Study: Nutrition support shown to prevent TB, related deaths in India

A monthly food basket with adequate protein and multivitamins has been found to reduce new tuberculosis cases by nearly half among family members of TB patients in India.

New Delhi: A monthly food basket with adequate protein and multivitamins has been found to reduce new tuberculosis cases by nearly half among family members of TB patients in India, according to a study published in The Lancet Global Health journal.

An international team of researchers enrolled household contacts of 2,800 patients with confirmed pulmonary tuberculosis across 28 TB units of the National Tuberculosis Elimination Programme in four districts of Jharkhand.

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All patients received a monthly 10 kilograms food basket (rice, pulses, milk powder, oil) and multivitamins for 6 months. In family members, the intervention group received 5 kg rice and 1.5 kg pulses per head per month.

After screening all household contacts for co-prevalent tuberculosis, all participants were followed up actively until July 31, 2022, for the primary outcome of incident TB.

Between August 2019 and January 2021, there were 10,345 household contacts, of whom 5,328 (94·8 per cent) of 5,621 household contacts in the intervention group and 4,283 (90·7 per cent) of 4,724 household contacts in the control group completed the primary outcome assessment.

Almost two-thirds of the population belonged to Indigenous communities (eg, Santhals, Ho, Munda, Oraon, and Bhumij) and 34 per cent (3,543 of 10,345) had undernutrition.

The results of the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial, published in the Lancet on Tuesday, show that improved nutrition in family members of a patient with lung TB reduced incidence of all forms of TB by nearly 40 per cent, and infectious TB by nearly 50 per cent.

An accompanying paper in The Lancet Global Health, based on the outcomes in patients in the RATIONS trial showed that severe undernutrition was present in nearly half of all patients underlining the need for nutritional support.

An early weight gain in the first two months was associated with 60 per cent lower risk of TB mortality.

The other benefits to patients were higher treatment success, better weight gain, low rates of loss to follow up. Only 3 per cent were able to work at enrolment, but this figure rose to 75 per cent at end of treatment.

An estimated 30 households (111 household contacts) would need to be provided nutritional supplementation to prevent one incident tuberculosis, the researchers said.

“Food is an important adjunct to TB treatment to save lives and improved outcomes,” study lead author Anurag Bhargava, a professor at the Yenepoya Medical College, Center for Nutrition Studies, Mangalore, tweeted on Wednesday.

“Monthly food basket with adequate protein alongside effective therapy led to better weight gain. Nearly half of the cohort had BMI less than 16. Compared to other cohorts, mortality was 35-50 per cent less. Early weight gain by 2 months was associated with 60 per cent reduction in mortality,” Bhargava added.

Nutritional support needs to be an integral component of patient-centred care to improve treatment outcomes in such settings, the experts added.

“Given the high prevalence and severity of undernutrition in patients that increases their risk of death, nutritional support needs to be an essential part of patient-centred care in the Indian context,” said another lead author of the study, Madhavi Bhargava from Yenepoya Medical College.

The team also included researchers from McGill University in Canada; National Institute for Research in Tuberculosis, Chennai; National Tuberculosis Institute, Bengaluru, State TB Cell in Ranchi and officials from National TB Elimination Programme in the Union Health Ministry.

India had an estimated 3 million cases of tuberculosis and 494,000 (4.94 lakh) TB deaths among HIV-negative people in 2021, according to the study.

The National Strategic Plan for Tuberculosis Elimination in India has targets of an 80 per cent reduction in incidence and a 90 per cent reduction in tuberculosis mortality by 2025, the authors said.

The modest progress in reducing tuberculosis mortality since 2015 was reversed during the COVID-19 pandemic, they added.

Soumya Swaminathan, the Chairperson of M.S. Swaminathan Research Foundation and former Chief Scientist of the WHO, underscored the importance of nutrition as a key public health intervention.

“Improving the nutritional status of our population could potentially have a big impact on reducing TB incidence and achieving the ambitious goal of TB elimination in the next few years,” Swaminathan said.

“As we think about policy actions, we need to explore strategies to expand dietary diversity and provide adequate calories and protein to undernourished people who are at a much higher risk of developing active TB,” she added.