'Nutrition can cut disease risk in TB patient's kin'

A monthly food basket containing 5 kg rice and 1.5 kg lentils per adult along with multi-vitamin tablets can cut by nearly half new tuberculosis cases among family members of TB patients, a landmark study in India reported on Tuesday.

The study, carried out in four districts of Jharkhand over three years, is the world's first to demonstrate the efficacy of a food basket -- nutritional intervention -- to prevent new TB cases in people at high risk of infection and opens up a window to explore fresh policy measures to ensure improved food supply to TB-affected households.

Led by a husband-wife duo working at a medical college in Mangaluru, the trial shows how extra food given to the family members of a TB patient brings down the TB incidence rate by 48% in household contacts, which may include the patient's children, spouse or parents.

There are also tangible benefits for patients who were given a monthly food basket of 5 kg rice, 1.5 kg milk powder, 3 kg roasted chickpea flour (sattu), 500 ml of oil and multivitamin pills. The ration was for six months for regular TB patients and a year for those having multi-drug-resistant TB.

"Better nutrition can reduce the incidence of infectious TB incidence by 48% in family members, whereas food availability for TB patients brings down mortality by 35%, and lead to early weight gain, which in turn can reduce the risk of TB mortality by 60%," said Anurag Bhargava, the lead researcher from Yenepoya Medical College, Mangaluru.

Anurag, along with his wife Madhavi Bhargava and researchers from McGill University in Canada; National Institute for Research in Tuberculosis, Chennai; National Tuberculosis Institute, Bengaluru, State TB Cell in Ranchi and officials from National TB Elimination Programme in the Union Health Ministry carried out the study in four districts in Jharkhand.

They enrolled 2,800 adult patients with pulmonary TB and their 10,345 household contacts, which were subdivided in two blocks – one receiving additional food support (intervention group with over 5,000 participants) while others (4,000 plus) were on normal diet and served as the control arm of the study.

After a two-year follow-up, 218 new cases of TB were detected, 2.6% in the control arm as against 1.7% in the intervention arm. "This translates to a 48% reduction of incidence of infectious TB in the intervention group," Bhargava said.

This would mean approximately 30 households (111 household-contacts) would need to be provided nutritional supplementation to prevent one incident of TB, he said.

The monthly cost of the food basket was Rs 1,100 for each patient and Rs 325 for each household contact.

"This is the first study in the world to show nutrition supplements can reduce TB incidences," said Soumya Swaminathan, former WHO Chief Scientist and ICMR director general who is not directly associated with the research.

India has one of the largest burdens of tuberculosis globally, with an annual estimated incidence of 27.7 lakh cases in 2022. The country aims to achieve 80% reduction in TB incidence, and 90% reduction in TB mortality by 2025.

Over the years, scientists have established a direct link between better treatment outcomes with improved nutrition among TB patients, leading to a monthly food subsidy offered by the government to TB patients.

The findings were published in two separate papers published in the Lancet and Lancet Global Health.