A recent scoping review aimed to evaluate the current evidence on the effects of nutritional interventions in managing tuberculosis (TB), including multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB), and to explore implications for public health and future research. Conducted using PRISMA-ScR guidelines, the review searched literature from 2000 to 2021 via PubMed and Russian databases such as Google Scholar, Cyberleninka, and PubMed with language filters. Studies included were randomized controlled or observational trials with proper control groups. The interventions primarily assessed the impact of diet and supplementation on TB outcomes like recovery, nutritional status, and physical strength.[1]
The findings revealed that calorie and protein supplementation had consistently positive effects on key health indicators in TB patients, including improved body weight, handgrip strength, TB healing, and body composition in about half of the reviewed studies. Perioperative nutritional support also maintained albumin levels and reduced wound drainage, while cholesterol-rich diets enhanced sputum sterilization. However, the effects of micronutrient supplementation were mixed. Zinc and vitamin A showed little benefit, vitamin D was mostly ineffective, and vitamin E yielded conflicting results—potentially harmful in smokers but immune-boosting in others. Iron and arginine had no observed benefits, whereas vitamin C showed limited promise. Observational studies also highlighted that MDR-TB patients tended to have poorer body composition despite similar nutritional intake, and abnormal ferritin levels were associated with adverse outcomes.[1]
The review concludes that nutritional support—particularly interventions boosting calorie and protein intake—plays a crucial role in improving treatment outcomes for TB. These interventions should be routinely included in TB care, especially for malnourished or at-risk patients. As malnutrition both predisposes individuals to TB and worsens treatment efficacy, integrating nutrition into TB management is essential. Moreover, the review underscores the importance of systemic nutritional screening and support as part of broader public health strategies in TB-endemic regions.[1]
In a prospective cohort study conducted from January to December 2020, researchers investigated the prevalence and clinical impact of malnutrition among 1,075 Chinese patients with pulmonary tuberculosis (TB). The findings revealed a high burden of malnutrition, with prevalence rates varying depending on the assessment tool used—ranging from 33.86% (PNI) to 88.74% (CONUT). Within a year of follow-up, 9.2% of patients had died, and those with severe malnutrition faced a significantly higher risk of mortality. This association was strongest when assessed using the CONUT (HR = 4.78), GNRI (HR = 3.53), and PNI (HR = 2.94) scales.[2]
Importantly, the study also evaluated whether incorporating nutritional assessments could improve the predictive accuracy of statistical models for TB-related mortality. Results showed that adding nutritional scales to these models enhanced their performance across multiple metrics, including the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). For instance, in the final model, NRI improvements reached 9.40% for CONUT, 10.60% for GNRI, and 13.34% for PNI—all statistically significant. These findings suggest that nutritional risk scores are not only reflective of patient health status but also valuable tools for predicting long-term outcomes in TB patients.[2]
References:
1. Ockenga, J., Fuhse, K., Chatterjee, S., Malykh, R., Rippin, H., Pirlich, M., Yedilbayev, A., Wickramasinghe, K. and Barazzoni, R., 2023. Tuberculosis and malnutrition: the European perspective. Clinical Nutrition, 42(4), pp.486-492.
2. Ma, J.J., Guo, Y.J., Li, Z., Chen, Y., He, H. and Li, W.M., 2022. Prevalence and prognostic significance of malnutrition risk in patients with pulmonary tuberculosis: a hospital-based cohort study. Frontiers in Public Health, 10, p.1039661.
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