Weight gain during successful tuberculosis treatment increases the risk of post-tuberculosis metabolic syndrome

Abstract Background Little is known about the relationship between weight gain during treatment and the subsequent risk of cardiovascular and metabolic (cardiometabolic) diseases. We assessed the relationship between changes in body mass index (BMI) during TB treatment with prevalence of post-TB metabolic syndrome, a strong predictor of cardiometabolic diseases. Methods We enrolled a prospective cohort of individuals successfully treated for TB disease in Tbilisi, Georgia, from 2019–2022. Eligible participants were HIV-negative individuals aged ≥16 years with newly diagnosed and laboratory-confirmed pulmonary TB. The primary exposure was relative change in BMI from treatment initiation to treatment completion, dichotomized at ³5% relative increase. Our primary study outcome was prevalence of post-TB metabolic syndrome (≥3 of the following: elevated blood pressure, elevated triglycerides, low high-density lipoprotein, elevated glycated hemoglobin [HbA1c], and abdominal obesity) at any study visits (including the end of, 6- and 12-months post-TB treatment). Multilevel models were used to estimate the effect of BMI change on post-TB metabolic syndrome. Results Among 120 participants, the adjusted risk of having metabolic syndrome after TB treatment among those with ≥5% relative increase in BMI was 2.1 times (95% confidence interval [CI] 1.1–4.0) the risk of those with <5% relative increase in BMI during treatment. Additionally, the adjusted mean of post-TB HbA1c among those with ≥5% relative increase in BMI was 0.4 (95%CI 0.0–0.7) points higher compared to those with <5% relative increase in BMI. Conclusions Among individuals who were successfully treated, individuals who had a ≥5% increase in BMI during TB treatment had a significantly increased risk of metabolic syndrome and higher HbA1c levels up to 12 months after TB treatment.