Association of obesity, diabetes, and risk of tuberculosis

Lin, H.H., Wu, C.Y., Wang, C.H., Fu, H., Lönnroth, K., Chang, Y.C. and Huang, Y.T., 2018. Association of obesity, diabetes, and risk of tuberculosis: two population-based cohorts. Clinical Infectious Diseases, 66(5), pp.699-705.

  • Obesity and Tuberculosis Paradox: Despite the association between obesity (high BMI) and diabetes, and diabetes being a risk factor for tuberculosis (TB), epidemiological data shows that higher BMI actually correlates with a reduced risk of TB.
  • Study Cohort Characteristics: Higher BMI in the study cohorts was associated with male gender, older age, current use of tobacco and alcohol, lower educational attainment, higher prevalence of diabetes, and lower household income (in the NHIS cohort).
  • Mediation and Pathway Analyses: Higher BMI significantly increased the odds of diabetes; diabetes increased the odds of active TB; however, obesity directly correlated with a reduced TB risk: 71.9% reduced odds in the NHIS cohort and 67.3% in the NTC cohort.
  • Inverse Association Across BMI Levels: Across all BMI levels, there was an inverse association with TB risk, with obese individuals having a two-thirds reduction in TB risk compared to normal-weight individuals.
  • Dual Effects of High BMI: A harmful effect mediated through diabetes and a strongly protective direct effect not mediated through diabetes; the overall effect of high BMI on TB risk was dominated by the direct protective effect.
  • Effect of Combined Obesity and Diabetes: Obese/diabetic individuals had similar or even lower TB risk compared to nondiabetic normal-weight individuals.
  • Exclusion of Reverse Causation and Confounding: The study accounted for potential confounders and the BMI data was collected at baseline, ruling out reverse causation (TB causing weight loss); residual confounding by socioeconomic status remains a possible limitation, as lower socioeconomic status is linked to both higher BMI and greater TB risk.

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