Link between Nutritional Supplementation and TB Treatment Outcome

Recent pioneering findings have shed light on a crucial connection between nutritional supplementation and the outcomes of tuberculosis (TB) treatment. The results of the RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status) trial, published in The Lancet, have revealed a strong correlation between nutritional support and improved TB treatment results as well as reduced mortality rates.

Contents

The RATIONS Trial and Study Details

The RATIONS trial, a cluster-randomised controlled trial, involved 10,345 household contacts of 2,800 microbiologically confirmed pulmonary TB patients. The study was conducted in the districts of Saraikela-Kharsawan, West Singhbhum, East Singhbhum, and Ranchi in Jharkhand, India, under the National Tuberculosis Elimination Programme (NTEP).

Background and Population Challenges

Jharkhand, being predominantly rural, faces challenges related to its population’s high poverty rates, with 25% of its residents belonging to scheduled tribes.

Treatment Approach in the RATIONS Trial

Nutritional Support for TB Patients

TB patients received nutritional support, including 1,200 kilocalories (kcal), 52 grams of protein daily, and micronutrients for a duration of 6 months.

Household Contacts in the Intervention Group

The intervention group of household contacts received monthly food rations and micronutrients, providing 750 kcal and 23 grams of protein daily.

Positive Outcomes

The study yielded significant positive outcomes:

A reduction in TB incidence by 39% for all forms and 48% for microbiologically confirmed pulmonary TB in the intervention group.
Another study published in The Lancet Global Health observed that weight gain in severely malnourished TB patients in Jharkhand led to a substantial reduction in TB mortality risks.
This study involved nutritional support for TB drug responders for 6 months and for multidrug-resistant TB patients for 12 months. The support included 1,220 kcal, 52 grams of protein daily, and micronutrient pills. An extension of up to 6 more months was given for patients with a BMI < 18.5 kg/m2 at the end of treatment.
The study reported that early weight gain in the first two months resulted in a 60% lower TB mortality risk, along with increased treatment success, better weight gain, and low weight loss rates in follow-ups.
The work ability of patients improved from 3% at enrolment to 75% post-treatment.
Other observations highlighted low prevalence of HIV, diabetes, and Multi-Drug Resistant-TB, but high usage of alcohol and tobacco. Approximately 10% of patients required inpatient care.

Tuberculosis Risk Factors in India

Undernutrition is the most prevalent risk factor for tuberculosis in India, accounting for over 40% of new cases each year. Other risk factors include diabetes, HIV, smoking, and alcohol consumption. Notably, undernutrition stands out as a significant risk factor.

A past study conducted by the National Institute for Research in Tuberculosis (NIRT) in Chennai revealed that TB patients with a weight below 35 kg had a fourfold higher mortality risk compared to those with a weight exceeding 45 kg.