Dietary pattern characterized by a balanced diet rich in high-quality protein intake is associated with mild initial clinical manifestations in tuberculosis

BACKGROUND: The relationship between a single food or nutrient and pulmonary tuberculosis (TB) has been explored in many studies; however, the relationship between dietary patterns and TB is still lacking. OBJECTIVE: Our study aims to investigate the association between dietary patterns and the initial clinical manifestations in patients with TB. MATERIALS AND METHODS: A cross-sectional study including 1,661 patients with active TB was conducted in Qingdao, China, from 2011 to 2019. A semiquantitative food frequency questionnaire was used to collect dietary data. Dietary patterns were determined by principal component factor analysis. Initial clinical manifestations were assessed using a combination of the patient self-reported clinical symptoms and the admission results indicated by the TB score. The associations between dietary patterns and TB scores in patients with TB were examined by the logistics regression model. RESULTS: The analysis identified four dietary patterns: meat-fruit-seafood pattern; dairy-egg pattern; beans and their products-whole grain pattern; and refined grain-vegetable pattern. In a multiple-adjusted model, higher adherence to the meat-fruit-seafood pattern showed a protective effect on the TB score (OR 0.53, 95% CI 0.39, 0.84, P for trend = 0.010) and the association was stronger in patients older than 45 years (OR 0.32, 95% CI 0.16, 0.64, P for trend < 0.001). The higher adherence to beans and their products-whole grain pattern was a protective factor for TB score (OR 0.57, 95% CI 0.37, 0.87, P for trend = 0.025), and the association was also observed in patients with concurrent TB and diabetes mellitus (DM) with a more significant effect (OR 0.33, 95% CI 0.14, 0.80, P for trend = 0.025). No significant association was found between dairy-egg pattern and refined grain–vegetable dietary pattern with TB score. CONCLUSION: Dietary patterns characterized by a balanced diet rich in high-quality protein, sufficient energy, as well as marine n-3 PUFA, phytochemicals, B vitamins, and fiber are associated with mild initial clinical manifestations, and the association is stronger in patients older than 45 years and those with concurrent TB and DM.