Iron Supplementation and Omega-3 Fatty Acids in Tuberculosis: Friend or Foe?

Iron supplementation in patients with tuberculosis remains a controversial issue due to the complex role of iron in the host immune response and in the pathogenesis of Mycobacterium tuberculosis infection. Although supplementation may be beneficial for some patients with persistent iron deficiency, the available evidence does not support its routine use. The efficacy and safety of such an intervention appear to depend, among other factors, on the activity of the inflammatory process, the severity of iron metabolism disturbances, and the timing of supplementation initiation. Current evidence highlights the need for an individualized assessment of iron status and for further research to establish clear clinical recommendations. At the same time, growing interest has been directed toward the role of long-chain omega-3 polyunsaturated fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as potential modulators of immune and inflammatory responses in tuberculosis. EPA and DHA may influence immune cell function, cytokine production, and the formation of lipid mediators involved in the resolution of inflammation. Experimental evidence suggests that omega-3 fatty acids may reduce the severity of inflammation and infection-associated anemia; however, their effectiveness may depend on baseline fatty acid status, the stage of disease, and interactions with other nutrients, including iron. Human clinical evidence remains very limited and is currently based mainly on one small intervention study, therefore, clinical claims regarding omega-3 fatty acids supplementation should be interpreted cautiously and should not be understood as a recommendation for routine use. The aim of this review is to discuss the significance of iron metabolism and omega-3 fatty acids in tuberculosis, with particular emphasis on their roles in the regulation of inflammation, immune responses, anemia, and potential nutritional support. Current evidence underscores the need for individualized nutritional interventions and further clinical research to determine the safety, efficacy, and optimal timing of iron and omega-3 fatty acids supplementation in patients with tuberculosis.