In the ongoing crusade against tuberculosis (TB), a groundbreaking study conducted by the Indian Council of Medical Research (ICMR) and the TB Institute of Chennai has illuminated a cost-effective and feasible strategy. This study, carried out in Jharkhand—a region grappling with a high TB burden and multidimensional poverty—unveiled a transformative approach that could potentially redefine India’s fight against this debilitating disease.
The findings, recently published in The Lancet, assert that by supplementing clinical care with nutritional support, India could achieve substantial reductions in TB mortality, and consequently, advance towards its ambitious target of significantly curbing TB-related deaths and incidences by 2025. The results of the “Reducing Activation of Tuberculosis by Improvement of Nutritional Status” (RATIONS) trial lay bare a pivotal insight: the introduction of dietary support can lead to a remarkable 60% decrease in the mortality risk of TB patients. Furthermore, the study pinpoints a critical nexus between under-nutrition and TB susceptibility. An intervention as simple as providing a monthly 10-kg food basket encompassing rice, pulses, milk powder, oil, and multivitamins can precipitate a 40% reduction in all forms of TB and a staggering 50% reduction in infectious lung TB among individuals exposed to victims over a six-month period. Notably, family members would need a 5-kg rice and 1.5-kg pulses allocation per person per month to mitigate infection risks.
While clinical care remains vital, the integration of nutritional support emerges as a complementary element that holds the potential to bolster treatment outcomes. This holistic approach resonates with India’s larger objective of comprehensively tackling the TB menace. This urgency is underscored by India’s status as a global leader in TB incidence and mortality, accounting for a daunting 27% of TB incidences and 35% of TB-related deaths, as per the WHO’s 2022 report. The study’s groundbreaking “RATIONS” trial, published in The Lancet, concretizes the link between improved nutrition and TB incidence reduction. Family members’ incidence of all TB forms was slashed by almost 40%, while infectious TB saw a nearly 50% decrease.
An accompanying study in The Lancet Global Health underscores the urgency of nutritional support, revealing that nearly half of all patients suffered severe undernutrition— a glaring indicator of the dire need for dietary intervention. Crucially, rapid weight gain in the initial two months was associated with a remarkable 60% drop in TB mortality risk. This approach translated into higher treatment success rates, improved weight gain, and minimal drop-out rates. A striking transformation saw only 3% of patients able to work at enrollment, a figure that soared to 75% upon treatment completion. Quantifying the impact, researchers project that around 30 households, equivalent to 111 household contacts, need to receive nutritional supplementation to prevent a single incident of tuberculosis.
This revelation underscores the efficacy of a nutritional-focused approach in preventing and mitigating TB cases. Prominent voices in the medical community have emphasized the role of nutrition in TB management. Anurag Bhargava, a lead author of the study and professor at the Yenepoya Medical College, Mangalore, tweeted that “Food is an important adjunct to TB treatment to save lives and improved outcomes.” He highlighted that the provision of a monthly food basket with sufficient protein, alongside effective therapy, facilitated better weight gain and correlated with reduced mortality rates.
As India forges ahead with its National Strategic Plan for Tuberculosis Elimination, targeting an 80% reduction in incidence and a 90% reduction in TB mortality by 2025, the imperative of nutritional support has never been more pronounced. By weaving nutrition into the fabric of patient-centered care, India could make significant strides towards transforming its TB landscape. The power of nutrition, harnessed in partnership with clinical care, might just be the game-changer in India’s relentless pursuit of TB elimination.
