Protein-calorie malnutrition, macronutrient supplements, and tuberculosis

Area of Science:

• Nutritional Science
• Infectious Disease Research
• Public Health

Background:

• Protein-calorie malnutrition (PCM) is a known risk factor for developing tuberculosis (TB) disease.
• Malnutrition significantly impacts TB treatment outcomes, including increased mortality and relapse rates.
• Limited data exists on malnutrition's role in tuberculous infection risk.

Purpose of the Study:

• To review the literature on PCM and low body mass index (BMI) as risk factors for TB.
• To evaluate the effects of malnutrition on anti-tuberculosis treatment outcomes.
• To summarize clinical trial findings on macronutrient supplementation for TB patients.

Main Methods:

• Literature review of studies on PCM, low BMI, and TB.
• Analysis of clinical trials investigating macronutrient supplementation in TB treatment.
• Synthesis of data on malnutrition's impact on TB infection, disease, and treatment.

Main Results:

• PCM is a well-established risk factor for TB disease, with malnutrition linked to higher mortality and relapse.
• Macronutrient supplementation trials show modest weight gain (2-3 kg at 2 months) and potential improvements in physical function, sputum conversion, and treatment completion.
• Studies were not powered to assess the impact of supplementation on mortality or relapse.

Conclusions:

• Standard assessment of dietary intake, food security, and BMI is crucial for TB patients.
• Dietary counseling should be a routine part of TB treatment.
• Patients with BMI <18.5 kg/m² should receive balanced macronutrient supplementation due to modest benefits and lack of adverse events.