Impact of body mass index on development of nontuberculous mycobacterial pulmonary disease

Abstract

The incidence and prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) have been increasing worldwide. The risk of NTM-PD may be higher in undernourished populations. We tried to elucidate the impact of body mass index (BMI) and its change on development of NTM-PD in this study.We performed a retrospective cohort study including South Koreans age >40 years who underwent biennial National Health Insurance System (NHIS) health checkups in both 2005 and 2009 or 2006 and 2010. We monitored eligible individuals from the study initiation date (NHIS health checkup date on 2009 or 2010) until the diagnosis of NTM-PD or December 31, 2017. Enrolled individuals were classified based on BMI at initiation date. We compared NTM-PD incidence per 100 000 person-years by BMI group as well as by BMI change by calculating hazard ratio (HR).A total of 5 670 229 individuals were included in the final analysis. Compared with the BMI <18.5 kg·m−2 group, the incidence of NTM-PD gradually decreased with increased BMI: adjusted HR (aHR) 0.38 (95% confidence interval [CI] 0.35–0.42) for BMI 18.5–22.9, 0.17 (0.15–0.19) for BMI 23–24.9, 0.1 (0.09–0.11) for BMI 25–29.9, and 0.01 (0.07–0.13) for BMI ≥30. A BMI decrease of ≥1 kg/m2 over 4 years increased the incidence of NTM-PD (aHR 1.08, 95% CI 1.01–1.16) whereas a BMI increase of ≥1 decreased the NTM-PD incidence (0.77, 95% CI 0.71–0.83).In conclusion, BMI was inversely related to development of NTM-PD and weight loss increased the risk of NTM-PD.

Association between serum anti-glycopeptidolipid-core IgA antibody titers and clinical characteristics of Mycobacterium avium complex pulmonary disease

“…In our study, 66.3% of the patients newly diagnosed with MAC-PD were positive for anti-GPL-core IgA antibodies, which is comparable to the sensitivity reported in a previous review (Shibata et al, 2016). Furthermore, the clinical characteristics of the patients with MAC-PD in our study were consistent with those in previous reports (i.e., the patients were predominantly slim women with nodular bronchiectatic disease) (Prevots & Marras, 2015;Tan et al, 2018;Furuuchi et al, 2019;Kendall & Winthrop, 2013;Simons et al, 2011;Daley et al, 2020;Izumi et al, 2019;Song et al, 2021). Kitada et al reported that the antibody titers reflect the disease activity to some extent (Numata et al, 2015;Kitada et al, 2008;Kitada et al, 2005) and found a weak correlation between the antibody titer levels and the extent of the disease on chest computed tomography (CT) (Kitada et al, 2015;Kitada et al, 2007).…”

Factors affecting in-hospital mortality of non-tuberculous mycobacterial pulmonary disease

“…This study included BMI data in the multivariable analysis for mortality; to the best of our knowledge, no published studies have examined BMI prior to death in patients with NTM-PD. However, several studies have reported an association between weight loss and [12,13,[21][22][23]. In this study, patients with NTM-PD who required unscheduled hospitalization had remarkably low BMIs, the median being 17.5 kg/m 2 .…”

Osteoporosis in nontuberculous mycobacterial pulmonary disease: a cross-sectional study

“…A study in mice suggested that E 2 may have a protective role against intracellular mycobacterial infection [ 44 ]. Additionally, low BMI has been associated with the development and severity of NTM-PD [ 45 ]. Taken together, female hormones and a low BMI are strongly associated with the development of NTM-PD, as well as with osteoporosis, and may have affected the high comorbidity of osteoporosis in the current study.…”