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Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting^1,2,3

¹ From the Department of Infectious Diseases (NIP and Y-KC), the Clinical Research Unit (AE), and the Tuberculosis Control Unit, Department of Respiratory Medicine (CBEC), Tan Tock Seng Hospital, Singapore

Background: Nutritional support is often recommended as part of the treatment of tuberculosis, but it has never been properly tested.

Objective: We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting.

Design: Patients who started antituberculous therapy within the previous 2 wk were randomly assigned to receive standard nutritional counseling (control group) or nutritional counseling to increase their intake through diet and high-energy supplements (nutritional supplement group) for 6 wk. Body composition was measured by dual-energy X-ray absorptiometry, and physical function was assessed by maximum grip strength.

Results: Patients in the nutritional supplement group (n = 19) had a significantly greater increase in body weight (2.57 ± 1.78 compared with 0.84 ± 0.89 kg, P = 0.001), total lean mass (1.17 ± 0.93 compared with 0.04 ± 1.26 kg, P = 0.006), and grip strength (2.79 ± 3.11 compared with –0.65 ± 4.48 kg, P = 0.016) than did the control subjects (n = 17) at week 6. During subsequent follow-up, the increase in body weight remained greater in the nutritional supplement group, but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group.

Conclusions: Early intervention to increase nutritional intake increases lean mass and physical function. This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that deserve investigation in large-scale trials. Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat.

Key Words: Tuberculosis • wasting • nutritional supplements • body composition • physical function

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