TB is often associated with nutritional deficiencies. A study of 30 patients with pulmonary TB in England revealed a reduction in BMI, triceps skin hold, arm muscle circumference and serum albumin
. In an Indian study, tuberculosis patients were respectively 11 and seven times more likely to have a BMI < 18.5 and mid-arm circumference < 24 cm
The mortality rate among TB patients in Spain who completed treatment was found to be associated with vulnerable populations such as the elderly, alcohol abusers and HIV-infected injecting drug users
. We previously reported that subjective global assessment was useful in predicting the survival in patients with pulmonary tuberculosis
. In Japan, only 124 newly identified TB patients were reported as having HIV in 2007–2008
. It seems that HIV infection does not have a large influence on the mortality rate among TB patients in Japan.
Patients with TB very frequently suffer from deficiencies of nutrients, such as vitamins A, B complex, C and E, as well as selenium, which are fundamental to the integrity of the immune response
[9–11]. Three studies found lower levels of serum vitamin D in TB patients compared with those in controls
[12–14]. Recently, Martineau et al. reported that vitamin D did not significantly affect time to sputum culture conversion in the whole study population, but it did significantly hasten sputum culture conversion in participants with the tt genotype of the TaqI vitamin D receptor during intensive-phase antimicrobial treatment of pulmonary tuberculosis
. In addition to the central role of lipid storage, adipose tissue has major endocrine functions and releases a variety of proinflammatory and anti-inflammatory factors, including adipocytokines, such as leptin, adiponectin and resistin, as well as cytokines and chemokines. Altered levels of different adipocytokines have been observed in a variety of inflammatory conditions and, in particular, the role of leptin in immune responses and inflammation has lately become increasingly evident
. Active tuberculosis is associated with cachexia, weight loss and low serum concentration of leptin
[17, 18]. Moreover, leptin-deficient mice are more susceptible to M. tuberculosis than wild-type mice, and T cell numbers, including those producing IFN-γ, are reduced in infected lungs, suggesting that leptin contributes to protection against tuberculosis
. However, a causative correlation between the severity of TB and leptin has not been fully established, and leptin concentrations do not predict wasting in human TB
. Nutrition and infection interact with each other synergistically. Recurrent infections lead to a loss of body nitrogen and worsen nutritional status; the resulting malnutrition, in its turn, produces a greater susceptibility to infection.
A number of nutrition screening tools have therefore been developed. MUST is a well-validated and reliable screening tool. Stratton et al. showed that MUST has predictive validity in an elderly hospitalized population, with regard to mortality, both in hospital and after discharge, and length of hospital stay
. Harris et al. reported that MUST was a sensitive and specific method of identifying those requiring further nutritional assessment in elderly people living in sheltered accommodation
. Recently, a cross-sectional study of the nutritional status of community-dwelling people with idiopathic Parkinson’s disease revealed the usefulness of MUST as an early screening tool
Adoption of a cut-off value of 3.5 improves the predictive ability of MUST score as a prognostic indicator in pulmonary TB patients. MUST will be used in future studies of nutrition support in TB patients. One of the limitations in this study is the short duration of follow up. Minimum follow-up duration was 90 days. Other limitations of this study are the small sample size and imbalance of male/female ratio. For these reasons, it cannot be regarded as representative of the whole pulmonary TB population.