{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:29:33Z","timestamp":1789626573021,"version":"build-2803163510"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001700","name":"Ministry of Education, Culture, Sports, Science & Technology, Japan","doi-asserted-by":"crossref","award":["Kakenhi: 17H04662"],"award-info":[{"award-number":["Kakenhi: 17H04662"]}],"id":[{"id":"10.13039\/501100001700","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Diabetes and undernutrition are common risk factors for tuberculosis (TB), associated with poor treatment outcomes and exacerbated by TB. Limited data exist describing patterns and risk factors of multiple comorbidities in persons with TB. Nine-hundred participants (69.6% male) were enrolled in the <jats:bold>S<\/jats:bold>tarting <jats:bold>A<\/jats:bold>nti-<jats:bold>T<\/jats:bold>B <jats:bold>T<\/jats:bold>reatment (St-ATT) cohort, including 133 (14.8%) initiating treatment for multi-drug resistant TB (MDR-TB). Comorbidities were defined as: diabetes, HbA1c \u22656.5% and\/or on medication; hypertension, systolic blood pressure \u2265140 mmHg or diastolic blood pressure \u226590 mmHg and\/or on medication; anaemia (moderate\/severe), haemoglobin &lt;11g\/dL; and, undernutrition (moderate\/severe) body-mass-index &lt;17 kg\/m<jats:sup>2<\/jats:sup>. The most common comorbidities were undernutrition 23.4% (210\/899), diabetes 22.5% (199\/881), hypertension 19.0% (164\/864) and anaemia 13.5% (121\/899). Fifty-eight percent had \u22651 comorbid condition (496\/847), with 17.1% having \u22652; most frequently diabetes and hypertension (N = 57, 6.7%). Just over half of diabetes (54.8%) and hypertension (54.9%) was previously undiagnosed. Poor glycemic control in those on medication (HbA1c\u22658.0%) was common (N = 50\/73, 68.5%). MDR-TB treatment was associated with increased odds of diabetes (Adjusted odds ratio (AOR) = 2.48, 95% CI: 1.55\u20133.95); but decreased odds of hypertension (AOR = 0.55, 95% CI: 0.39\u20130.78). HIV infection was only associated with anaemia (AOR = 4.51, 95% CI: 1.01\u201320.1). Previous TB treatment was associated with moderate\/severe undernutrition (AOR = 1.98, 95% CI: 1.40\u20132.80), as was duration of TB-symptoms before starting treatment and household food insecurity. No associations for sex, alcohol or tobacco use were observed. MDR-TB treatment was marginally associated with having \u22652 comorbidities (OR = 1.52, 95% CI: 0.97\u20132.39). TB treatment programmes should plan for large proportions of persons requiring diagnosis and management of comorbidities with the potential to adversely affect TB treatment outcomes and quality of life. Dietary advice and nutritional management are components of comprehensive care for the above conditions as well as TB and should be included in planning of patient-centred services.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000011","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T18:25:45Z","timestamp":1637173545000},"page":"e0000011","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort"],"prefix":"10.1371","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9908-2936","authenticated-orcid":true,"given":"Sharon E.","family":"Cox","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6110-014X","authenticated-orcid":true,"given":"Tansy","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5506-0014","authenticated-orcid":true,"given":"Benjamin N.","family":"Faguer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4178-0747","authenticated-orcid":true,"given":"Julius P.","family":"Ferrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8922-7428","authenticated-orcid":true,"given":"Shuichi J.","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuki","family":"Koh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzana","family":"Ferdous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi R.","family":"Saludar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Marie C. G.","family":"Garfin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4289-7253","authenticated-orcid":true,"given":"Mary C.","family":"Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5709-2629","authenticated-orcid":true,"given":"Juan A.","family":"Solon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"issue":"2","key":"pgph.0000011.ref001","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.rppnen.2017.11.003","article-title":"Tuberculosis, social determinants and co-morbidities (including HIV)","volume":"24","author":"R Duarte","year":"2018","journal-title":"Pulmonology"},{"key":"pgph.0000011.ref002","unstructured":"WHO. Global TB Report. 