Nilanjan
Tuberculosis (TB) is a major public health problem in India, which accounts for about a quarter of the global TB burden. According to the World Health Organization (WHO), in 2019, an estimated 2.64 million people fell ill with TB in India, and about 4.4 lakh people died from the disease. One of the key factors that contributes to the high incidence and mortality of TB in India is undernutrition, which affects the immune system and increases the susceptibility and severity of TB infection.
However, a recent trial conducted in India has shown that providing nutritional support to people with TB and their household contacts can significantly reduce the risk of developing TB disease and dying from it. The trial, called RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status), was led by Anurag Bhargava from the Yenepoya Medical College, Mangaluru, and involved researchers from India, Canada, UK, and Switzerland. The trial was funded by the Canadian Institutes of Health Research and the Indian Council of Medical Research. The results of the trial were published on August 9th in The Lancet and The Lancet Global Health.
The trial involved two groups of participants: patients with confirmed pulmonary TB and their household contacts. The patients were provided with a monthly food basket containing rice, pulses, milk powder, oil, and multivitamins for six months (or 12 months for those with multidrug-resistant TB). The household contacts were randomly assigned to either receive a similar food basket per head for six months (intervention group) or no nutritional supplementation (control group). The participants were followed up for six months to assess the primary outcome of incident TB disease.
The trial found that nutritional support led to a 39-48% reduction in TB disease in the intervention group compared with the control group. The 39% reduction included all forms of TB (pulmonary and extra-pulmonary), while the 48% reduction was in microbiologically confirmed pulmonary TB. The trial also found that nutritional support reduced mortality by 58% among patients with pulmonary TB.
The trial also documented high levels of severe and extremely severe undernutrition in patients at diagnosis. Nearly half of the patients had a body mass index (BMI) less than 16 kg/m2, which is considered as severely underweight. Severe undernutrition is one of the contributory causes of deaths in TB patients, as it impairs their response to anti-TB treatment and increases their risk of complications.
The trial also revealed that early weight gain in the first two months of treatment was associated with a lower risk of death among patients with pulmonary TB. Therefore, nutritional support can help improve the treatment outcomes and survival rates of patients with TB.
The trial also highlighted the role of nutritional support in preventing TB transmission among household contacts of patients with pulmonary TB. Household contacts are at a high risk of getting infected and developing TB disease due to close and prolonged exposure to the index patient. Nutritional support can help boost their immunity and resistance to TB infection.
The trial also demonstrated the feasibility and acceptability of providing nutritional support to people with TB and their household contacts in India. The trial used locally available and affordable food items that were culturally acceptable and palatable to the participants. The trial also used existing health system infrastructure and personnel to deliver the intervention.
The trial has important implications for TB control and elimination in India and other high-burden countries. The trial shows that nutritional support is an effective and cost-effective intervention that can complement existing strategies for TB prevention and treatment. The trial also shows that nutritional support can have multiple benefits for people with TB and their household contacts, such as improving their health, well-being, quality of life, productivity, and income.
The trial is a landmark achievement that provides strong evidence for scaling up nutritional support as part of comprehensive care for people with TB and their household contacts in India. The trial also provides a model for conducting large-scale trials on social determinants of health in resource-limited settings.If you want to know more about the trial and its results, you can read the full papers published in The Lancet and The Lancet Global Health. You can also watch a video summary of the trial here. If you want to know more about TB and its prevention and treatment, you can visit the WHO website here. If you have any questions or comments about this blog post, please feel free to share them below.
