ABSTRACT
The interaction between tuberculosis (TB) and nutrition in humans has long been recognized. Malnutrition is thought to modulate the risk for the development of active TB. Patients with TB may then develop wasting and micronutrient deciency. Figure 8.1 summarizes this complex malnutrition-TB-malnutrition interaction between different nutritional factors and TB. In vitro and animal studies of protein-energy malnutrition and micronutrient deciency have demonstrated dysfunctions in the innate and adaptive immune systems against Mycobacterium tuberculosis (MTb). This is thought to be the mechanism behind the increased risk for the development of active TB in patients with evidence of undernutrition. This immune dysfunction is also thought to explain the strong association between diabetes mellitus (DM) and TB. These interactions have important implications in populations with high
Introduction ............................................................................................................ 179 Effect of Malnutrition on TB ................................................................................. 180
Malnutrition and the Risk for TB ...................................................................... 180 Undernutrition and the Risk for TB ............................................................. 181 Obesity, Diabetes Mellitus, and Risk for TB ................................................ 184
Malnutrition and Effects on TB Testing ............................................................ 186 Effects on TST .............................................................................................. 186 Effects on IFN-γ Release Assays ................................................................. 187
Effects of TB on Human Nutrition ........................................................................ 188 Effects on Macronutrients ................................................................................. 188
Protein-Energy Malnutrition and Mechanisms of Wasting ......................... 188 Potential Mediators of Wasting .................................................................... 190 Evidence for Nutritional Supplementation for Treatment of Wasting .......... 193
Micronutrients and TB ...................................................................................... 198 Macrominerals .............................................................................................. 198 Vitamins........................................................................................................ 198 Trace Elements .............................................................................................208
