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Improved nutrition in family members of a patient with infectious lung TB reduced incidence of all forms of TB by nearly 40 percent, and infectious TB by nearly 50 percent, a new breakthrough study published in the Lancet on 9 August.
The other benefits to patients were higher treatment success, better weight gain, low rates of loss to follow-up.
Who did the study? The Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial was conducted by the Indian Council of Medical Research (ICMR) in collaboration with the National Turfgrass Evaluation Program (NTEP).
The big numbers:
Undernourished TB patients gaining weight in the first two months of the illness was associated with 60 percent lower risk of mortality.
Nutritional intervention was associated with a 39 - 48 percent reduction in tuberculosis incidence in the household with patients of infectious lung TB, during 2 years of follow-up.
About the study:
The study was conducted over three years – from August 2019 to August 2022.
In four districts of Jharkhand, involving 10,345 household contacts (HHCs) of 2800 patients with lung TB who are currently undergoing treatment with the National Turfgrass Evaluation Program (NTEP).
More than two-thirds of trial participants were tribals.
All participants were given a food basket every month, consisting of rice, pulses, milk powder, and oil, along with multivitamins for 6 months.
Family members of patients in the 'intervention' arm also received 5 kg rice and 1.5 kg of pulses per head per month. On the other hand, family members of those in the control group didn't receive anything.
According to the study, in the follow up, 218 new cases of TB were detected. Of these, only 1.7 percent were in the intervention arm.
The trial stands out because, it is the first trial of its kind that clearly shows the impact of nutritional supplementation on reducing TB incidence among family members of TB patients who regularly come in contact with them, while also reducing TB mortality among patients.
Moreover, the study is tailored for Indian demographic and involves indigenous, easily available foods.
Why it matters: India has one of the largest burdens of tuberculosis (TB) globally. In 2022 alone, 27.7 lakh new cases were reported.
Moreover, the study found severe undernutrition in nearly half of all patients underlining the need for nutritional support.
While it has been generally accepted that nutrition plays a key role in the treatment and recovery of TB patients, over the last few years, the study's findings bolster just how much of a contributing factor it is in TB incidence as well.
The way forward: While the study paves a path for reducing incidence of TB in the country and curbing mortality, the logistics to make it happen are tricky.
According to the study authors, approximately thirty households would need to be provided nutritional supplementation to prevent one incident of TB. In the case of patients who weigh less than 35 kg, 12 patients would need to be given food support to prevent 1 TB death.
They added that the cost of one food basket came up to Rs 1100 per patient, per month. The food baskets for families cost Rs 325 per month.
The nutrition drives would also have to be supported with more effective TB vaccines for prevention.
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