Malnutrition is an important risk factor for TB-DILI. Drug-induced liver injury (DILI) owing to anti-tubercular treatment (ATT) leads to increased mortality and morbidity in patients with tuberculosis (TB). 

In a prospective cohort study (September 2017 to August 2019), all newly diagnosed in-patients with TB beyond the age of 18 years were included. Patients with BMI < 18.5 kg/m2 were considered malnourished. The patients were supervised for the development of DILI. Liver function tests were completed at the baseline (before initiation of ATT), on the third day and at discharge in all the patients. Chi-square tests and conditional multiple logistic analysis was performed to classify risk factors associated with DILI. Out of the 319 enrolled patients, a total of 138 patents selected to follow up at hospital. Around 14 patients (10%) developed DILI. The average time to onset of DILI was found to be ten days. Extra-pulmonary TB, low BMI and high baseline liver enzyme levels had a noteworthy association with the development of DILI (p < 0.05). Low serum albumin had bigger odds ratio but wasnt statistically important. 

Malnutrition in TB is both a reason and an outcome. Malnutrition leading to dysfunction of the immune system is one of the utmost recurrent causes of secondary immunodeficiency globally. It must be known as one of the dynamic reasons for the gentler deterioration of the TB epidemic in India in spite of all the steps taken nationally towards TB eradication. Given the multidimensional nature of this two conditions, tuberculosis and malnutrition, it is of excessive importance to understand the link between the two and ensure that high-quality treatment can be provided to these patients with minimal interruptions. DILI is a noteworthy cause of treatment interruption in people on ATT. This leads to increased morbidity and mortality among pretentious patients. It is therefore imperious to consider the inferences that coincident malnutrition may have on the impact of DILI in patients with TB, specifically bearing in mind that the incidence of DILI is far more in developing countries where malnutrition is widespread.

Source: Drug Discoveries & Therapeutics. 2020; 14(3):135-138