How nutrition and tuberculosis are linked
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TB incidence was 4-fold higher in people with the lowest standard of living
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95 per cent of new TB cases every year occur in developing countriesDeficiencies of protein, vitamins and minerals have detrimental effects on immune system
In spite of the dramatic advances made in health care in the past decades, it is hard to believe that tuberculosis (TB) kills three people every two minutes in India. Mycobacterium tuberculosis is one of the oldest infectious agents known to mankind.
While infection occurs in 50 per cent of people, an enigma of this disease is why and how the majority (90 per cent) of people is able to keep the bacteria under check all their lives, while in a minority, the immune system loses the battle. The clues are probably in the air we breathe and the food we eat.
Globally, 95 per cent of new TB cases every year occur in developing countries, making it an infectious disease of poverty.
Incidence of TB
While TB can and does affect people from all social classes, a survey done by the Tuberculosis Research Centre (TRC), Chennai showed that the incidence of TB was four-fold higher in people with the lowest standard of living index in the community as compared to the highest.
The determinants
The mechanism by which malnutrition predisposes to TB is an ongoing area of research but it is clear that deficiencies of protein, vitamins and minerals have detrimental effects on all arms of the immune system.
A study done in Harlem in the 1940s where family members of half the black TB patients were given vitamin and mineral supplements found that they developed TB less frequently than those in families without the supplements.
There appears to be enough evidence to suggest that improving the nutritional status of people reduces TB incidence — yet, this has never been given priority as an infection control measure.
Globally about 8.8 million new cases and 1.7 million TB related deaths occurred in 2007 — India alone accounted for one fifth of the global TB burden and 400,000 deaths.
Achieving the goal
While the core of the Revised National TB Control Program (RNTCP) will continue to be the detection and treatment by DOTS (directly observed treatment, short-course) of all TB cases in the community, improving the nutritional status of large segments of our population could help achieve the Millennium Development Goal of reducing TB incidence by 2015.
Malnutrition not only increases the risk of developing TB but also the risk of dying from it. At the individual level, smoking cessation advice and nutritional supplementation should be added to TB treatment.
Food or nutritional support during TB treatment is likely to have multiple beneficial effects — better TB treatment outcomes by improving adherence, improved quality of life and work capacity and serving as an incentive for others to seek out and use government TB diagnostic and treatment services.
While there are few clinical trials demonstrating the benefit of such interventions, operational research while providing food supplements to TB patients, particularly in the hunger hotspots in India could provide the needed evidence as well as be responsive to patient needs.
The DOTS strategy for tuberculosis was based on clinical trials done in Chennai in the 1960s and 70s — we now have the opportunity to once again lead the global fight against tuberculosis by focusing on a neglected area of infectious disease control.
DR. SOUMYA SWAMINATHAN
TUBERCULOSIS RESEARCH CENTRE, CHENNAI.
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