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Drug Des Devel Ther. 2017; 11: 1193–1194.
Published online 2017 April 11. doi:  10.2147/DDDT.S133094
PMCID: PMC5395282

Vitamin D deficiency and tuberculosis: what about body mass index?

Dear editor

Huang et al conducted a meta-analysis of published studies on various aspects of association between vitamin D and tuberculosis (TB).1 The study concluded that vitamin D deficiency (VDD) was associated with higher risk of TB. However, low body mass index (BMI), a well-recognized and a stronger risk factor of TB than VDD, was not mentioned in this review nor was it accounted for in the multivariable analysis in the majority of case–control studies included in the meta-analysis exploring the association between TB and VDD. Vitamin D levels are likely to be positively correlated with weight/BMI. Infected people who are underweight by ≥15%, 10%–14% and 5%–9% are at increased risk of progression to TB disease with 2.6, 2.0 and 2.2 cases per 1,000 person-year, respectively.2 Contradictory results were found in the few studies of this meta-analysis1 that considered weight/BMI in the multivariable analysis. One study showed a weak association between VDD and TB (odds ratio: 1.07, 95% confidence interval 1.01–8.52) but only in men.3 Another study found no such association.4

Protein-calorie malnutrition is recognized as a well-established risk factor of TB disease, if not the strongest.5 Some studies in the meta-analysis1 consistently showed that TB patients have lower weight/BMI as compared to controls and therefore this should always be considered in the multivariable analysis assessing nutritional risk factors of TB. Besides low levels of vitamin D, underweight TB patients likely have low levels of other vitamins, calcium, albumin, ferritin or cholesterol (to mention a few) as shown by some studies included in Huang et al meta-analysis.1

Future studies focusing on nutritional deficiency risk factors for TB should consider all of these factors together and/or independently as playing a role.



The author reports no conflicts of interest in this communication.


1. Huang SJ, Wang XH, Liu ZD, et al. Vitamin D deficiency and the risk of tuberculosis: a meta-analysis. Drug Des Devel Ther. 2017;11:91–102. [PMC free article] [PubMed]
2. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med. 2000;161(4 Pt 2):S221–S247. [PubMed]
3. Ho-Pham LT, Nguyen ND, Nguyen TT, et al. Association between vitamin D insufficiency and tuberculosis in a Vietnamese population. BMC Infect Dis. 2010;10:306. [PMC free article] [PubMed]
4. Wejse C, Olesen R, Rabna P, et al. Serum 25-hydroxyvitamin D in a West African population of tuberculosis patients and unmatched healthy controls. Am J Clin Nutr. 2007;86(5):1376–1383. [PubMed]
5. Koethe JR, von Reyn CF. Protein-calorie malnutrition, macronutrient supplements, and tuberculosis. Int J Tuberc Lung Dis. 2016;20(7):857–863. [PubMed]

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