The relation between leptin and inflammatory markers with respiratory and peripheral muscle strength in tuberculosis: A case–control study

Skupien, Erika Cavalheiro; Lazzari, Tássia Kirchmann; Coutinho, Sandra Eugênia; Silva, Denise Rossato

doi:10.1111/crj.12956

Cited by 6 publications

(8 citation statements)

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“…TNF-α acts on muscle cells to promote protein loss through nuclear transcription factor κB and activate the ubiquitin–proteasome pathway to promote muscle degradation, leading to weight loss ( Morley et al., 2006 ). Weight loss in tuberculosis patients may also be associated with decreased plasma leptin levels in the host ( Skupien et al., 2018 ). Studies have shown that the more severe the inflammation, the lower the leptin levels, the greater the WL ( van Crevel et al., 2002 ).…”

Section: Discussionmentioning

confidence: 99%

Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis

Liu

Tang

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveThis study was designed to assess and analyze nutritional status (NS) and immune status in patients with tuberculosis.MethodsA retrospective analysis was conducted on 93 TB patients hospitalized in the tuberculosis ward of the West China Hospital of Sichuan University. Subgroup comparisons were made according to age (<65 years and ≥65 years), nutritional risk score 2002 (NRS 2002 <3 and ≥3), tuberculosis location [pulmonary tuberculosis and extrapulmonary tuberculosis (including pulmonary tuberculosis complicated with extrapulmonary tuberculosis)], and prognostic nutrition index (PNI) (<45 vs ≥45).ResultsSignificantly increased weight loss was associated with extrapulmonary tuberculosis (P =0.0010). Serum albumin (P =0.0214), total lymphocyte count (P = 0.0009) and PNI (P = 0.0033) were significantly decreased in older patients. Neutrophils/lymphocytes (NLR) (P =0.0002), monocytes/lymphocytes (MLR) (P < 0.0001), and platelets/lymphocytes (PLR) (P =0.0107) were higher. According to NRS 2002, higher nutritional risk was associated with lower body weight and body mass index (BMI) (P < 0.0001), higher weight loss (P = 0.0012), longer duration of hospitalization (P =0.0100), lower serum albumin level and hemoglobin concentration (P <0.01), lower creatinine level, and lower PNI (P < 0.01). 0.0001), lower total lymphocyte count (P = 0.0004), higher neutrophil and monocyte counts (P <0.05), and higher NLR (P = 0.0002), MLR (P = 0.0006), and PLR (P = 0.0156). Lower PNI was associated with lower body weight (P = 0.0001) and BMI (P =0.0074), lower total protein, albumin, and hemoglobin concentrations (P < 0.0001), and lower total lymphocyte count (P < 0.0001) and creatinine levels (P = 0.0336), higher age (P =0.0002) and NRS 2002 score, P < 0.0001), longer hos-pital stay (P = 0.0003), higher neutrophil count (P = 0.0042), and NLR, MLR, and PLR (P <0.0001) were significantly correlated. In multivariate logistic regression analysis, weight loss (OR: 0.209, 95% CI: 0.060-0.722; p =0.013) was significantly associated with higher nutritional risk (NRS 2002≥3). In multiple linear regression analysis, the NRS 2002 score was higher (B=2.018; p =0.023), and extrapulmonary tuberculosis (B=-6.205; p =0.007) was linked with a longer duration of hos-pitalization.ConclusionsOlder tuberculosis patients are at nutritional risk, and older patients (≥65 years old) need to pay attention to nutritional monitoring and intervention. Older TB patients and those at risk of malnutrition have increased immune ratio and impaired immune function. Management of TB patients using basic diagnostic tools to assess nutritional and immune status and calculate PNI and immunological indexes (NLR, MLR, PLR) to improve treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis

Liu

Tang

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Like these authors, we agree that this is happens due to HIV infection, because the patients in our study had high viremia at the time of the first assessment, and HIV alone could have a negative influence on functional capacity in these individuals. It is also noteworthy that the high frequency of dynapenia may explain non-compliance with the 6MWD, as reduced muscle strength may contribute to the feeling of fatigue and functional limitation (47).…”

Section: Discussionmentioning

confidence: 99%

“…Considering reduction in muscle strength may contribute to the feeling of fatigue and functional limitation (47), HGS provides data not available from routine clinical and laboratory evaluations. Thus, the measurement of this variable during follow-up with the infectologist may provide additional information for risk stratification during the evaluation of outpatient PLWHA.…”

