A retrospective cohort study conducted in Georgia investigated the relationship between BMI change during M/XDR-TB treatment and mortality. The researchers used routinely collected clinical and laboratory data, enabling them to follow a large cohort over a decade. Their focus on the early treatment period (3–6 months) was well justified, given that early weight changes may reflect treatment response, disease severity, and nutritional recovery.
The findings revealed that a majority of patients (nearly 70%) experienced BMI increases during treatment, highlighting a potential recovery trajectory. However, those who did not gain weight—or who lost weight—faced substantially higher risks of death, particularly among patients with low or normal BMI at treatment start. Notably, among individuals with normal BMI, weight loss was linked to a fivefold higher risk of death during treatment, and among those underweight at baseline, not gaining weight was associated with a fivefold higher post-treatment mortality risk.
Although some results did not reach statistical significance, likely due to limited sample size and the low number of deaths, the consistent patterns across analyses strengthen confidence in the findings. Importantly, this study underscores that weight gain is not just a marker of nutritional recovery but may be an independent prognostic factor for survival in TB treatment.
These results have significant clinical implications. Routine monitoring of BMI and targeted nutritional support for patients who fail to gain weight during the early months of treatment could be integrated into TB programs. Such interventions may improve survival, particularly for patients with undernutrition—a known risk factor for poor TB outcomes.
Overall, the study provides evidence that can inform TB care guidelines and highlights the need for additional research. Future studies should evaluate whether nutritional supplementation and metabolic support could reduce mortality in high-risk patients with drug-resistant TB.
Source:
- Chakhaia, T., Blumberg, H.M., Kempker, R.R., Luo, R., Dzidzikashvili, N., Chincharauli, M., Tukvadze, N., Avaliani, Z., Stauber, C. and Magee, M.J., 2025. Lack of weight gain and increased mortality during and after treatment among adults with drug-resistant tuberculosis: a retrospective cohort study in Georgia, 2009–2020. ERJ Open Research.
