A recent study has shed light on the crucial role of adequate nutrition support in tandem with effective therapy in significantly reducing new tuberculosis (TB) cases in India.
Published in The Lancet Global Health journal, the study uncovered that a monthly provision of a food basket containing sufficient protein, coupled with effective therapy, has the potential to slash new TB cases by almost half among family members of TB patients in the country.
Conducted by an international consortium of researchers, the study involved enrolling household contacts of 2,800 patients diagnosed with confirmed pulmonary tuberculosis across 28 TB units of the National Tuberculosis Elimination Programme in four districts of Jharkhand.
The intervention group, comprising household contacts, received monthly food rations and micronutrients (equivalent to 750 kcal and 23 grams of protein daily, with micronutrients). Following the screening of all household contacts for concurrent tuberculosis, participants were actively tracked until July 31, 2022, for the primary outcome of incident TB.
Between August 2019 and January 2021, a total of 10,345 household contacts were observed, with 94.8% (5,328 of 5,621) from the intervention group and 90.7% (4,283 of 4,724) from the control group successfully completing the primary outcome assessment.
Notably, a significant portion of the population—about two-thirds—belonged to Indigenous communities such as Santhals, Ho, Munda, Oraon, and Bhumij. Furthermore, 34% (3,543 of 10,345) of the participants were affected by undernutrition. The study yielded a relative reduction in tuberculosis incidence ranging from 39% (all forms) to 48% (microbiologically confirmed pulmonary TB) within the intervention group.
According to the researchers, it would require the provision of nutritional supplementation to approximately 30 households (encompassing 111 household contacts) to prevent a single incident of tuberculosis.
“Food is an important adjunct to TB treatment to save lives and improved outcomes,” remarked Anurag Bhargava, the study’s corresponding author and a professor at Yenepoya Medical College’s Center for Nutrition Studies, Mangalore, in a tweet.
The study underscored the value of a monthly food basket enriched with adequate protein, in conjunction with effective therapy, leading to notable weight gain. A significant proportion of the cohort had a body mass index (BMI) below 16. In comparison with other cohorts, the mortality rate was 35-50% lower. Bhargava also highlighted that early weight gain within two months was linked to a 60% reduction in mortality.
In a setting characterized by a high prevalence of severe undernutrition, the study provided nutritional support. The researchers identified that weight gain, particularly within the initial two months, was linked to a substantial reduction in the risk of tuberculosis mortality. They emphasized that nutritional support must be an integral facet of patient-centered care in such contexts to enhance treatment outcomes.
The study involved researchers from institutions including McGill University in Canada, National Institute for Research in Tuberculosis in Chennai, National Tuberculosis Institute in Bengaluru, State TB Cell in Ranchi, and officials from the National TB Elimination Programme in the Union Health Ministry.
In 2021, India reported an estimated 3 million TB cases and 494,000 TB-related deaths among individuals without HIV infection, according to the study.
The authors noted that the National Strategic Plan for Tuberculosis Elimination in India has set targets of an 80% reduction in incidence and a 90% reduction in tuberculosis mortality by 2025. They also highlighted the reversal of modest progress in reducing tuberculosis mortality since 2015, which was exacerbated by the COVID-19 pandemic.