Artificial neural network to predict the effect of obesity on the risk of tuberculosis infection

  • Alaa Badawi
    Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Canada.
  • Christina J. Liu
    Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Canada.
  • Anas A. Rehim
    Ontario Tech University, Oshawa, Canada.
  • Alind Gupta
    Cytel Inc., Toronto, Canada.


Background: Body weight has been implicated as a risk factor for latent tuberculosis infection (LTBI) and the active disease.

Design and Methods:
 This study aimed to develop artificial neural network (ANN) models for predicting LTBI from body weight and other host-related disease risk factors. We used datasets from participants of the US-National Health and Nutrition Examination Survey (NHANES; 2012; n=5,156; 514 with LTBI and 4,642 controls) to develop three ANNs employing body mass index (BMI, Network I), BMI and HbA1C (as a proxy for diabetes; Network II) and BMI, HbA1C and education (as a proxy for socioeconomic status; Network III). The models were trained on n=1018 age- and sex-matched subjects equally distributed between the control and LTBI groups. The endpoint was the prediction of LTBI.

: When data was adjusted for age, sex, diabetes and level of education, odds ratio (OR) and 95% confidence intervals (CI) for risk of LTBI with increased BMI was 0.85 (95%CI: 0.77 – 0.96, p=0.01). The three ANNs had a predictive accuracy varied from 75 to 80% with sensitivities ranged from 85% to 94% and specificities of approximately 70%. Areas under the receiver operating characteristic curve (AUC) were between 0.82 and 0.87. Optimal ANN performance was noted using BMI as a risk indicator.

Body weight can be employed in developing artificial intelligence-based tool to predict LTBI. This can be useful in precise decision making in clinical and public health practices aiming to curb the burden of tuberculosis, e.g., in the management and monitoring of the tuberculosis prevention programs and to evaluate the impact of healthy weight on tuberculosis risk and burden.


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