2020."},{"key":"pgph.0000011.ref003","unstructured":"Food and Nutrition Research Institute DoSaT, the Philippines,. 8th National Nutrition Survey2015 12th Jan 2019. Available from: http:\/\/www.fnri.dost.gov.ph\/index.php\/nutrition-statistic\/19-nutrition-statistic\/118-8th-national-nutrition-survey."},{"issue":"10072","key":"pgph.0000011.ref004","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(17)30402-6","article-title":"Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations","volume":"389","author":"E Mendenhall","year":"2017","journal-title":"Lancet"},{"issue":"1","key":"pgph.0000011.ref005","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ije\/dyp308","article-title":"A consistent log-linear relationship between tuberculosis incidence and body mass index","volume":"39","author":"K Lonnroth","year":"2010","journal-title":"Int J Epidemiol"},{"issue":"3","key":"pgph.0000011.ref006","first-page":"286","article-title":"The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals","volume":"8","author":"JP Cegielski","year":"2004","journal-title":"Int J Tuberc Lung Dis"},{"issue":"7","key":"pgph.0000011.ref007","doi-asserted-by":"crossref","first-page":"871","DOI":"10.5588\/ijtld.10.0352","article-title":"A systematic review of risk factors for death in adults during and after tuberculosis treatment","volume":"15","author":"CJ Waitt","year":"2011","journal-title":"Int J Tuberc Lung Dis"},{"issue":"11","key":"pgph.0000011.ref008","doi-asserted-by":"crossref","first-page":"e0187967","DOI":"10.1371\/journal.pone.0187967","article-title":"Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis","volume":"12","author":"RH Al-Rifai","year":"2017","journal-title":"PLoS One"},{"issue":"12","key":"pgph.0000011.ref009","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S1473-3099(09)70282-8","article-title":"Tuberculosis and diabetes mellitus: convergence of two epidemics","volume":"9","author":"KE Dooley","year":"2009","journal-title":"Lancet Infect Dis"},{"issue":"4","key":"pgph.0000011.ref010","doi-asserted-by":"crossref","first-page":"507","DOI":"10.5588\/ijtld.18.0103","article-title":"Diabetes mellitus and tuberculosis in Korean adults: impact on tuberculosis incidence, recurrence and mortality","volume":"23","author":"JE Golub","year":"2019","journal-title":"Int J Tuberc Lung Dis."},{"key":"pgph.0000011.ref011","unstructured":"International Diabetes Foundation. IDF Diabete Atlas, 2019. 2019."},{"key":"pgph.0000011.ref012","unstructured":"The Academy of Medical Sciences. Multimorbidity: a priority for global health research 2018."},{"issue":"2","key":"pgph.0000011.ref013","doi-asserted-by":"crossref","first-page":"87","DOI":"10.5588\/ijtld.20.0751","article-title":"TB multimorbidity: a global health challenge demanding urgent attention","volume":"25","author":"K Siddiqi","year":"2021","journal-title":"International Journal of Tuberculosis and Lung Disease"},{"issue":"4","key":"pgph.0000011.ref014","doi-asserted-by":"crossref","first-page":"e448","DOI":"10.1016\/S2214-109X(18)30487-X","article-title":"Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2.3 million patients with tuberculosis","volume":"7","author":"JJ Noubiap","year":"2019","journal-title":"Lancet Glob Health."},{"issue":"1","key":"pgph.0000011.ref015","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12916-017-0975-5","article-title":"Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries.","volume":"15","author":"A Koyanagi","year":"2017","journal-title":"BMC Med."},{"key":"pgph.0000011.ref016","article-title":"Tuberculosis and non-communicable disease multimorbidity: An analysis of the World Health Survey in 48 low- and middle-income countries.","author":"B Stubbs","year":"2020","journal-title":"Lancet Public Health"},{"issue":"1","key":"pgph.0000011.ref017","first-page":"4100","article-title":"Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines","volume":"10","author":"LV White","journal-title":"Sci Rep. 2020"},{"key":"pgph.0000011.ref018","unstructured":"WHO. Implementing the END TB Strategy: The Essentials. Geneva: World Health Organisation, 2015."