Tuberculosis and nutrition

[Gert van der Hoek]

Lung India. 2009 Jan-Mar; 26(1): 9?16.
doi: 10.4103/0970-2113.45198



Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels.

Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls. Malnutrition can lead to secondary immunodeficiency that increases the host's susceptibility to infection. In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting.

Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. Nutritional status of patients improves during tuberculosis chemotherapy. High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations.

Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.


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Abstract

[Gert van der Hoek]

Indian J Med Res. 2016 Jul; 144(1): 11–20.
doi: 10.4103/0971-5916.193278

PMCID: PMC5116882

Undernutrition & tuberculosis in India: Situation analysis & the way forward

Abstract

Undernutrition and tuberculosis (TB) are linked and have a bidirectional relationship. Undernutrition increases the risk of TB which in turn, can lead to malnutrition. Undernutrition not only is a risk factor for progression of latent TB infection to active disease, but also increases the risk of drug toxicity, relapse and death once TB develops.

The dietary intake of TB patients in the country is inadequate. Nutritional supplementation in patients with TB is associated with faster sputum conversion, higher cure and treatment completion rates, significant gain in body weight and body composition as well as better performance status.

The Government of India has various social support schemes (including nutrition supplementation schemes) and policies, at the Centre as well as State levels. Here we discuss some successful examples and suggest a few solutions to address this gap; like considering TB patients as a vulnerable group for “Targeted Public Distribution System” and providing extra rations for the duration of treatment. Recommendations for the research community, civil societies, government organizations, non-governmental and corporate sector on the actions needed to achieve the goals of the End TB Strategy are also provided.

Ultimately, reduction of TB burden in India and its elimination will require improving the nutritional status of the community as a whole.



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[Gert van der Hoek]

Treatment of Tuberculosis with a Low Carbohydrate High Protein Diet

BENJAMIN P. SANDLER


Chest. 1950;17(4):398-422. doi:10.1378/chest.17.4.398

Abstract


Based on the concept that carbohydrate-rich foods exert a depressant effect on total bodily oxygen consumption with resultant lowering of the organism's ability to overcome infection, 38 patients with pulmonary tuberculosis of varying severity were given a low carbohydrate high protein diet. Thirty-five made apparent favorable response to the diet of whom 17 showed roentgenologic improvement. The remaining 18 patients, most of whom had pneumothorax, showed no change by roentgenogram, the lesions having apparently become stabilized.

The beneficial effects of the diet are attributed to increased glucose-oxygen consumption brought about by elevation of the blood sugar to normal level in patients with hypoglycemia, and by restricting carbohydrate-rich foods in patients with hyperglycemia. The high percentage of tuberculous patients with disturbed carbohydrate metabolism as revealed by the glucose tolerance test demands correction by diet regimen.

We believe that the fundamental factor responsible for susceptibility to, and persistence of the tuberculous infection, namely, a reduced glucose-oxygen consumption, is overcome by the low carbohydrate diet. A normal carbohydrate metabolism, with concomitant normal liver glycogen stores, is an essential and fundamental mechanism upon which other defense mechanisms depend. This is true not only for the diabetic, but also for the nondiabetic. The normal combustion of glucose supplies the energy for chemical reactions needed for the production of tissue and humoral immunological substances. In addition, the high protein intake makes available chemical substances more suitable for tissue repair.

The favorable response to the diet by patients who show normal glucose tolerance curves may be attributed to an increase in liver glycogen stores with resultant improved carbohydrate metabolism. Experimental evidence is cited to show that ingestion of so-called "balanced" diets containing ample amounts of carbohydrate-rich foods do not necessarily produce normal glycogen storage and may even bring about fatty and fibrotic livers. Recent clinical reports describing good results in the treatment of cirrhosis of the liver with high protein diets further attest to the superiority of protein over carbohydrate in maintaining normal liver glycogen storage.

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