Determinants of underweight and overweight/obesity among people with tuberculosis in Kampala, Uganda: a cross-sectional study

Abstract Background Malnutrition significantly contributes to mortality among people with tuberculosis (TB). However, evidence on factors associated with the specific forms of malnutrition, specifically underweight and overweight/obesity beyond clinical determinants, remains limited in many settings. We investigated the prevalence and determinants of underweight and overweight/obesity among people with bacteriologically confirmed pulmonary TB across five health facilities in Kampala, Uganda. Methods This analytic cross-sectional study involved people with bacteriologically confirmed pulmonary TB aged ≥18 years sampled across five health facilities in Kampala, Uganda. Nutritional status was assessed using body mass index (BMI, kg/m 2 ) and categorized as underweight (<18.5), normal weight (18.5-24.9), and overweight/obese (≥25.0). To identify factors independently associated with nutritional status, normal weight was considered as the reference category in a multi-nomial logistic regression analysis, adjusting for multiple covariates and clustering at the health facility level. The measure of association was the adjusted relative risk ratios (aRRR) and its 95% confidence intervals (CI). Results Of the 818 participants studied, 13.2% had normal weight, 36.9% were underweight, and 12.1% were overweight/obese. Adjusted analysis showed that being underweight was associated with household food insecurity (aRRR 2.04, 95% CI: 1.48-2.80) while being overweight or obese was associated with self-employment (aRRR 2.26, 95% CI: 1.35-3.79) and being newly diagnosed with TB (aRRR 2.10, 95% CI: 1.30-3.41). Conclusion This study conducted among people with bacteriologically confirmed pulmonary TB in an urban setting in Uganda showed that underweight and overweight/obesity are prevalent. Furthermore, the study showed that food insecurity is associated with being underweight while being overweight or obese is associated with being self-employed or newly diagnosed with TB. Therefore, TB control programs need to regularly assess the nutritional status of people with TB to mitigate the effect of being underweight or overweight on treatment outcomes.