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Free Content Diabetes and body mass index in relation to risk of active tuberculosis: a prospective population-based cohort

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SETTING: Although diabetes (DM) and low body mass index (BMI) are established risk factors for active tuberculosis (TB), the joint effect of type 2 diabetes (T2D) and BMI is unclear.

DESIGN: A prospective cohort of 63,257 adults aged 45–74 years were recruited from 1993 to 1998 in Singapore. Active TB cases were identified via linkage with the National TB Registry up to December 2014. Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the relations of T2D and BMI, independently and jointly, with TB risk.

RESULTS: T2D was associated with increased TB risk (HR 2.31, 95% CI 1.93–2.78). Conversely, BMI was inversely associated with TB risk: HR for underweight (BMI < 18.5 kg/m2) was 2.87 (95% CI 2.15–3.82) compared to obese (BMI ≥ 27.5 kg/m2) individuals. Compared to obese individuals without T2D, HR for active TB among underweight individuals with T2D was 8.30 (95% CI 4.43–15.54). There was no statistically significant interaction between BMI and T2D on TB risk (P interaction = 0.85).

CONCLUSION: Underweight and T2D are independent determinants for active TB. This has important public health implications in Asia where prevalence of tuberculous infection is high, and T2D occurs at lower levels of BMI.
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Keywords: active tuberculosis; cohort study; epidemiology; type 2 diabetes

Document Type: Research Article

Affiliations: 1: Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore 2: Singapore Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore 3: Division of Cancer Control and Population Sciences, University of Pittsburgh Medical Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA 4: Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore

Publication date: December 1, 2019

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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