Effect Of Nutritional Status Of Tuberculosis Patients On Gastrointestinal Adverse Reactions

Objective:Tuberculosis（TB）is a nutrition-related disease.Epidemiological studies have shown that there is a two-way causal relationship between nutritional status and tuberculosis.Gastrointestinal adverse reactions often occur in anti-tuberculosis drug treatment,and severe cases can lead to drug withdrawal and forced interruption of treatment.Therefore,by investigating the nutritional intake of TB patients and the occurrence of gastrointestinal adverse reactions during anti-TB treatment,this study explored the nutritional factors related to gastrointestinal adverse reactions and provided a scientific basis for nutritional improvement and promotion of drug treatment in TB patients.Methods:Patients with pulmonary tuberculosis who met the inclusion and exclusion criteria in a chest hospital in Shandong Province from 2011 to 2019 were selected as the object of study.Collect patient demographic characteristics,disease history,and clinical symptoms through face-to-face interviews;measure patient height,weight,and calculate body mass index（BMI）;detect serum albumin,hemoglobin,and lymphocyte levels in patients with tuberculosis.A semi-quantitative food frequency table was used to investigate the dietary status of 258 patients in the past month,and the average daily intake of five categories of food（cereal,animal food,vegetables and fruits,soy and milk,oil）was calculated,and the average daily intake of nutrients in patients with TB was calculated by NutriSurvey software.The definition of gastrointestinal adverse reactions was defined according to the criteria established by the Roman Commission.The incidence of gastrointestinal adverse reactions during anti-tuberculosis treatment was followed up,and the incidence of overall and various gastrointestinal symptoms was calculated.According to different malnutrition evaluation indicators（albumin,anemia,lymphocyte count,BMI）,pulmonary tuberculosis patients are divided into normal nutrition group and malnutrition group.The quantile method was used to divide TB patients into low,medium and high groups according to food intake.According to whether the nutrient intake exceeds the recommended dietary nutrient intake of Chinese residents,it is divided into a nutrient sufficient group and a nutrient insufficient group.Using the incidence of anti-tuberculosis drug-induced gastrointestinal adverse reactions as a dependent variable,a multivariate logistic regression model was established to analyze the correlation between nutritional status,food intake,and nutrient intake with gastrointestinal adverse reactions.Result:A total of 1266 patients with pulmonary tuberculosis were included in the study.The results showed that the incidence of hypoalbuminemia,anemia,low lymphocyte malnutrition and low weight malnutrition in TB patients before anti-tuberculosis treatment was 26.0%,21.7%,26.2%and 17.9%,respectively.A total of 31.4%of TB patients suffered from gastrointestinal adverse reactions（at least one of nausea,vomiting,diarrhea and loss of appetite）,of which 16.8%had loss of appetite,the largest number.The results of overall symptom regression analysis showed that hypoalbuminemia could significantly increase the risk of gastrointestinal adverse reactions（GAE）,with an OR value of 1.81（95%CI:1.35-2.44）.The results of symptom regression analysis showed that hypoalbuminemia could increase the risk of gastrointestinal symptoms such as nausea,diarrhea and loss of appetite,with OR values of 1.63（95%CI:1.10-2.42）,1.95（95%CI:1.14-3.34）and 1.71（95%CI:1.20-2.45）,respectively.Low-weight malnutrition can increase the risk of nausea,with an OR value of 1.69（95%CI:1.11-2.58）.Both low lymphocyte dystrophy and anemia can increase the risk of anorexia,with OR values of1.45（95%CI:1.00-2.10）and 1.50（95%CI:1.03-2.17）,respectively.80 of the 258 TB patients who completed the dietary survey experienced gastrointestinal adverse reactions during anti-TB treatment,with an incidence rate of 31.0%.The results of multivariate analysis showed that compared with the group with low intake of oils（0～33g/d）,the risk of GAE during TB patients in the group with high intake（>83g/d）during anti-TB treatment was significantly increased,with an OR value of 1.99（95%CI:1.04-3.83）.The results of various symptom analysis showed that the risk of nausea and vomiting was significantly increased in the medium intake group（34～83 g/d）and the high intake group of oils,with OR values of 3.25（95%CI:1.17-9.01）and 3.04（95%CI:1.11-8.34）,respectively.Adequate vitamin B₁ intake could significantly reduce the incidence of GAE with OR values of 0.32（95%CI:0.12-0.83）.The incidence of nausea and vomiting in the vitamin B1 adequate group（0.0%）was significantly lower than that in the deficiency group（14.5%）.Adequate potassium intake could significantly reduce the incidence of GAE and nausea and vomiting with OR values of 0.30（95%CI:0.14-0.68）and 0.27（95%CI:0.08-0.91）,respectively.Adequate magnesium intake could reduce the incidence of GAE and anorexia with an OR value of 0.41（95%CI:0.20-0.85）and 0.30（95%CI:0.10-0.96）,respectively.Adequate selenium intake could significantly reduce the risk of GAE,with an OR value of 0.39（95%CI:0.19-0.82）.Conclusion:Pulmonary tuberculosis patients have a high incidence of malnutrition,and malnutrition can significantly increase the risk of gastrointestinal adverse reactions induced by anti-tuberculosis drugs.The malnutrition status of patients should be corrected while anti-tuberculosis treatment.Pay attention to the intake of oils in patients with tuberculosis,and ensure the sufficient intake of nutrients vitamin B₁,potassium,magnesium,selenium and other micronutrients.