Malnutrition assessment methods in adult patients with tuberculosis: a systematic review

doi:10.1136/bmjopen-2021-049777

. 2021 Dec 30;11(12):e049777.

doi: 10.1136/bmjopen-2021-049777.

Malnutrition assessment methods in adult patients with tuberculosis: a systematic review

Lies Ter Beek^#^{1

2

3}, Mathieu S Bolhuis^#⁴, Harriët Jager-Wittenaar^{5

6}, René X D Brijan³, Marieke G G Sturkenboom⁴, Huib A M Kerstjens¹, Wiel C M de Lange^{1

2}, Simon Tiberi^{7

8}, Tjip S van der Werf^{1

9}, Jan-Willem C Alffenaar^{10

11

12}, Onno W Akkerman^{13

2}

Affiliations

¹ Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
² Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands.
³ Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
⁴ Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
⁶ Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁷ Department of Infection, Barts Health NHS Trust, London, UK.
⁸ Blizard Institute, Queen Mary University of London, London, UK.
⁹ Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
¹⁰ Faculty of Medicine and Health, University of Sydney, School of Pharmacy, Sydney, New South Wales, Australia.
¹¹ Westmead Hospital, Sydney, New South Wales, Australia.
¹² Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
¹³ Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands o.w.akkerman@umcg.nl.

^# Contributed equally.

PMID: 35344503
PMCID: PMC8719177
DOI: 10.1136/bmjopen-2021-049777

Malnutrition assessment methods in adult patients with tuberculosis: a systematic review

Lies Ter Beek et al. BMJ Open. 2021.

. 2021 Dec 30;11(12):e049777.

doi: 10.1136/bmjopen-2021-049777.

Authors

Affiliations

¹ Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
² Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands.
³ Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
⁴ Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
⁶ Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁷ Department of Infection, Barts Health NHS Trust, London, UK.
⁸ Blizard Institute, Queen Mary University of London, London, UK.
⁹ Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
¹⁰ Faculty of Medicine and Health, University of Sydney, School of Pharmacy, Sydney, New South Wales, Australia.
¹¹ Westmead Hospital, Sydney, New South Wales, Australia.
¹² Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
¹³ Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands o.w.akkerman@umcg.nl.

^# Contributed equally.

PMID: 35344503
PMCID: PMC8719177
DOI: 10.1136/bmjopen-2021-049777

Abstract

Objectives: Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.

Design: Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.

Results: Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.

Conclusions: Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.

Prospero registration number: CRD42019122832.

Keywords: nutrition; nutrition & dietetics; tuberculosis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: HJ-W was codeveloper of the Patient-Generated Subjective Global Assessment©-based Pt-Global© app/web tool.

Figures

**Figure 1**
Flow diagram of the selection process of studies describing assessment in the context of malnutrition.

See this image and copyright information in PMC

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References

1. World Health Organisation . Global tuberculosis report. Geneva, 2020.
1. World Health Organization . Addressing poverty in TB control - options for national TB control programmes. Geneva, 2005.
1. Bhargava A, Chatterjee M, Jain Y, et al. . Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality. PLoS One 2013;8:e77979. 10.1371/journal.pone.0077979 - DOI - PMC - PubMed
1. Nthiga I, David-Kigaru D, Mugendi J. The nutritional status of pulmonary tuberculosis patients aged 25-44 years attending tuberculosis clinic at Lodwar County and referral Hospital, Turkana County, Kenya 2017;2:2455–4898.
1. Wondmieneh A, Gedefaw G, Getie A, et al. . Prevalence of undernutrition among adult tuberculosis patients in Ethiopia: A systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis 2021;22:100211. 10.1016/j.jctube.2020.100211 - DOI - PMC - PubMed

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[1] World Health Organisation . Global tuberculosis report. Geneva, 2020.

[2] World Health Organisation . Global tuberculosis report. Geneva, 2020.

[3] World Health Organization . Addressing poverty in TB control - options for national TB control programmes. Geneva, 2005.

[4] World Health Organization . Addressing poverty in TB control - options for national TB control programmes. Geneva, 2005.

[5] Bhargava A, Chatterjee M, Jain Y, et al. . Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality. PLoS One 2013;8:e77979. 10.1371/journal.pone.0077979 - DOI - PMC - PubMed

[6] Bhargava A, Chatterjee M, Jain Y, et al. . Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality. PLoS One 2013;8:e77979. 10.1371/journal.pone.0077979 - DOI - PMC - PubMed

[7] Nthiga I, David-Kigaru D, Mugendi J. The nutritional status of pulmonary tuberculosis patients aged 25-44 years attending tuberculosis clinic at Lodwar County and referral Hospital, Turkana County, Kenya 2017;2:2455–4898.

[8] Nthiga I, David-Kigaru D, Mugendi J. The nutritional status of pulmonary tuberculosis patients aged 25-44 years attending tuberculosis clinic at Lodwar County and referral Hospital, Turkana County, Kenya 2017;2:2455–4898.

[9] Wondmieneh A, Gedefaw G, Getie A, et al. . Prevalence of undernutrition among adult tuberculosis patients in Ethiopia: A systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis 2021;22:100211. 10.1016/j.jctube.2020.100211 - DOI - PMC - PubMed

[10] Wondmieneh A, Gedefaw G, Getie A, et al. . Prevalence of undernutrition among adult tuberculosis patients in Ethiopia: A systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis 2021;22:100211. 10.1016/j.jctube.2020.100211 - DOI - PMC - PubMed

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Malnutrition assessment methods in adult patients with tuberculosis: a systematic review

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Malnutrition assessment methods in adult patients with tuberculosis: a systematic review

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