Extended Abstract
Introduction
Tuberculosis (TB) can lead to weight loss, and inadequate nutrition can predispose individuals to TB. Malnutrition is a common occurrence among adults with pulmonary TB. In TB patients, reduced appetite, malabsorption of nutrients and micronutrients, and altered metabolism contribute to body energy wasting. On one hand, due to an elevated basal metabolic rate, TB patients require increased energy intake to maintain bodily functions, consequently culminating in weight loss. On the other hand, impaired nutrient absorption can negatively affect TB patients and lead to malnutrition. Insufficient protein and calorie intake can hinder the function of certain general host defense mechanisms that are essential for overcoming the mycobacterium TB. Additionally, vitamins and minerals play a crucial role in the body’s immunity, and a deficiency in either or both can impact resistance to any type of infection. Nutritional status is a significant determinant of clinical outcomes during the course of TB. Increased energy intake combined with supplementation at the initiation of TB treatment leads to a significant increase in body weight, fat-free mass, and physical performance after six weeks. Nutritional interventions, including nutritional counseling and dietary support, can positively influence the successful progression of treatment. Golestan is among the provinces with a high prevalence of TB in the country. Nutritional support alongside anti-TB treatment is a crucial strategy in TB management, emphasized by the World Health Organization (WHO). Considering the significance of nutritional support in TB treatment and given that, with the support of the Nutrition Improvement Office of the Ministry of Health, two supportive food baskets were experimentally allocated to some TB patients in Golestan Province, Iran during 2017, this study was conducted to determine the effect of nutritional support on the treatment outcomes of TB patients in Golestan Province.
Methods
This descriptive-analytical study, supported by the Nutrition Improvement Office of the Ministry of Health, was conducted longitudinally in two parallel groups in Golestan Province, Iran during 2017. The first group comprised 129 TB patients under treatment who had received two supportive food baskets and had completed their treatment course. The second group consisted of 399 TB patients who had not received any supportive food baskets.
The outcomes, including mortality, treatment non-adherence, treatment failure, and recovery, were tracked for both patient groups by the healthcare system, and the necessary information was recorded in the patients’ records and compared.
In the group receiving the supportive food baskets, in addition to the treatment outcome, the patients’ weight was also recorded during the period of receiving the food basket, and the weight gain trend of these patients was evaluated.
Patient information was extracted in the form of a checklist from the TB Registry System. If necessary, data were supplemented through telephone contact or via the health information software (NAB) system.
All definitions and concepts used in this study aligned with the standard definitions and concepts of the National TB Control Program.
Results
Of the 129 patients who completed treatment and received food baskets, 55.8% were male, 90.7% were Iranian, and 24.03% were single. Among the 399 patients who did not receive food baskets, 60.2% were male, 95.2% were Iranian, and 17.79% were single. There was no statistically significant difference in these demographic characteristics between the two groups.
The mean age and standard deviation for the group receiving food baskets were 46.19 ± 20.31 years, with an age range of 1-86 years. For the group not receiving food baskets, the mean age and standard deviation were 47.77 ± 19.19 years, with an age range of 1-88 years. There was no statistically significant difference in age between the two groups.
The mean and standard deviation of the body mass index (BMI) at the initiation of treatment for the group receiving the food basket were 19.71 ± 4.43 kg/m² with a range of 36.26-12.68 kg/m², and for the other group, 19.55 ± 4.03 kg/m² with a range of 34.16-12.48 kg/m². These differences were not statistically significant.
The mean weight of the patients receiving the food basket showed an increasing trend and was statistically significant (P < 0.013).
The mean weight of patients was not influenced by the disease type during the six months following receiving the supportive food basket so that in all disease types, the mean weight exhibited a similar increase.
The recovery rate in patients receiving the supportive food basket upon completion of the treatment period was 94.6%, while it was 88.7% in patients not receiving the supportive food basket. This difference was statistically significant (P < 0.033).
The relative risk of non-recovery in the group not receiving the supportive food basket was 2.078 times higher than that in the group receiving the supportive food basket (95% confidence interval [CI]: 0.961-4.494).
Conclusion
The recovery rate was higher in the group receiving the supportive food basket than in the other group, which can be attributed to better nutrition. Although the distribution of the supportive food basket occurred only during two periods, it increased the likelihood of recovery for TB patients by 5.9%. On the other hand, the relative risk of treatment failure was determined to be higher in the group not receiving the supportive food basket than in the group receiving the supportive food basket.
Weight loss is considered a prominent characteristic of TB. TB causes a decrease in BMI as a result of the loss of both fat-free and fat mass.
In the present study, 54% of patients exhibited a BMI greater than 18.5 kg/m² at the initiation of treatment, while 43.2% had a BMI ranging between 18.5-25 kg/m². Consequently, a weight gain averaging 3 kg appears to represent a favorable outcome.
Although the weight gain trend in the group receiving the supportive food basket among smear-positive TB patients did not demonstrate a statistically significant difference compared to other groups, the increasing trend in weight gain within this group, devoid of the fluctuations observed in other groups, indicated a subtle difference in weight recovery for these patients.
In the present study, the risk of treatment failure was higher in the group not receiving the supportive food basket compared to the group receiving the supportive food basket, which corroborates the effect of nutrition and receiving the supportive food baskets on TB treatment.
A limitation of this study is the provision of only two supportive food baskets to TB patients.
Ethical Statement
The current study was approved by the Research Ethics Committee of Golestan University of Medical Sciences (IR.GOUMS.REC.1401.039).
Funding
This article has been extracted from Zahra Rashidian’s Ph.D dissertation in Medicine at Golestan University of Medical Sciences.
Conflicts of Interest
No conflicts of interest.
Acknowledgement
We would like to thank the esteemed Vice-Chancellor for Health Affairs of Golestan University of Medical Sciences, the Community Nutrition Improvement Office of the Ministry of Health, and our colleagues in the Disease Prevention and Control and Community Nutrition Improvement offices of the province for their support in the implementation of this project.
Key Message: Receiving a supportive food basket is effective in the treatment of TB patients in Golestan Province.