This is an archive article published on August 9, 2023

Improved nutrition, early weight gain can cut TB cases, mortality: Lancet’s India research

According to the findings of the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial, improved nutrition can reduce the incidence of all forms of TB by up to 40 per cent.

4 min readPuneUpdated: Aug 9, 2023 06:10 AM IST

Improved nutrition, early weight gain can cut TB cases, mortality: Lancet’s India research

It also found that early weight gain among underweight patients with TB could reduce risk of mortality by up to 60 per cent, as it ensured higher treatment success.

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Improved nutrition, early weight gain can cut TB cases, mortality: Lancet’s India research

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WHEN AN 18-year-old tribal from Jharkhand was diagnosed with tuberculosis, he weighed just 26 kg. With his family barely managing to get one square meal per day, his condition deteriorated. But when given nutritious food packets, he gained 16 kg in six months, and showed improvement.

The teenager was part of two studies — conducted between August 2019 and August 2022 in four districts of Jharkhand — that offer the first evidence of how nutritional support reduces risk of mortality among TB patients.

According to the findings of the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial, improved nutrition can reduce the incidence of all forms of TB by up to 40 per cent, and of infectious TB by up to 50 per cent among those in contact with patients suffering from infectious lung TB.

It also found that early weight gain among underweight patients with TB could reduce risk of mortality by up to 60 per cent, as it ensured higher treatment success.

The findings of the studies by the Indian Council of Medical Research (ICMR), in collaboration with the National TB Elimination Programme and National Institute for Research in Tuberculosis, Chennai, have been published in The Lancet and The Lancet Global Health Journals.

As part of the trial, 10,345 “household contacts” of 2,800 TB patients were randomised to receive food parcels. While 5,621 people were given food with additional micronutrients (750 kcal, 23 gm proteins) for a year, the rest got food parcels with no extra nutrients. At the end of the trial, the incidence of TB was 39 per cent less in the former group as compared to the latter.

The second study tracked 2,800 TB patients for six months and found that weight gain following improved nutrition was directly linked to reduced risk of mortality, especially in the first two months when deaths occur. The risk of death was reduced by up to 13 per cent for a one per cent weight gain, and up to 61 per cent for 5 per cent weight gain.

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These findings, which come at a time when the Centre is seeking to eliminate TB by 2025, can have implications at the policy implementation level. Under the national programme, TB patients are given monthly nutritional support of Rs 500 through direct benefit transfer for the duration of their treatment. And under the Ni-kshay Mitra programme, volunteers can provide monthly nutrition kits to their “adopted” patients.

“The findings shed light on how we can tackle TB in the future,” said Dr Nivedita Gupta, Head, Epidemiology and Communicable Diseases Division, ICMR.

In India, three million new TB cases and 4,94,000 deaths were reported in 2021, representing 27 per cent of the global TB incidence and 35 per cent of deaths, according to the WHO Global Tuberculosis Report, 2022.

Experts said the studies are significant because under-nutrition has now emerged as the leading risk factor for TB globally and simple dietary interventions have been found to be effective.

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“The results of the trial are significant as it shows improved nutrition in family members has worked at the community level,” said lead authors Dr Anurag Bhargava of the Department of Medicine,Yenepoya Medical College, Mangalore, and Dr Madhavi Bhargava.

“The study is the first of its kind in the world and the question was can nutritional intervention reduce TB incidence,” said author, Dr Soumya Swaminathan, Chairperson of the M S Swaminathan Research Foundation and former Chief Scientist of the World Health Organisation (WHO).

“It is wonderful that the evidence is coming from India that will also inform global policy. Essentially, a good nutritional package that provides a substantive amount of calories, proteins and micronutrients should be given to the household members of TB patients,” she said.

According to the study, to prevent a single case of TB, about 30 households (111 household contacts) and about 47 patients would need to be provided nutritional support. The monthly cost of a food basket was Rs 1,100 per patient, and Rs 325 per contact (at 2019 prices).

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The TB patients received a monthly 10 kg food basket (rice, pulses, milk powder, oil) and multivitamins for six months. Among family members, the intervention group received 5 kg rice and 1.5 kg pulses per head per month.

Jharkhand was chosen as a trial site because it has a high burden of TB (52,179 cases notified in 2021) and the second highest level of multi-dimensional poverty.

“That a low-cost food-based nutritional intervention could prevent TB to a significant degree is very encouraging,” said Dr Bhargava.

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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