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Nutrient partitioning during treatment of tuberculosis: gain in body fat mass but not in protein mass^1,2,3

¹ From the Department of Cellular and Molecular Medicine—Infectious Diseases, St George’s Hospital Medical School, London (AS, GEG, and DCM); HIV Medicine, Coleridge Unit, North Middlesex University Hospital NHS Trust, London (AS); the Departments of Clinical Dietetics (LH), Chest Medicine (CFJR), and Clinical Radiology (SG), St George’s Hospital NHS Trust, London; the Elsie Widdowson Laboratory, MRC Human Nutrition Research, Cambridge, United Kingdom (AW); and the Department of Biochemistry, University of Queensland, St Lucia, Australia (LCW).

Background: Tuberculosis is an important cause of wasting. The functional consequences of wasting and recovery may depend on the distribution of lost and gained nutrient stores between protein and fat masses.

Objective: The goal was to study nutrient partitioning, ie, the proportion of weight change attributable to changes in fat mass (FM) versus protein mass (PM), during antimycobacterial treatment.

Design: Body-composition measures were made of 21 men and 9 women with pulmonary tuberculosis at baseline and after 1 and 6 mo of treatment. All subjects underwent dual-energy X-ray absorptiometry and deuterium bromide dilution tests, and a four-compartment model of FM, total body water (TBW), bone minerals (BM), and PM was derived. The ratio of PM to FM at any time was expressed as the energy content (p-ratio). Changes in the p-ratio were related to disease severity as measured by radiologic criteria.

Results: Patients gained 10% in body weight (P < 0.001) from baseline to month 6. This was mainly due to a 44% gain in FM (P < 0.001); PM, BM, and TBW did not change significantly. Results were similar in men and women. The p-ratio decreased from baseline to month 1 and then fell further by month 6. Radiologic disease severity was not correlated with changes in the p-ratio.

Conclusions: Microbiological cure of tuberculosis does not restore PM within 6 mo, despite a strong anabolic response. Change in the p-ratio is a suitable parameter for use in studying the effect of disease on body composition because it allows transformation of such effects into a normal distribution across a wide range of baseline proportion between fat and protein mass.

Key Words: Body composition • bromides • densitometry • X-ray • deuterium oxide • longitudinal studies • nutrient partitioning • nutritional status • tuberculosis • wasting syndrome

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