},{"key":"pgph.0000011.ref019","unstructured":"Economic Research Service. U.S. Adult food security survey module: three-stage design with screeners 2012. Available from: https:\/\/www.ers.usda.gov\/media\/8279\/ad2012.pdf"},{"key":"pgph.0000011.ref020","unstructured":"WHO. Physical status: The use and interpretation of anthropometry: Report of a WHO expert committee. World Health Organisation, 1995."},{"key":"pgph.0000011.ref021","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.2337\/dc10-S062","article-title":"2010 Diagnosis and Classification of diabetes mellitus","volume":"33","author":"American Diabetes Association","year":"2010","journal-title":"Diabetes Care"},{"key":"pgph.0000011.ref022","volume-title":"Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity.:","author":"WHO","year":"2011"},{"issue":"17","key":"pgph.0000011.ref023","first-page":"e426","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"138","author":"PK Whelton","year":"2018","journal-title":"Circulation"},{"key":"pgph.0000011.ref024","doi-asserted-by":"crossref","DOI":"10.1145\/2369220.2369236","article-title":"Open Data Kit: Tools to build information services for developing regions.","author":"C Hartung","year":"2010","journal-title":"ICTD"},{"issue":"5","key":"pgph.0000011.ref025","doi-asserted-by":"crossref","first-page":"1431S","DOI":"10.1093\/jn\/136.5.1431S","article-title":"Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines","volume":"136","author":"HR Melgar-Quinonez","year":"2006","journal-title":"The Journal of nutrition"},{"key":"pgph.0000011.ref026","volume-title":"Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation","author":"WHO","year":"2008"},{"key":"pgph.0000011.ref027","volume-title":"Definitions and Reporting Framework for Tuberculosis.:","author":"WHO","year":"2013"},{"key":"pgph.0000011.ref028","article-title":"Management of diabetes mellitus-tuberculosis: A guide to the essential practice.","author":"Y Lin","year":"2019","journal-title":"Paris: International Union Against Tuberculosis and Lung Disease (The Union),"},{"issue":"8","key":"pgph.0000011.ref029","doi-asserted-by":"crossref","first-page":"e005317","DOI":"10.1136\/bmjopen-2014-005317","article-title":"Effects of the First Line Diabetes Care (FiLDCare) self-management education and support project on knowledge, attitudes, perceptions, self-management practices and glycaemic control: a quasi-experimental study conducted in the Northern Philippines","volume":"4","author":"GM Ku","year":"2014","journal-title":"BMJ Open."},{"key":"pgph.0000011.ref030","article-title":"Diabetes mellitus among pulmonary tuberculosis patients from four TB-endemic countries: the TANDEM study","author":"C Ugarte-Gil","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"11","key":"pgph.0000011.ref031","doi-asserted-by":"crossref","first-page":"738","DOI":"10.2471\/BLT.17.206227","article-title":"Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa","volume":"96","author":"D Grint","year":"2018","journal-title":"Bull World Health Organ"},{"key":"pgph.0000011.ref032","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ijid.2016.12.016","article-title":"Tuberculosis and hypertension-a systematic review of the literature","volume":"56","author":"AB Seegert","year":"2017","journal-title":"Int J Infect Dis"},{"key":"pgph.0000011.ref033","unstructured":"World Health Organisation. WHO package of essential noncommunicable (PEN) disease interventions for primary health care Geneva: WHO; 2020. Available from: https:\/\/www.who.int\/activities\/integrated-management-of-ncds."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T18:26:26Z","timestamp":1637173586000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000011"}},"subtitle":[],"editor":[{"given":"Siyan","family":"Yi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,17]]},"references-count":33,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0000011","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,17]]}}}