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

A monthly food basket with adequate protein alongside effective therapy 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.

Household contacts in the intervention group received monthly food rations and micronutrients (750 kcal, 23 grams of protein per day with micronutrients).

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 study found a relative reduction of tuberculosis incidence of 39 per cent (all forms) to 48 per cent (microbiologically confirmed pulmonary TB) in the intervention group.

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 corresponding 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.

In the study, nutritional support was provided to a group with a high prevalence of severe undernutrition.

The researchers found that weight gain, particularly in the first two months, was associated with a substantially decreased hazard of tuberculosis mortality.

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

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.