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A Cholesterol-Rich Diet Accelerates Bacteriologic Sterilization in Pulmonary Tuberculosis^*

Carlos Pérez-Guzmán, MD, MS; Mario H. Vargas, MD, MS, FCCP; Francisco Quiñonez, MD, MS; Norma Bazavilvazo, CCN and Adriana Aguilar, RD; the Instituto Nacional de Enfermedades Respiratorias Tuberculosis Outpatient Service Team

^* From the Hospital General Gaudencio González Garza (Dr. Pérez-Guzmán), Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (Dr. Vargas), Mexico City, Mexico; and the Instituto Nacional de Enfermedades Respiratorias (Drs. Pérez-Guzmán, Vargas, Quiñonez, Ms. Bazavilvazo, and Ms. Aguilar), Mexico City, Mexico. A list of members of the Instituto Nacional de Enfermedades Respiratorias Tuberculosis Outpatient Service Team is located in the ^Appendix.

Correspondence to: Mario H. Vargas, MD, MS, FCCP, Instituto Nacional de Enfermedades Respiratorias, Tlalpan 4502, CP 14080, México City, Mexico; e-mail: mhvargasb{at}yahoo.com.mx

Abstract

Background: Hypocholesterolemia is common among tuberculous patients and is associated with mortality in miliary cases. Some in vitro studies have shown that cholesterol is necessary for the good functioning of macrophages and lymphocytes.

Study objectives: To determine whether a cholesterol-rich diet could accelerate sputum sterilization in patients with pulmonary tuberculosis.

Design: An 8-week follow-up, randomized, controlled trial carried out from March 2001 to January 2002.

Setting: A third-level hospital for respiratory diseases in Mexico City.

Patients and interventions: Adult patients with newly diagnosed pulmonary tuberculosis were hospitalized for 8 weeks and randomly assigned to receive a cholesterol-rich diet (800 mg/d cholesterol [experimental group]) or a normal diet (250 mg/d cholesterol [control group]). All patients received the same four-drug antitubercular regimen (ie, isoniazid, rifampin, pyrazinamide, and ethambutol).

Measurements and results: Every week, a quantitative sputum culture and laboratory tests were done and respiratory symptoms were recorded. Patients in the experimental group (10 patients) and the control group (11 subjects) were HIV-negative and harbored Mycobacterium tuberculosis that was fully sensitive to antitubercular drugs. Sterilization of the sputum culture was achieved faster in the experimental group, as demonstrated either by the percentage of negative culture findings in week 2 (80%; control group, 9%; p = 0.0019) or by the Gehan-Breslow test for Kaplan-Meier curves (p = 0.0037). Likewise, the bacillary population decreased faster (p = 0.0002) in the experimental group. Respiratory symptoms improved in both groups, but sputum production decreased faster in the experimental group (p < 0.05). Laboratory test results did not differ between the groups.

Conclusions: A cholesterol-rich diet accelerated the sterilization rate of sputum cultures in pulmonary tuberculosis patients, suggesting that cholesterol should be used as a complementary measure in antitubercular treatment.

Key Words: colony count • diet • microbial • Mycobacterium tuberculosis

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