Changes in cholesterol level correlate with the course of pulmonary nontuberculous mycobacterial disease

Nutritional assessment is important in patients with pulmonary nontuberculous mycobacterial (PNTM) disease. The therapeutic effect of a cholesterol-rich diet in tuberculosis (TB) patients has been demonstrated, but the role of cholesterol in PNTM disease is unclear. This study evaluated the sequential changes in nutritional markers, including cholesterol, total lymphocyte count and visceral fat volume, according to the PNTM disease course.

This was an age-, sex- and number of comorbid diseases-matched case-control analysis of 89 patients with PNTM disease and 356 controls, who were participants in a Korean national survey.

The median body mass index (BMI) and cholesterol level in the PNTM group [BMI =19.7 kg/m²; interquartile range (IQR): 17.8-21.6; cholesterol: 159 mg/dL; IQR, 135-185] were lower than those in controls (BMI: 23.1 kg/m²; IQR, 21.3-25.3; cholesterol: 188 mg/dL; IQR, 164-217; both P<0.001). In a multivariate analysis, Age more than 70 years (OR =3.38; 95% CI: 1.13-10.15, P=0.029), BMI <19.5 kg/m² (OR =5.09; 95% CI: 1.67-15.48; P=0.004) and cavitary lesions (OR: 3.86; 95% CI: 1.30-11.47; P=0.015) were independently associated with extensive pulmonary lesions involving more than four lobes. The total cholesterol level, total lymphocyte count showed a tendency to decrease in PNTM patients with disease progression (both, P value <0.05), but not in those with a stable disease course. A decrease in cholesterol concentration of >20 mg/dL and a decrease in lymphocyte count more than 200/µL were predictive factors for disease progression (cholesterol: OR =10.50, 95% CI: 2.51-43.98, P=0.001; lymphocyte count: OR =5.32, 95% CI: 1.46-19.35, P=0.011).

These findings suggest that the change in cholesterol level may be a marker of disease progression in patients with PNTM disease.