Nutritional support during treatment of pulmonary TB recommended

Severely undernourished tuberculosis (TB) patients in rural India have twice a higher risk of death, a scientific research study has concluded.

The study conducted at Jan Swasthya Sahyog (JSS or Peoples’ Health Support Group), a non-profit voluntary organisation, suggests the need for nutritional support during treatment of pulmonary TB among these patients.

Under-nutrition is a known risk factor for TB and can adversely affect treatment outcomes.

However, data from India is sparse, despite the high number of cases of both TB and malnutrition.

Research findings

Researchers of this new study assessed the nutritional status of patients during TB treatment, both at the time of diagnosis and completion of therapy, and its association with deaths.

The study was conducted in a consecutive cohort of 1,695 adult patients with pulmonary TB in rural India during 2004 - 2009.

At the time of diagnosis, the body mass index (BMI) of the subjects indicated that 80 per cent of women and 67 per cent of men had moderate to severe under-nutrition while 57 per cent of men and 48 per cent of women were stunted, indicating chronic under-nutrition.

Severe under-nutrition during diagnosis was associated with a two-fold higher risk of death.

At the time of treatment, half the women and one third of men remained moderately to severely underweight. Sixty among 1179 patients (5 per cent) who were treated, died.

Overall, a majority of patients showed evidence of chronic severe under-nutrition at diagnosis, which persisted even after successful treatment in a significant proportion of them.

These findings have been published on PLOS ONE, an open-access peer-reviewed science journal, in a paper titled “Nutritional status of adult patients with pulmonary TB in rural central India and its association with mortality”, authored by Anurag Bhargava, Yogesh Jain, Madhuri Chatterjee and others.

JSS has been providing health services in Bilaspur district of Chhattisgarh since 2000. The organisation caters to the rural population through its community health programme in 54 villages. It has a secondary care level hospital which is accessed by people of over 1,500 villages, and 3 outreach clinics serving the villages under the community health programme and other remote villages.

Relation with weight

Men who died during treatment had significantly lower pre-treatment weight than those who were treated successfully (4-kg lower median weight), but in women this difference was not statistically significant.

Overall, among patients treated at JSS, 71 per cent were moderately to severely underweight at diagnosis, while among patients who died this proportion was 80 per cent.

There was no significant difference in baseline weights between men and women who completed treatment successfully compared to those who did not.

The deaths which occurred during TB treatment were premature – defined as those occurring below the age of 65 years. The median ages at death (42 years in men and 32 years in women) were in contrast to the current life expectancy of 65.8 years for men and 68.1 years for women in India.

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