Nutritional Supplementation Reduces Tuberculosis Risk by Nearly 50%, Groundbreaking Trial Finds
A groundbreaking trial conducted in India, called RATIONS, has uncovered a significant breakthrough in the fight against tuberculosis (TB). The trial aimed to determine the impact of nutritional supplementation on new cases of TB in households with adults suffering from pulmonary TB. The results of the trial revealed that providing food baskets to individuals with TB and their households could greatly contribute to the prevention and mitigation of the disease.
Tuberculosis has long been recognized as a social disease, thriving on social factors such as malnutrition, poor housing, overcrowding, unsafe work environments, and stigma. Shockingly, an estimated 2.2 million cases of TB in 2021 were attributed to undernourishment globally, surpassing the numbers linked to HIV infection, alcohol use disorders, smoking, and diabetes.
For centuries, efforts to combat TB have mainly revolved around biomedical solutions, often referred to as silver bullets. However, progress in addressing this social pathology has been limited. The COVID-19 pandemic has further exacerbated the situation, leading to increased TB mortality and incidence worldwide. Consequently, TB has regained its position as the deadliest infectious killer of humankind.
Undernutrition has been identified as the primary cause of TB, as numerous studies have demonstrated poor levels of nutrition in TB patients, particularly in countries like South Africa. The latest evidence suggests that undernutrition not only affects TB patients but also plays a significant role in the transmission of the disease within households.
The Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial sought to explore the impact of improved nutrition on the family members of patients with lung TB. Remarkably, the trial revealed a nearly 40% reduction in all forms of TB and a nearly 50% reduction in infectious TB among participants who received improved nutrition. In essence, food acted as a vaccine, effectively cutting the risk of household members developing TB.
The trial recruited 10,345 household members of 2,800 patients with lung TB, shedding light on the prevalence of severe undernutrition in nearly half of all patients. Encouragingly, the trial showed that early weight gain within the first two months was associated with a 60% lower risk of TB mortality. Additionally, participants experienced higher treatment success rates and better overall weight gain, resulting in an impressive treatment success rate of 94% during the six-month follow-up period.
One of the most significant aspects of the trial was the cost-effectiveness of the intervention. The provision of a food basket amounted to only US$13 per TB patient per month and US$4 per household member per month. Furthermore, the intervention proved feasible even in rural areas, thanks to the utilization of field staff.
India had already recognized the importance of nutrition support for individuals with TB and launched the Nikshay Poshan Yojana scheme in 2018. Under this initiative, each TB patient receives a financial incentive of US$6 per month throughout their anti-TB treatment period. While this scheme has improved treatment completion rates, delayed payments remain an issue, highlighting the need for enhanced efficiency and timely disbursements.
The success of the RATIONS trial suggests that providing food baskets directly to individuals with TB could be another effective strategy. Many countries, including India, have existing social security programs such as public distribution systems that offer subsidized food grains. Expanding these programs to provide additional food rations to TB patients and their households, including proteins like pulses and millets, could prove a valuable strategy. Moreover, this approach might have positive effects on other diseases, such as diabetes.
South Africa, labeled as a high TB burden country by the World Health Organization, also faces significant challenges in combating the disease. Statistics South Africa reports that a staggering 2.6 million people in the country had inadequate access to food in 2021, with an additional 1.1 million experiencing severe food insecurity. Furthermore, over 683,000 children under the age of five experienced hunger.
To effectively address the TB epidemic in South Africa, a comprehensive approach is needed. This includes nutritional support to prevent TB, the provision of drugs to prevent TB infections, early diagnosis through molecular tests, and timely treatment. Given the high levels of food insecurity and undernutrition in the country, exacerbated by extreme inequality, providing social benefits to people with TB and those in their households is crucial in reducing the prevalence of the disease and achieving the Sustainable Development Goals for 2030.
While advancements in tests, cures, and vaccines for TB remain critical, they alone cannot put an end to the epidemic. TB patients must be afforded the social benefits that they deserve as a basic human right, offering them the necessary support to overcome the disease. By implementing evidence-based approaches such as nutritional supplementation, we can take significant strides in the fight against TB and ultimately improve global health outcomes.
