Therapeutic nutrition can reduce Tuberculosis mortality

CHENNAI: As under nutrition and Tuberculosis are correlated and 34 percent of incident TB in India is attributed to undernutrition, a study published in Tamil Nadu Journal of Public Health and Medical Research states that therapeutic nutrition and inpatient care should be given to those with very severe undernutrition at TB diagnosis.

The sustainable development goals in India aim to bring down TB deaths by 90 percent when compared to 2015.

Therapeutic nutrition involves liquid formula feeds that can be prepared in hospital kitchen using available ingredients. It should also be in line with the standards of World Health Organisation and Central TB Division recommendations.

Tamil Nadu Kasanoi Erappila Thittam (TN-KET), which is TB death-free initiative has been implemented since April 2022, with an aim to reduce mortality due to TB.

As part of TN-KET, a system of triaging adult TB patients at diagnosis for severe illness is followed in routine health system settings.

The individuals with very severe undernutrition, respiratory insufficiency or poor performance status, are identified and prioritised for comprehensive clinical assessment and inpatient care. In TN, among 11,599 adults assessed between April to June 2022, 25 percent had severe undernutrition, while 6.3 percent had very severe undernutrition with BMI below 14 kg/m² at TB diagnosis.

The study by authors from the Division of Health Systems Research, ICMR-National Institute of Epidemiology, states that most patients with very severe undernutrition should not be provided and cannot tolerate high protein solid diet.

It recommends that TB diet should be used among TB patients without very severe undernutrition.

The author Hemant Deepak Shewade quotes in the study, "Most of these hospitals and relevant medical staff are also not aware of the need for therapeutic nutrition among adults with TB with very severe undernutrition. Paediatricians who manage TB among children are already sensitized to this concept as they commonly manage severe acute malnutrition."

"Assessment of undernutrition among adults with TB using BMI, classification of undernutrition along with therapeutic nutrition for those with very severe undernutrition should not only be implemented but also be made part of graduate and postgraduate medical training, specifically, included in respiratory medicine and other related postgraduate medical training."

The study recommends the provision of therapeutic nutrition in medical college hospitals and district head quarter hospitals. For existing physicians managing TB, orientation trainings are required. Tamil Nadu through TN-KET initiative has taken a step in the right direction.