Nutritional supplements for people being treated for active tuberculosis

• Published in: Cochrane database of systematic reviews 2011-11 (11), p.CD006086-CD006086
• Main Authors: Sinclair, David, Abba, Katharine, Grobler, Liesl, Sudarsanam, Thambu D
• Format: Article
• Language: English
• Subjects: Adult; Antitubercular Agents - therapeutic use; Child; Dietary Supplements; Energy Intake; HIV Infections - complications; HIV Infections - mortality; Humans; Malnutrition - complications; Malnutrition - diet therapy; Micronutrients - administration & dosage; Randomized Controlled Trials as Topic; Tuberculosis - complications; Tuberculosis - diet therapy; Tuberculosis - drug therapy; Tuberculosis - mortality
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD006086.pub3

Tuberculosis and malnutrition are linked in a complex relationship. The infection may cause undernutrition through increased metabolic demands and decreased intake, and nutritional deficiencies may worsen the disease, or delay recovery by depressing important immune functions. At present, there are no evidence-based nutritional guidance for adults and children being treated for tuberculosis. To assess the effects of oral nutritional supplements (food, protein/energy supplements or micronutrients) on tuberculosis treatment outcomes and recovery in people on antituberculous drug therapy for active tuberculosis. We searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, mRCT, and the Indian Journal of Tuberculosis to July 2011, and checked the reference lists of all included studies. Randomized controlled trials comparing any oral nutritional supplement given for at least four weeks with no nutritional intervention, placebo, or dietary advice only for people being treated for active tuberculosis. Two authors independently selected trials, extracted data, and assessed the risk of bias. Results are presented as risk ratios (RR) for dichotomous variables, and mean differences (MD) for continuous variables, with 95% confidence intervals (CI). Where appropriate, data from trials with similar interventions and outcomes have been pooled. The quality of evidence was assessed using the GRADE methods. Twenty-three trials, with 6842 participants, were included. Macronutrient supplementation Five trials assessed the provision of free food, or high energy supplements, although none were shown to provide a total daily kilocalorie intake above the current daily recommended intake for the non-infected population.The available trials were too small to reliably prove or exclude clinically important benefits on mortality, cure, or treatment completion. One small trial from India did find a statistically significant benefit on treatment completion, and clearance of the bacteria from the sputum, but these findings have not been confirmed in larger trials elsewhere (VERY LOW quality evidence).The provision of free food or high-energy nutritional products probably does produce a modest increase in weight gain during treatment for active tuberculosis (MODERATE quality evidence). Two small studies provide some evidence that physical function and quality of life may also be improved but the trials were too small to