Undernutrition is the most widely prevalent risk factor for development of tuberculosis (TB) in India, as per Sandhya Pandey, chief clinical nutritionist, Fortis Memorial Research Institute, Gurugram. Not only this, it is the major driver of the TB epidemic in India contributing to around half of annual incidences. It impairs immunity and makes the patient vulnerable to multiple infections. Absence of nutrients in the diet can lead to drug-induced hepatotoxicity or drug-induced liver injury, death, relapse after the cure.
Measurements like Body Mass Index (BMI), dietary recall, weight loss history, pathology tests like haemoglobin are analysed to check the nutritional status of TB patients.
Significance of a balanced diet
Much like the importance of regular medication, TB patients and their caregivers need to understand the importance of nutritional requirements. One’s nutritional counselor should emphasise on consumption of a healthy balanced diet to attain the desired protein-intake for energy.
A balanced diet is one that contains an adequate quantity of the nutrients that we require in a day i.e. fats, proteins, carbohydrates, fibre, vitamins and minerals. Though there is no special diet or requirements for TB patients, a diet plan is created according to a person’s BMI and physical activities, mentioned Pandey.
TB patients have higher energy and protein requirements to refill the exhausted deposits from the body. As recovery occurs, it is very important that patients do not remain completely sedentary, and engage in some physical activity (such as house chores and walking) as tolerated; since it helps build muscle mass and excess fat deposition should be avoided in the regained weight.
The proportion of carbohydrates in the diet recommended is 55-75 per cent of total energy intake, and this is derived from intake of cereals, pulses, roots and tubers and vegetables.
In India, major sources of carbohydrates are cereals like wheat, and rice, and local millets such as jowar, bajra and ragi (high in calcium content, especially recommended for children and lactating women).
The requirements of protein would be 1.2-1.5 g/kg ideal body weight per day. Proteins or the building components can be of animal or plant origin. Proteins of animal origin includes milk, eggs, and meat, whereas a mixture of vegetable proteins from cereals and pulses are available for vegetarians.
These can comprise 15-30 per cent daily energy intake. Fats are present in oils, nuts, milk and milk products and meat. Groundnuts act as a good source of calories as well as protein. Soyabean oil, mustard oil, butter and ghee can also be taken in moderate amount.
Anaemia is one of the most prevalent nutrient deficiency disease in TB patients. Micronutrients such as iron and folate, vitamin A, zinc, vitamin D are important for immunity development and fighting mechanism of the busy. Leafy vegetables and fruits are vital sources of vitamins and minerals and these should be a part of the daily diet with five-six servings in each day.
What should be avoided?
• Skip tobacco in all forms.
• Don’t drink alcohol — it can add to the risk of liver damage from some of the drugs used to treat your TB.
• Limit coffee and other caffeinated/carbonated drinks.
• Limit excess use of spices and salt or refined products, like sugar, white breads, and white rice.
Food hygiene and cooking practices
A balanced diet alone cannot be fruitful, unless food hygiene and healthy cooking practices are ensured. Simple steps can avoid several infections like diarrhoea.
*Washing hands before cooking, eating and after using toilet.
*Cleaning vegetables and fruits before consuming.
*Cooking vegetables with a lid to preserve the nutritive value
*Cooking at controlled temperature to prevent destruction of nutrients.
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