In Practice

Nutritional supplements for people being treated for active tuberculosis: A technical summary

L Grobler, S Durao, S M van der Merwe, J Wessels, C E Naude

Abstract


Tuberculosis and nutrition are intrinsically linked in a complex relationship. Altered metabolism and loss of appetite associated with tuberculosis may result in undernutrition, which in turn may worsen the disease or delay recovery. We highlight an updated Cochrane review assessing the effects of oral nutritional supplements in people with active tuberculosis who are receiving antituberculosis drug therapy. The review authors conducted a comprehensive search (February 2016) for all randomised controlled trials comparing any oral nutritional supplement, given for at least 4 weeks, with no nutritional intervention, placebo or dietary advice only in people receiving antituberculosis treatment. Of the 35 trials (N=8 283 participants) included, seven assessed the provision of free food or high-energy supplements, six assessed multi-micronutrient supplementation, and 21 assessed single- or dual-micronutrient supplementation. There is currently insufficient evidence to indicate whether routinely providing free food or high-energy supplements improves antituberculosis treatment outcomes (i.e. reduced death and increased cure rates at 6 and 12 months), but it probably improves weight gain in some settings. Plasma levels of zinc, vitamin D, vitamin E and selenium probably improve with supplementation, but currently no reliable evidence demonstrates that routine supplementation with multi-, single or dual micronutrients above the recommended daily intake has clinical benefits (i.e. reduced death, increased cure rate at 6 and 12 months, improved nutritional status) in patients receiving antituberculosis treatment. In South Africa, most provinces implement a supplementation protocol based on nutritional assessment and classification of individuals rather than on disease diagnosis or treatment status.

 


Authors' affiliations

L Grobler, Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

S Durao, Cochrane Nutrition, hosted jointly by the Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, and Cochrane South Africa, South African Medical Research Council; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa

S M van der Merwe, Integrated Nutrition Programme, Mpumalanga Department of Health, Nelspruit, South Africa

J Wessels, Standerton Tuberculosis Specialised Hospital, Mpumalanga Department of Health, Standerton, South Africa

C E Naude, Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Cochrane Nutrition, hosted jointly by the Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, and Cochrane South Africa, South African Medical Research Council

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Keywords

Tuberculosis; Nutrition; South Africa; Public health

Cite this article

South African Medical Journal 2018;108(1):16-18. DOI:10.7196/SAMJ.2017.v108i1.12839

Article History

Date submitted: 2017-12-13
Date published: 2017-12-13

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