Cardiometabolic biomarkers and systemic inflammation in US adolescents and young adults with latent tuberculosis infection: a population-based cohort study

Abstract Background Mycobacterium tuberculosis ( M.tb ) infection in adults increases incident type 2 diabetes and atherosclerotic cardiovascular disease risk, but it is unknown if this cardiometabolic detriment occurs in the young. We sought to determine if young persons with latent tuberculosis infection (LTBI) have worse cardiometabolic health than their tuberculosis (TB) uninfected peers. Methods Peripubescent adolescents (12-15 years old) and older adolescents and young adults (16-30 years old) (older participants) were cross-sectionally surveyed. LTBI was assessed by tuberculin skin testing (induration ≥10mm). Fasting plasma glucose (FPG), HbA1c, c-peptide, NTproBNP, hs-Troponin T, c-reactive protein (CRP), ferritin, diabetes/prediabetes (FPG ≥5.6 mmol/L and/or HbA1c ≥5.7%) and homeostatic model of insulin resistance (IR) (HOMA2-IR) were measured as study outcomes. LTBI cases were propensity score matched 1:4 on sociodemographic and lifestyle indicators with TB uninfected controls to estimate adjusted median (adjMedian), mean differences (adjMD), and odds ratios (adjOR) of cardiometabolic indices. Results Seventy-five young persons with LTBI were matched with 300 TB uninfected peers of similar age [mean (SD): 18.3 (5.5) vs. 18.0 (5.5) years], race [Hispanic: 74.7% vs. 76.7%], and sedentary time [3.5 (1.5%) vs. 3.5 (1.6) hours/day]. LTBI was associated with higher inflammation [adjMedian (IQR) CRP: 0.22 (0.05, 0.34) vs. 0.11 (0.04, 0.35) mg/dL; p=0.027; ferritin: 55.0 (25.1, 90.3) vs. 41.1 (29.5, 136.2) ng/mL; p=0.047] among older participants, but not peripubescent adolescents [CRP: 0.08 (0.04, 0.36) vs. 0.05 (0.02, 0.17) mg/dL; p=0.42; ferritin: 23.0 (18.5, 33.5) vs. 32.7 (21.5, 48.2) ng/mL; p=0.011]. By contrast, there were no meaningful differences in FPG [adjMD (95%CI): −0.05 (−0.22, 0.12) mmol/L; p=0.57], HbA1c [0.0 (−0.17, 0.17) %; p=0.98] or diabetes/prediabetes prevalence [adjOR (95%CI): 0.9 (0.29, 2.29); p=0.85] by LTBI status. Insulin secretion and resistance, NTproBNP and hs-Troponin T were also similar. Conclusion Older adolescents and young adults with LTBI had greater markers of inflammation than those without LTBI while cardiometabolic profiles were similar across TB and/or age strata. Unlike in adults, M.tb infection in young persons does not appear associated with cardiometabolic derangement, although longterm consequences of chronic inflammation requires further study.