PLoS One. 2015 Aug 27;10(8):e0134785.

Nutritional Supplementation Is a Necessary Complement to Dietary Counseling among Tuberculosis and Tuberculosis-HIV Patients.

 

Bacelo AC1, Ramalho A2, Brasil PE3, Cople-Rodrigues Cdos S4, Georg I5, Paiva E6, Argolo SV7, Rolla VC8.
  • 1Nutrition Service, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.
  • 2Josué de Castro Institute, UFRJ, Rio de Janeiro/RJ, Brazil.
  • 3Clinical Reasearch Laboratory on Chagas Disease, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.
  • 4Institute of Nutrition, UERJ, Rio de Janeiro/RJ, Brazil.
  • 5Diagnostics Activities Coordinating, Immunodiagnostic Section, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.
  • 6Department of Nutrition, UNISUAM, Rio de Janeiro/RJ, Brazil.
  • 7Sergio Franco Laboratory, Caxias/RJ, Brazil.
  • 8Clinical Research Laboratory on Mycobacteria, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.

 

Abstract

The Brazilian Ministry of Health and the World Health Organization recommend dietary counseling for patients with malnutrition during tuberculosis treatment. Patients under tuberculosis therapy (infected and not infected with HIV) were followed-up to evaluate the effectiveness of dietary counseling.

OBJECTIVE: describe the nutritional status of patients with tuberculosis.

METHODS: an observational follow-up study over a 180-day period of tuberculosis therapy in adults was conducted. Subjects were assessed for body composition (using BMI, TSF and MUAC parameters), serum biomarkers and offered dietary counseling. The data obtained at each visit (D15, D30, D60, D90, D120, D150, and D180) were analyzed, showing trajectories over time and central tendencies each time.

RESULTS: at baseline, the mean age was 41.1 (± 13.4) years; they were predominantly male, with income lower than a local minimum wage and at least six years of schooling. Patients showed predominantly pulmonary tuberculosis. At baseline, all patients suffered from malnutrition. The overall energy malnutrition prevalence was of 70.6%. Anemia at baseline was observed in both groups (63.2%), however, it was significantly more pronounced in the HIV+. At the end, energy malnutrition was reduced to 57.1% (42.9% of HIV- and 71.4% of the HIV+). Micronutrients malnutrition was evident in 71.4% of the HIV- patients and 85.7% of HIV+ patients at the end of tuberculosis therapy. Using BMI (≤ 18.5 kg/m2cutoff) as an index of malnutrition, it was detected in 23.9% of the HIV- and 27.3% of the HIV+ patients at baseline, with no evident improvement over time; using TSF (≤ 11.4mm as cutoff) or MUAC (≤ 28.5cm as cutoff), malnutrition was detected in 70.1% and 85.3% of all patients, respectively. Nevertheless, combining all biomarkers, at the end of follow-up, all patients suffered from malnutrition.

CONCLUSION: Although with a limited number of patients, the evidence does not support that dietary counseling is effective to recover from malnutrition in our population.

PMID: 26313258

 

Supplements:

Tuberculosis is an important global public health police (1) which causes reduced appetite and increased caloric demand (2). It is common to observe the association between tuberculosis and human immunodeficiency virus (HIV) (3,4), which is historically associated with malnutrition as well.

HIV infection also can reduce appetite, reduce absorption and increased caloric demand (3–6)

Poverty is directly associated with TB, due to poor ventilations, poor diet and difficult access to quality of life (7). It has became epidemic after the HIV contagion (8,9).

Nowadays we have too different problems in TB treatment. First, the reality of TB worldwide, including rich countries. And the second, social reality in poor countries where TB spreads (7).

This finding were very interest because the discussion on nutritional status during and after tuberculosis treatment. Especially in patients treated in Brazil where drugs have been used in the public health care system free of charge for tuberculosis and HIV treatments. But, on the other hand the micronutrient were not included as a biomarker (10,11), so the possibility of the supplementation were not a reality to all patients.

Is it possible for poor countries to be able to offer supplementations?

Like other countries Brazil has difficulty to guarantee a healthy diet of its population (12) to reduce risk of TB transmission (13).

We found in our study that dietary guidance proposed by WHO and the Brazilian Ministry of Health was not able to reverse the malnutrition of TB patients. We also, realize that BMI was not a good malnutrition indicator, which leads us to conclude that it must be applied along with other body measurement tools.

Nutritional guidelines seem to be insufficient in cases of people TB and TB-HIV, even though the prevalence of micronutrients malnutrition which was high and persistent until the end of the treatment, thus making it vital to review these recommendations.

 

References

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  10. Ministério da Saúde. Tuberculose [Internet]. Portal da Saúde – Ministério da Saúde – www.saude.gov.br. 2014 [citado 17 de julho de 2014]. Recuperado de: http://portalsaude.saude.gov.br/index.php
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  12. FAO, organizador. Strengthening the enabling environment for food security and nutrition. Rome: FAO; 2014. 52 p.
  13. Spence DP, Hotchkiss J, Williams CS, Davies PD. Tuberculosis and poverty. Bmj. 1993;307(6907):759–61.

 

 

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