By Shalini Bhardwaj
New Delhi [India], August 19 : A study funded by the Indian Council of Medical Research (ICMR) has demonstrated the powerful impact of nutritional supplementation on tuberculosis (TB) patients and their families.
The World Health Organisation (WHO) has lauded the findings and incorporated them into its updated global guidance on TB control, marking a major milestone in India's contribution to global health policy.
"A landmark study by the Indian Council of Medical Research (ICMR), conducted in Jharkhand, has demonstrated the powerful impact of improved nutrition in reducing tuberculosis (TB) cases and fatalities. World Health Organisation (WHO) has recognised this research, incorporating its findings into updated global guidance on TB control, marking a significant milestone in India's contributions to global health policy," the ICMR said in a statement.
"In India, tuberculosis and undernutrition are syndemics with a high burden of tuberculosis coexisting with a high burden of undernutrition in patients and in the population. The aim of this study was to determine the effect of nutritional supplementation on tuberculosis incidence in household contacts of adults with microbiologically confirmed pulmonary tuberculosis," said the ICMR study published by The Lancet.
"To our knowledge, this is the first randomised trial looking at the effect of nutritional support on tuberculosis incidence in household contacts, whereby the nutritional intervention was associated with a substantial (39-48%) reduction in tuberculosis incidence in the household during 2 years of follow-up. This biosocial intervention can accelerate reduction in tuberculosis incidence in countries or communities with a tuberculosis and undernutrition syndemic," the study said.
The study was conducted on 2800 patients with TB across 28 tuberculosis units of the National Tuberculosis Elimination Programme in four districts of Jharkhand.
"In this field-based, open-label, cluster-randomised controlled trial, we enrolled household contacts of 2800 patients with microbiologically confirmed pulmonary tuberculosis across 28 tuberculosis units of the National Tuberculosis Elimination Programme in four districts of Jharkhand, India," the study mentioned.
"The tuberculosis units were randomly allocated 1:1 by block randomisation to the control group or the intervention group, by a statistician using computer-generated random numbers. Although microbiologically confirmed pulmonary tuberculosis patients in both groups received food rations (1200 kcal, 52 grams of protein per day with micronutrients) for 6 months, only household contacts in the intervention group received monthly food rations and micronutrients (750 kcal, 23 grams of protein per day with micronutrients)," it said.
"After screening all household contacts for co-prevalent tuberculosis at baseline, all participants were followed up actively until July 31, 2022, for the primary outcome of incident tuberculosis (all forms). The ascertainment of the outcome was by independent medical staff in health services," the study added.
"We used the Cox proportional hazards model and Poisson regression via the generalised estimating equation approach to estimate unadjusted hazard ratios, adjusted hazard ratios (aHRs), and incidence rate ratios (IRRs)," it added.