Nutrition often fails to fully recover after drug-resistant tuberculosis treatment

Many patients who finish treatment for drug-resistant tuberculosis still leave therapy malnourished, according to a retrospective cohort study conducted at Dr. Hasan Sadikin Bandung Hospital, a tertiary referral hospital in West Java, Indonesia. The research, published in BMC Pulmonary Medicine, tracked body mass index and serum albumin levels in adult pulmonary DR-TB patients from the start of treatment to its completion, and found that while both measures improved on average, a substantial share of patients did not return to healthy nutritional status.

The study enrolled adult pulmonary DR-TB patients whose drug resistance was confirmed by GeneXpert testing and phenotypic drug susceptibility testing. Researchers retrospectively collected data from the medical records of patients treated at the hospital’s DR-TB clinic between 2021 and 2023, documenting demographics, BMI and serum albumin at treatment initiation and again upon successful or completed treatment.

Body mass index improved significantly after treatment compared with baseline, with a reported p value below 0.0001. Half of the participants had a low BMI when therapy began. By the end of treatment, 73 patients, or 44.5 percent, had achieved a normal BMI, while 54 patients, or 32.9 percent, remained underweight. The proportion of patients who were overweight or obese rose from 25 participants, or 15.2 percent, at baseline to 37, or 22.6 percent, after treatment.

Serum albumin levels also improved significantly over the course of therapy, again with p below 0.0001. Hypoalbuminemia, or abnormally low albumin, was present in 54 participants, or 32.9 percent, at baseline, but in only 4 participants, or 2.4 percent, after treatment.

A key observation from the study is that BMI and serum albumin did not always recover in parallel. Some patients who completed treatment successfully still showed signs of malnutrition on at least one of these measures, indicating that a single indicator may not capture the full nutritional picture of a patient recovering from DR-TB.

Drug-resistant tuberculosis remains a global health challenge, the authors note, because of its prolonged treatment and negative impact on quality of life. Poor nutritional status is associated with an increased risk of developing the disease and with poorer treatment outcomes, making nutritional monitoring a relevant concern throughout the long course of DR-TB therapy.

The authors conclude that routine nutritional assessment and nutritional support should be part of DR-TB management, with the aim of enhancing immunological recovery and long-term health outcomes. Their findings underscore that completing treatment successfully does not necessarily mean a patient’s nutritional status has fully returned to normal.

As a retrospective, single-center record review of patients treated at one Indonesian tertiary hospital between 2021 and 2023, the study describes patterns in this specific patient population rather than testing an intervention, and the authors’ conclusions emphasize the importance of continued nutritional monitoring in DR-TB care.

Subject of Research: Nutritional recovery, measured by body mass index and serum albumin, in drug-resistant tuberculosis patients completing treatment

Article Title: Body mass index and albumin levels of drug-resistant tuberculosis patients: a retrospective cohort study

Article References: Latifah, S., Ferdian, F., Luftimas, D. E., Dewi, I. M. W., & Kulsum, I. D. (2026). Body mass index and albumin levels of drug-resistant tuberculosis patients: a retrospective cohort study. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04419-4

Image Credits: AI Generated

DOI: 10.1186/s12890-026-04419-4

Keywords: drug-resistant tuberculosis, body mass index, serum albumin, hypoalbuminemia, malnutrition, nutritional assessment, treatment completion, retrospective cohort study, Indonesia, BMC Pulmonary Medicine, Body, mass