System.
Patients’ body weight was recorded before and after treatment across three groups: Smear-positive pulmonary TB, smear-negative pulmonary TB, and extra-pulmonary TB.
Results
The mean post-treatment weight exhibited a statistically significant increase across all three groups (smear-positive pulmonary TB, smear-negative pulmonary TB, and extra-pulmonary TB) (P<0.001). Notably, weight gain was more pronounced in both smear-positive and smear-negative pulmonary patients compared to those with extra-pulmonary involvement.
Prior to treatment, 208 patients (59.77%) presented with positive sputum smears. Based on the grade of sputum smear positivity, these patients were categorized into three groups, including +, ++, and +++. Weight measurements were assessed both before and after the treatment course. In all three groups, a comparison of weights revealed a statistically significant difference (P<0.001). The most substantial weight gain was observed in the ++ sputum smear group (2.46 kg).
For the 271 patients whose sputum smear results were recorded at the end of the treatment course, pre- and post-treatment mean weights were compared. Patients with negative sputum smears at the completion of treatment exhibited a greater weight gain compared to those with positive sputum smears (including +, ++, or +++) (2.30 kg versus 1.32 kg); however, the weight increase was statistically significant in both groups (P<0.05).
Comparing patients’ pre- and post-treatment mean weights revealed a statistically significant increase in both genders (P<0.001). This weight gain was more pronounced in men than in women (2.16 kg versus 1.80 kg).
Moreover, comparing patients’ pre- and post-treatment mean weights among both urban and rural residents revealed a significant difference (P<0.001), so that the mean weight gain was 1.79 kg for urban residents and 2.16 kg for rural residents.
After the treatment, a statistically significant increase was observed in mean weight across all three age groups: Under 15 years (2.58 kg, P<0.003), 15–65 years (2.05 kg, P<0.001), and over 65 years (1.71 kg, P<0.001). Advanced age demonstrated a significant inverse correlation with weight gain (R = -0.10, P=0.03). Specifically, patients over the age of 65 gained less weight by the end of the treatment, whereas weight gain was higher for those under 15 years than those in other groups and even exceeded the overall mean weight gain of the total patient population.
Conclusion
Based on the findings, there was a significant difference in the mean weight of patients recorded in the TB Registry System in Golestan Province over a one-year period before and after treatment. The weight gain observed was less than 5% of the initial body weight. Furthermore, the mean post-treatment weight changes were more pronounced in pulmonary TB patients (both smear-positive and smear-negative) compared to extra-pulmonary TB patients, based on their pre-treatment sputum smear positivity grades. Overall, the weight change was statistically significant across all three groups.
Weight gain during the intensive phase of the directly observed treatment, short-course (DOTS) regimen enhances clinical response. Specifically, each one-kilogram increase in a patient's body weight is associated with an 11% improvement in clinical response. In patients with TB, the clinical response correlates with several factors, including age, previous history of TB, intestinal parasites, hemoglobin concentration, weight gain, micronutrient supplementation, and gender.
Weight gain occurs more rapidly in patients with pulmonary TB compared to those with extra-pulmonary TB, and the clinical response to treatment is directly linked to this weight gain. This disparity may be attributed to the earlier detection of pulmonary TB cases-before the immune system is further compromised and the patient's capacity to combat the infection diminishes. However, if the necessary infrastructure and specialists for the timely identification of extra-pulmonary TB are available, the observed correlation between the type of TB and weight gain might no longer be significant.
In our study, a more significant weight gain was observed among patients with pulmonary TB-who constituted the majority of the population-and who achieved better treatment outcomes (negative sputum smear). It appears that disease severity is higher in individuals with higher grades of sputum smear positivity. Consequently, oxidant levels are elevated, and the patient's appetite for food intake is reduced during the acute phase of the illness. Upon receiving anti-TB treatment, oxidant levels decrease, leading to a higher food intake compared to other patients. Therefore, weight gain in these patients is more pronounced than in others.
Weight gain occurred significantly in both male and female groups; however, a more pronounced increase was observed in males. Given that gender is a determining factor in quality of life and treatment adherence, it appears that within the studied population of Golestan Province, treatment adherence was higher among men than women, consequently leading to the observed treatment outcome of weight gain.
In our study, patients residing in rural areas exhibited significantly greater weight gain compared to their urban counterparts. This observation reflects a favorable treatment outcome among rural residents. It is plausible that this positive therapeutic response is attributable to the more conducive climate in the rural regions of Golestan Province (Northeast of Iran), which may have positively influenced the recovery process and weight gain.
Since the weight gain observed in patients was lower than that reported in other studies, factors such as the patients' nutritional status and the families' nutritional literacy, coupled with potential genetic factors stemming from the ethnic diversity of Golestan Province, may account for this finding.
Ethical Statement
This study was approved by the Research Ethics Committee at Golestan University of Medical Sciences (IR.GOUMS.REC.1401.064).
Authors' Contributions
Mohammad Reza Honarvar (M.D): Project administration and design, Project execution, Data collection, Data analysis, Interpretation of the results, Drafting of the initial manuscript, Approval of the final manuscript.
Mahsa Ghaffari (M.D): Project execution, Data collection, Interpretation of the results.
Naser Behnampour (Ph.D): Project administration and design, Project execution, Data analysis, Interpretation of the results, Drafting of the initial manuscript, Approval of the final manuscript.
Conflicts of Interest
No conflicts of interest.
Acknowledgement
This article has been derived from the doctoral dissertation (approval code: 112615) by Mahsa Ghaffari in Doctor of Medicine (MD) at Golestan University of Medical Sciences. The authors would like to thank the Department of Communicable Diseases (Health Deputy) of Golestan University of Medical Sciences for their collaboration and also the support provided by the International Campus and the Vice-Chancellor for Research and Technology of the University.
Key Message: Factors such as the type of TB (pulmonary versus extra-pulmonary), the grade of sputum smear positivity, treatment outcomes, gender, place of residence, and age were identified as factors associated with weight changes in patients with TB.
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Honarvar M R, Ghaffari M, Behnampour N. Weight Changes During Tuberculosis Treatment and Associated Factors: A Historical Cohort Study in Golestan Province, Iran (2020). J Gorgan Univ Med Sci 2025; 27 (4) :73-82 URL: http://goums.ac.ir/journal/article-1-4594-en.html
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