Lower Risk of Tuberculosis in Obesity

Chi C. Leung, MBBS; Tai H. Lam, MD; Wai M. Chan, MBBS; Wing W. Yew, MBBS; Kin S. Ho,
MBBS; Gabriel Leung, MD; Wing S. Law, MBChB; Cheuk M. Tam, MBBS;Chi K. Chan,
MBBS; Kwok C. Chang, MBBS

Arch Intern Med. 2007;167(12):1297-1304.

Background

Obesity is increasingly prevalent in both developed and developing areas. Although

undernutrition is well associated with tuberculosis, few studies have systematically
examined the association with obesity.

Method

A cohort of 42 116 individuals 65 years or older enrolled at 18 health centers for elderly
patients in Hong Kong, China (which has a tuberculosis incidence of approximately 90 per
100 000 population), in 2000 were followed up prospectively through the territory-wide
tuberculosis registry for the development of active tuberculosis from 3 months after
enrollment until December 31, 2005, using the identity card number as the unique identifier.
The association with body mass index (BMI; calculated as weight in kilograms divided by the
square of height in meters), as categorized by the Asian standards, was assessed with
the control of other baseline characteristics.

Results

Obese (BMI 30) and overweight (BMI, 25 to <30) individuals were at significantly lower
risks of developing active tuberculosis than normal-weight individuals (BMI, 18.5 to <25),
with hazard ratios (95% confidence intervals) of 0.36 (0.20-0.66) and 0.55 (0.44-0.70),
respectively, after adjustment for baseline demographic, social, and clinical variables.
An inverse linear association was observed predominantly for pulmonary but not
extrapulmonary tuberculosis. This association persisted after controlling for potential
confounders or excluding individuals with known tuberculosis risk factors.

Conclusions

Obesity is associated with a lower risk of active pulmonary tuberculosis in the older
population of Hong Kong. The presence of such a strong but selective association across the
whole spectrum of BMI could have major biological, clinical, and/or epidemiological
implications. Further studies are indicated to explore the underlying mechanisms,
potential clinical utilities, and possible epidemiological consequences.

Author Affiliations:

Tuberculosis and Chest Service (Drs C. C. Leung, Law, Tam, C. K. Chan, and Chang),
Elderly Health Service, Department of Health (Drs W. M. Chan and Ho), and Department of
Community Medicine (Drs Lam and G. Leung), The University of Hong Kong, and
Tuberculosis and Chest Unit, Grantham Hospital (Dr Yew), Hong Kong, China.
Evidence Based
Nursing
Lower Risk of Tuberculosis in Obesity

Anne Fritzie Mayuga

BSN144 – GROUP 175