Section: Discussionmentioning

confidence: 99%

“…The English Longitudinal Study of Ageing (ELSA), conducted in England with an eight-year follow-up showed that higher HGS would be associated with lower levels of inflammation (35). In another interesting study of hospitalized patients with and without TB, proved that higher levels of Tumor Necrosis Factor Alpha (TNF-α) but not Interleukin-6 (IL-6) were associated with a reduction in MIP, MEP and HGS (47). In addition, previous study data pointed out that HGS appears to steadily increase over time for ART in men, although it has stabilized after the first 12 weeks of treatment in women (40), corroborating with our findings.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Antiretroviral Therapy With Tenofovir, Lamivudine And Dolutegravir On Respiratory And Peripheral Muscles Strengh In People Living With Hiv/Aids

Cardoso

Araújo

Maranhão

et al. 2019

Preprint

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Background Some antiretrovirals (ARVs) cause muscle toxicity and their use has been attributed to beginning of respiratory and peripheral muscle weakness in people living with HIV/AIDS (PLWHA) on treatment. Dolutegravir (DTG) has been adopted by Brazil as a first-line regimen with Tenofovir/Lamivudine (TDF/3TC) since 2017, with low toxicity profile. Due to the short use of this regimen, we have not found data in the literature regarding its effects in the respiratory and peripheral muscles in PLWHA. The aim of this study was to compare respiratory and peripheral muscle strength before and after start of this new combined ART (TDF/3TC/DTG).Methods Descriptive, longitudinal and prospective study, observational and analytical with 41 PLWHA evaluated before the initiation of antiretroviral therapy (ART) (T0) which of these, 28 were reevaluated after more than 50 days of treatment (T1).The assessments of maximum functional capacity (six-minute walk test distance), maximal inspiratory (MIP) and expiratory (MEP) pressures and handgrip strength (HGS) were performed using standardized methods. In addition, laboratory data (CD4, CD4/CD8 ratio and viral load-VL) were collected. Shapiro-Wilk test was applied for normality while Fisher's exact test and t-test or Wilcoxon test were used for comparisons of categorical and continuous variables, respectively. Pearson or Spearman correlations were used according to data normality and p-value < 0.05 were considered significant for all analyzes.Results The frequency of peripheral muscle weakness in patients evaluated at T0 was 97.6%, while 31.7% had inspiratory and / or expiratory muscle weakness. HGS was positively correlated with CD4 (p = 0.027) and negatively correlated with VL (p = 0.046). Both MIP (p = 0.0176) and HGS (p = 0.0018) showed improvement in T1.Conclusion ART combined with TDF / 3TC / DTG increased MIP and HGS after more than 50 days of treatment. Cohort studies are needed to better understand the action of these medications on PLWHA musculature under treatment.

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“…Low leptin concentrations due to decreased body fat may be associated with decrease immunity and worse disease outcome. In addition, leptin concentrations may be high because of the host's inflammatory response, suppressing appetite and contributing to weight loss in patients with TB [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Leptin and advanced glycation end products receptor (RAGE) in tuberculosis patients

et al. 2021

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Introduction The pathogenesis of consumptive syndrome of tuberculosis (TB) is largely unknown. Leptin concentrations may be high because of the host’s inflammatory response, contributing to weight loss in patients with TB. The receptor for advanced glycation end products (RAGE) is also associated with weight loss in patients with TB and is related to enhanced mortality. The objective of this study was to evaluate the association between leptin and AGE/RAGE. Methods Case-control study. Leptin, AGE (carboxymethyl lysine, CML) and soluble RAGE (sRAGE) were measured from blood samples by ELISA. Results We included in the study 34 patients with TB and 34 controls. We found an inverse correlation between serum leptin levels and sRAGE, only in cases (r = -0.609, p < 0.0001). sRAGE levels were lower in patients with TB who died as compared with patients who survive (21.90 ± 4.24 pg/mL vs 66.14 ± 29.49 pg/mL; p = 0.045). Leptin levels were higher in patients with TB who died as compared with patients who survive (14.11 [7.48–14.11] ng/mL vs 3.08 [0.54–6.34] ng/mL; p = 0.028). Conclusions We identified lower sRAGE levels and higher leptin levels in patients with TB who died as compared with patients who survive. In addition, an inverse and significant correlation between serum leptin and sRAGE levels was demonstrated. Future studies, with a larger sample size and in different settings, including not only hospitalized patients, are needed to confirm these findings.

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The relation between leptin and inflammatory markers with respiratory and peripheral muscle strength in tuberculosis: A case–control study

Abstract: Peripheral and respiratory muscle strength and leptin levels were reduced in patients with active TB. Lower levels of leptin and higher levels of TNF-α were associated with malnutrition and with reduced MIP, MEP and HS.

Cited by 6 publications

References 26 publications

Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis

Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis

Effect of Antiretroviral Therapy With Tenofovir, Lamivudine And Dolutegravir On Respiratory And Peripheral Muscles Strengh In People Living With Hiv/Aids

Leptin and advanced glycation end products receptor (RAGE) in tuberculosis patients

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