In a recent study published in The Lancet Global Health In the journal, researchers evaluated the impact of nutritional supplementation on Indian adults with microbiologically confirmed pulmonary tuberculosis. This study aimed to assess the impact of micro- and macronutrient supplementation on tuberculosis treatment success, outcomes and mortality in a study cohort.
Tuberculosis remains a major public health concern worldwide. In 2021, about 3 million people will contract TB in India, and 494,000 people with TB who are HIV-negative will die. Early diagnosis, management of comorbidities, quality care, and thorough evaluation are necessary to prevent tuberculosis-related deaths.
Moreover, in countries with a high TB burden such as India, malnutrition is a prevalent comorbidity of TB. Undernourished active tuberculosis patients are at risk of drug toxicity, disease relapse, and tuberculosis-related death.
The World Health Organization (WHO) recommends nutritional counseling, support and assessment for tuberculosis, but these guidelines are not always followed. Studies have shown that undernutrition management may reduce tuberculosis mortality, but there are conflicting results regarding the effects of micro- and macronutrient supplementation during tuberculosis treatment.
In this study, the researchers found that nutritional support reduced tuberculosis activation through improved tuberculosis treatment efficacy, tuberculosis-related mortality, and nutritional status (RATIONS) over the six-month intervention period. Determined what impact nutritional support had.
RATIONS is a cluster-randomised, field-based controlled trial analyzing the impact of nutritional support among household contacts of adult patients with microbiologically confirmed pulmonary tuberculosis in Jharkhand, India.
Patients aged 18 years and older from 28 tuberculosis wards of the National Tuberculosis Eradication Program (NTEP) were enrolled in the study. The exam is incorporated within his NTEP in his four districts of West Simbum, Saraikela Harsavan, Ranch and East Simbum in Jharkhand.
Family contacts of tuberculosis cases were included if they lived with the index case, shared the same kitchen, and had no diagnosis of tuberculosis.
Both subject cohorts of the rations, tuberculosis patients and their household contacts, received nutritional supplementation in the form of micronutrient tablets and food rations, ie 52 g protein and 1200 kcal per day.
Patients received nutritional support for 6 months for drug-sensitive tuberculosis and 12 months for multidrug-resistant tuberculosis. In addition, a drug-susceptible tuberculosis patient was eligible for her 6-month extension of nutritional support if her body mass index (BMI) was less than her 18.5 kg/m.2 End of treatment.
The team recorded baseline diabetic status, modified Eastern Cooperative Oncology Group (ECOG) performance status, and BMI. Weight gain and clinical outcomes such as mortality from tuberculosis, treatment success, changes in performance status, and loss to follow-up were then recorded 6 months after him.
Tuberculosis mortality predictors were evaluated with the help of Poisson and Cox regression using adjusted hazard ratios (HR) and adjusted incidence rate ratios (IRR).
The research team found that between August 16 and 31, 2019, 2,800 tuberculosis patients, including 1,979 men (70.7%) and 821 women (29.3%), were enrolled in the study, with an average age of women. were 37.3 years old, and men were 41.5 years old. January 2021.
Most of the participants were from indigenous communities, known as Scheduled Tribes, engaged in manual labor and received subsidized food rations from the public distribution system. About 40% of the participants had no formal education. Of the 2,264 participants tested, 6 (0.3%) had co-infection with tuberculosis and HIV, and 139 (5%) of the total of 2,800 participants had diabetes.
Additionally, 2,291 (82.4%) participants had a BMI less than 18.5 kg/m.2 Therefore, they were underweight, with 480 (17.3%) participants having a BMI <14 kg/m.2 Enrolled.Mean BMI and weight were 16.4 kg/m32 42.6kg for men, 16.2kg/m2 Women weigh 36.1 kg each.
Additionally, of 2,676 participants, 54% or 1,444 patients showed a weight gain of approximately 5% of baseline weight after 2 months. Cox regression analysis showed an association between reduced tuberculosis-related mortality and relative and absolute weight gain during his first two months.
Predictors of tuberculosis mortality included BMI, baseline body weight, hemoglobin, diabetes, and poor performance. A 5% weight gain over 2 months was associated with a reduced risk of death.
At 6-month follow-up, 5 patients failed treatment, 28 were lost to follow-up, 108 participants died of tuberculosis, and 2,623 participants were successfully treated. Median weight gain was 4.6 kg. However, 1,441 of his 2,630 participants (54.8%) remained underweight.
Findings indicate that malnutrition is a serious and potentially fatal comorbidity among patients with pulmonary tuberculosis in India. Although baseline body weight was reported to be a risk factor for death from tuberculosis in this study, weight gain from supplementation during the first two months was associated with a significantly reduced risk of death during treatment. also pointed out.
The results of this study demonstrated that micronutrients and a food basket nutritional support strategy normalized performance status, higher treatment success rates, reduced loss to follow-up, and weight gain in most tuberculosis patients compared to NTEP. showed that it is a practical solution related to the improvement of data.
The researchers found that tuberculosis programs in India and other countries with high rates of undernutrition and high tuberculosis rates regularly assessed hemoglobin levels, performance status and nutritional status during tuberculosis diagnosis and provided graded nutritional support. suggested that close supervision and referral to inpatient care should be provided during the intensive period. About illness.