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Nutritional Intervention in Controlling Tuberculosis

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Nutritional intervention is crucial in controlling tuberculosis as a preventive measure and as part of the treatment protocol.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At February 8, 2024
Reviewed AtFebruary 29, 2024


Malnutrition and tuberculosis (TB) are major issues in many underdeveloped countries around the world. It is essential to consider the difficulties of one another. Malnutrition can increase the risk of developing clinical disease, and it can be exacerbated by tuberculosis. Before the development of antituberculosis chemotherapy, a diet high in proteins, fats, calories, minerals, and vitamins was widely considered important. However, the management of tuberculosis has changed drastically with the advent of antituberculosis medications, which has reduced the importance of food due to these treatment improvements.

Nutrients are necessary for the regulation of body mechanisms, such as maintaining and repairing tissues, thereby improving overall health and the prevention of diseases. Macronutrients such as carbohydrates, proteins, and fats are taken in large quantities. Some fat and carbohydrates are transformed into energy, whereas fat and protein are required to make the structural and functional elements of human tissues. Micronutrients, such as vitamins and minerals, are taken in smaller quantities and are required for metabolic processes. Both micro and macronutrients contribute to the function of cellular integrity and tissue regeneration.

The word “malnutrition” can refer to undernutrition, overnutrition, or both. Undernutrition is a condition in which an individual’s health and growth may be impaired due to insufficient nutritional status. Undernutrition can be brought on by illnesses that affect metabolism and nutritional intake, or it can result from insufficient amounts of macro, micro, or both types of nutrients.

Undernutrition can frequently lead to infections and illnesses such as HIV (human immunodeficiency virus), TB, pneumonia, gastrointestinal disorders, and malabsorption. Malnutrition can result from a variety of factors, including inadequate access to food, abuse of alcohol and illegal drugs, and other situations. Evaluation and therapy are necessary for malnutrition and underlying disorders linked to undernutrition.

Undernutrition and tuberculosis are strongly related. Because TB exacerbates undernutrition and lowers immunity, thereby increasing the chance of latent TB developing as an active condition. Most individuals with active TB are in a catabolic state and experience weight loss and some show signs of vitamin and mineral deficiencies at diagnosis. Several reasons can contribute to weight loss in TB patients, such as decreased food intake brought on by nausea, vomiting, and abdominal pain, loss of nutrients from diarrhea and vomiting, and changes in metabolism caused by the condition.

A low body mass index (BMI) (less than 18.5 kg/m2) and inadequate weight gain during TB therapy are linked to a higher risk of death and recurrence. They may also be signs of other associated diseases, a poor response to treatment, or the severity of the TB infection.

What Are the Effects of Nutrition on Tuberculosis?

Patients suffering from active pulmonary tuberculosis have significantly worse nutritional status. According to an Indian study, patients with tuberculosis had worse nutritional conditions than those with leprosy, showing that tuberculosis can be linked to severe malnutrition compared with other chronic illnesses. Wasting disease occurs in tuberculosis patients due to decreased appetite, micronutrient malabsorption, nutritional malabsorption, and altered metabolism.

Patients with tuberculosis used a higher percentage of oral dietary proteins for oxidation and energy production. This inability of dietary protein to enter the body and be used in endogenous protein synthesis is called "anabolic block.". This anabolic block is one of the processes involved in wasting in tuberculosis and inflammatory conditions.

Another condition that leads to wasting in tuberculosis is anorexia. Patients with tuberculosis lost weight at a rate of 45%, with 20% affected by anorexia. Tuberculosis patients lose more energy due to increased cytokine production with lipolytic and proteolytic activities. Wasting may also be influenced by leptin. Atypical manifestations of tuberculosis have been linked to malnutrition.

What Are the Nutritional Requirements of Children With Tuberculosis?

An appropriate food intake for the child is necessary to sustain the rapid growth stages of infancy and childhood. Tuberculosis can result in growth retardation and malnutrition. A child with tuberculosis has higher needs due to both growth and the disease; therefore, it is essential to provide them with enough energy and nutrition. Numerous research investigations have shown that a TB evaluation is necessary for every youngster who exhibits signs of malnutrition or failure to thrive. Meeting children's dietary needs can be challenging due to their minimal stomach capacity and hunger.

How Does Drugs Interact With Nutrients?

It has been demonstrated that simultaneous feeding and antituberculosis medication administration with food reduces the bioavailability of Isoniazid and Rifampicin. Rats exposed to Ethambutol have demonstrated increased urinary zinc loss in addition to increased zinc absorption, which lowers the quantity of zinc in the blood. Isoniazid is well known for causing peripheral neuropathy. Malnutrition is a common cause of Isoniazid-induced peripheral neuropathy among the poorer groups of the population. The side effects of antituberculosis medications are the risk factors for malnutrition, regardless of age, gender, occupation, education, or food availability.

What Is the Role of Micronutrients?

Micronutrients are now recognized as necessary for optimal human health due to various metabolic traits and functions. Micronutrient deficiency is the most common cause of secondary immunodeficiency and infection-related morbidity, including tuberculosis.

  • Zinc:

Administering zinc supplements to patients suffering from bacterial pneumonia and pulmonary tuberculosis boosts immune function. Adequate zinc may also prevent inflammation and free radical membrane damage.

  • Vitamin A:

Studies show that vitamin A has an immunocompetent role in TB in humans. Vitamin A prevents pathogenic bacilli from multiplying in human macrophage cultures.

  • Vitamin D:

It has been documented that TB patients have abnormal vitamin D levels, and vitamin D regulates macrophage function, which is a major element in tuberculosis host resistance.

  • Vitamin E:

Several investigations show that vitamin E concentrations in tuberculosis patients have decreased.

  • Vitamin C: Several studies have associated vitamin C insufficiency with tuberculosis. High levels of malonaldehyde were linked to clinical severity in tuberculosis patients in Ethiopia, and antioxidant vitamin A, vitamin C, and vitamin E concentrations were much lower in these patients.
  • Selenium: Selenium, an essential trace element, plays a key role in immune system function and may, therefore, play an important part in mycobacteria clearance. The relative risk of mycobacterial infections in HIV-positive patients has been influenced by selenium.
  • Iron: Adults with pulmonary TB commonly develop anemia. There are two possible causes of anemia: one is a chronic illness, and the other is iron deficiency, which makes a person more vulnerable to infections like tuberculosis.
  • Copper: In a recent study, tuberculosis patients' serum contained significantly higher concentrations of copper and the copper/zinc ratio than iron, zinc, and selenium.


Nutritional supplements can improve the clinical outcomes of tuberculosis patients. The nutritional awareness to improve energy intake with the necessary supplementation of nutrients, especially in the initial phase of tuberculosis treatment, improves body weight, physical functions, and total lean mass after six weeks. This may also cause immunological changes and reduce infections.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


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