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

Background Mycobacterium tuberculosis (M.tb) infection in adults increases incident type 2 diabetes and atherosclerotic cardiovascular disease risk. It is unknown if this cardiometabolic detriment occurs in the young. We investigated whether young persons with latent tuberculosis infection (LTBI) have worse cardiometabolic health than uninfected peers. Methods Peripubescent adolescents (12-15 years old) and older adolescents/young adults (16-30 years old) were assessed for LTBI by tuberculin skin testing (induration ≥10mm). Outcomes included fasting plasma glucose (FPG), HbA1c, c-peptide, NTproBNP, hs-Troponin T, CRP, ferritin, diabetes/prediabetes (FPG ≥5.6 mmol/L and/or HbA1c ≥5.7%) and homeostatic model of insulin resistance (HOMA2-IR). LTBI cases were propensity score-matched 1:4 with TB-uninfected controls on sociodemographics to estimate adjusted median (adjMedian), mean differences (adjMD), and odds ratios (adjOR) of cardiometabolic indices. Results Seventy-five LTBI cases were matched with 300 TB uninfected peers. Among older participants, LTBI 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], but not among peripubescent adolescents. No meaningful differences were observed 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], insulin secretion/resistance, NTproBNP, or hs-Troponin T by LTBI status. Conclusion Older adolescents and young adults with LTBI had higher inflammation than those without LTBI while cardiometabolic profiles were similar. Unlike adults, M.tb infection in young people may not be associated with cardiometabolic derangement, though the longterm consequences of chronic inflammation require further study.