Ren et al. BMC Infectious Diseases (2019) 19:907 https://doi.org/10.1186/s12879-019-4481-6

RESEARCH ARTICLE Open Access Nutritional intakes and associated factors among tuberculosis patients: a cross- sectional study in Zhewen Ren1†, Fei Zhao1,2†, Hui Chen1†, Dongmei Hu1†, Wentao Yu3†, Xiaoli Xu3†, Dingwen Lin4†, Fuyi Luo5†, Yueling Fan6†, Haijun Wang7†, Jun Cheng1* and Liyun Zhao3*

Abstract Background: The objectives of this study were to examine nutrient intakes of tuberculosis (TB) patients and to identify their associated factors. Methods: In this cross-sectional study, 300 adult TB patients were surveyed in two impoverished counties in China. Nutrient intakes were evaluated through two consecutive 24-h dietary recalls and compared with the Chinese Dietary Reference Intakes (DRIs) 2013. The potential socio-demographic and behavioral factors were analyzed using multivariate logistic model to identify strong influential factors. Results: We found that mean daily energy intake was 1655.0 kcal (SD: 619.3 kcal) and 1360.3 kcal (SD: 552.1 kcal) for male and female patients, respectively. The mean daily energy intake was significantly lower than that has been recommended by DRI (i.e., 2250 and 1800 kcal for males and females, respectively), with 87.4% of the male patients and 59.9% of female patients failed to consume adequate energy. The protein intakes were 44.6 g (SD: 18.2 g) and 35.9 g (SD: 12.3 g) for male and female patients, respectively, which were lower than the recommended values by DRI (i.e., 65 and 55 g for males and females, respectively). Most male (90.8%) and female (58.4%) TB patients had insufficient daily protein intake. Further analyses suggested that mean daily intakes of many micronutrients, were insufficient, while for most of patients, intakes of vitamin E and sodium were sufficient. We identified that unemployment was a risk factor for low energy intake (p < 0.05) and out-home-eating was a protective factor for low protein intake (p < 0.01). Conclusions: In impoverished areas in China, intakes of macronutrients and most micronutrients in TB patients were inadequate compared with DRIs, especially for unemployed patients and patients eating at home. These findings suggested that public health actions are needed to promote education on TB patients about significance of nutritional support, and, further interventions in TB patients’ nutritional intakes are also required. Keywords: Tuberculosis patients, Nutrient intakes, Socio-demographic factors, Behavioral factors

* Correspondence: [email protected]; [email protected] †Zhewen Ren and Fei Zhao first authors and contributed equally to this work. †Dongmei Hu, WentaoYu and Xiaoli Xu are contributed equally to this work. †Dingwen Lin, Fuyi Luo, Yueling Fan, Haijun Wang are contributed equally to this work. 1National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China 3National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China Full list of author information is available at the end of the article

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ren et al. BMC Infectious Diseases (2019) 19:907 Page 2 of 8

Background 2016 were 106.97 per 100,000 and 63.16 per 100,000 in Tuberculosis (TB) is an airborne disease caused by Lingyun county and Lin county, respectively. Mycobacterium tuberculos