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

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 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. Our study exposure was the relative change in BMI from treatment initiation to treatment completion, dichotomized using ≥5% relative increase cut-off. Our primary study outcome was prevalence post-TB metabolic syndrome (i.e., having ≥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 2.07 times (95% confidence interval [CI] 1.07-4.01) 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 0.37 (95%CI 0.03-0.71) points higher compared to those with <5% relative increase in BMI. Conclusions: Our findings indicate that weight gain during TB treatment may influence the risk of cardiovascular/metabolic diseases after TB treatment.