Opinion Express View on Lancet TB study: Food for cure

Undernutrition has, for long, been recognised as the leading risk factor for tuberculosis. The link between diet and the disease is also borne out by the public health history of Europe and North America — TB cases fell drastically when people started eating well following improvements in living conditions in the 20th century. In India, modelling studies have suggested that addressing undernutrition could reduce cases by over 70 per cent in vulnerable states. Now a study published in the medical journal Lancet shows that a good diet not only reduces the incidence of the disease amongst vulnerable people living with infected people, but it also reduced mortality in TB patients. Conducted in Jharkhand, the study found that early weight gain in people with this bacterial disease lowers the risk of mortality by 60 per cent. The findings have significant policy implications for the TB elimination programme of the country that has the highest burden of the disease in the world — according to government data, more than 4.5 lakh died of consumption in 2020.

TB, and its medication, often reduce appetite. Fever increases the rate at which calories are expended — and in severe cases, the disease causes “wasting” or low weight-for-height. A recovered patient with a poor diet has a serious chance of a relapse. The National Tuberculosis Elimination Programme (NTEP) recognises the need to improve nutrition. The Nikshay Poshan Yojana gives Rs 500 a month to those diagnosed with TB. By all accounts, this is paltry. The NTEP guidelines recommend that a tuberculosis patient consume 2,800 calories every day. The severe form of the disease can often incapacitate a patient for long periods and result in livelihood losses and financial strain to families. Experts reason that eliminating TB requires improving the living conditions of patients and their families. Nikshay Poshan is a half-hearted attempt at addressing one of the root causes of the problem. The scheme has also been dogged by systemic challenges. A 2020 study in the Indian Journal of Tuberculosis reported that healthcare providers complained of a lack of training and complex reporting formats as the main hurdles in the implementation of the scheme. Low patient awareness has also affected the nutritional programme’s reach.

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The government has plans to eliminate TB by 2025. The target has been seen as too ambitious by experts. The Lancet study offers important cues. It also underlines the need to make sure that people have a healthy diet of proteins, carbohydrates and micro-nutrients. Policymakers must take note of the study.