Micronutrient Biomarkers of Nutrition Status Influence the Risk of TB in US Men and Women: NHANES I Epidemiologic Follow-up Study Público

Abstract

Abstract
Micronutrient biomarkers of Nutrition Status Influence the Risk of TB in US Men
and Women: NHANES I Epidemiologic Follow-up Study

By Farah Srichandra

Background: One third of the world's population is thought to be infected with
tuberculosis (TB), and new infections occur at a rate of about one per second. The
proportion of people who become sick with TB each year is stable or falling in different
regions of the world, but, because of population growth, the absolute number of new
cases is still increasing. Undernutrition is an important risk factor for TB, but, primarily,
studies have been conducted on anthropometric measures for nutritional status and few
studies have used biomarkers for nutritional status.

Objective: This research analyzes the risk of developing TB in relation to micronutrient
biomarkers of nutritional status. Our specific interest is whether micronutrient biomarkers
of nutritional status at baseline are related to the incidence of TB during the follow-up of
10 to 20 years.

Methods: In the NHANES-1 epidemiological follow-up study,a nationally representative
data set of 14,407 adults who were followed up on 3 to 4 occasions over a period of 10 to
20 years. Secondary data analysis was carried out using SAS statistical software, to
examine the relationship between deficiencies in hemoglobin, albumin, vitamins A,
iron and the incidence of TB. The primary dependent variable is incidence of TB during the follow - up period.

Results: Anemia and low serum albumin are independent risk factors for physician
diagnosed TB, and it's magnitude of effect is 3.02 (1.44, 6.34) 95% CI.As a result, the chances of
developing TB increase by 3-fold for persons who are anemic. Vitamin A was not associated with physician diagnosed TB.

Discussion: The longitudinal cohort study provides data on a large national sample, it presents a unique opportunity for health researchers to study changes in health status and the factors that contribute to good health as well as illness. This study provides implications to address the importance of micronutrient biomarkers as a way to combat TB globally.

Table of Contents

Table of Contents
I. Introduction ............................................................................................................................... 1
Title ............................................................................................................................................. 1
II. Specific Aims ............................................................................................................................ 3
III.Literature Review .................................................................................................................... 3
A. Epidemiology of Tuberculosis ................................................................................................... 3
B. Recent Studies on TB ................................................................................................................. 5

IV. Subjects and Methods ............................................................................................................ 6
A.The first National Health and Nutrition Examination Survey (NHANES-1) ............................. 6
B. The NHANES-1 Epidemiological Follow-up Study (NHEFS) ................................................. 7
C. The present analytic data set ...................................................................................................... 8
1. Inclusion/exclusion criteria ..................................................................................................... 8
2. Exposure Variables ................................................................................................................. 9
3. Outcome Variable ................................................................................................................... 9
4. Follow-up time ...................................................................................................................... 11
5. Covariates ............................................................................................................................. 12
D. Analysis .................................................................................................................................... 12

V. Results ..................................................................................................................................... 15
A. Description of the Study Sample ............................................................................................. 15
B. Bivariate Analysis .................................................................................................................... 16
C. Logistic Regression and Modeling ........................................................................................... 17

VI. Discussion .............................................................................................................................. 17
A. Limitations ............................................................................................................................... 18
B. Strengths ................................................................................................................................... 19
C. Future Research ........................................................................................................................ 20
D. Importance for Public Health ................................................................................................... 21


VII. Literature Cited .................................................................................................................. 22

Appendix A - Tables ................................................................................................................... 24

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	TB
Committee Chair / Thesis Advisor	Cegielski, J. Peter, CDC Ramakrishnan, Usha, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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