Body mass index trajectories and association with tuberculosis risk in a cohort of household contacts in Southern Africa

Larsson, Leyla, Calderwood, Claire J, Marambire, Edson T, Held, Kathrin, Banze, Denise, Mfinanga, Alfred, Madziva, Karlos, Walsh, Phoebe, Jacob, Joseph, Fernandez, Francisco Trinchan, Lungu, Patrick, Mesic, Anita, Khosa, Celso, Minja, Lilian T, Mutsvangwa, Junior, Bhargava, Madhavi, Lauseker, Michael, Gupta, Rishi K, Heinrich, Norbert and Kranzer, Katharina (2025) 'Body mass index trajectories and association with tuberculosis risk in a cohort of household contacts in Southern Africa'. Clinical Infectious Diseases. (In Press)

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Abstract

Background
Studies have demonstrated an inverse log-linear relationship between body mass index (BMI) and tuberculosis incidence. However, a person's BMI is dynamic, and longitudinal changes may be more informative than cross-sectional assessments. We evaluate the association between cross-sectional and changing BMI and risk of tuberculosis and describe longitudinal trajectories in a high-risk cohort.

Methods
ERASE-TB was a prospective longitudinal cohort study of household contacts ≥10 years in Southern Africa (Zimbabwe, Tanzania, and Mozambique), with 6-monthly follow-up up to 24 months. Associations between BMI and tuberculosis were investigated based on baseline (including hemoglobin) and changing BMI, using logistic, Poisson, and Cox models. Prevalent tuberculosis was defined as diagnosis during <30 days after recruitment. Growth mixture modelling was used to model longitudinal latent trajectories.

Results
Of 2107 recruited household contacts (621 [29.5%] adolescents and 1310 [62.2%] female), 520 (24.7%) were underweight. There were 21 and 41 people diagnosed with prevalent and incident tuberculosis, of whom 5/21 (23.8%) and 12/41 (29.3%) were underweight. Being underweight and anemic (adjusted hazard ratio: 3.77; 95% confidence interval: 1.50–9.51) and >10% negative change in BMI during follow-up (adjusted incidence rate ratio: 2.27; 95% confidence interval: 0.22–22.9) were associated with increased risk of incident tuberculosis. The association between continuous BMI-for-age Z-scores were nonlinear, with increased risk of tuberculosis with lower BMI. Four latent groups were defined in the growth mixture modelling: increasing, decreasing, and low/high stable BMI.

Conclusions
Declining BMI, regardless of absolute value, is a strong predictor of tuberculosis among household contacts. Longitudinal measurements should be considered in active case finding among tuberculosis-affected households.

Item Type:	Article
Subjects:	QU Biochemistry > Biochemistry of the Human Body > QU 100 Body composition WA Public Health > WA 30 Socioeconomic factors in public health (General) WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
Faculty: Department:	Biological Sciences > Department of Tropical Disease Biology
Digital Object Identifer (DOI):	https://doi.org/10.1093/cid/ciaf222
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	06 Jun 2025 14:33
Last Modified:	06 Jun 2025 14:33
URI:	https://archive.lstmed.ac.uk/id/eprint/26734

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