INSTITUT study : Impact on nutritional status and tuberculosis treatment outcomes

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Extract from the article: Undernutrition is the main risk factor for tuberculosis worldwide. Immunological deficits associated with undernutrition can be reversed through nutritional rehabilitation. However, the fight against undernutrition lags behind efforts to identify and

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Undernutrition is the main risk factor for tuberculosis worldwide. Immunological deficits associated with undernutrition can be reversed through nutritional rehabilitation. However, the fight against undernutrition lags behind efforts to identify and treat human immunodeficiency virus (HIV) and diabetes in tuberculosis (TB) patients. It is with this in mind that the INSTITUT study will begin with TB patients from the National Tuberculosis Control Programs in Togo and Benin.

Malnutrition in all its forms includes undernutrition (wasting, stunting, underweight), vitamin or mineral deficiencies, overweight, obesity and diet-related non-communicable diseases.

Indeed, undernutrition is the main risk factor for tuberculosis (TB) worldwide, with an estimated 19% attributable to the population (compared with 7.6% for HIV and 3.1% for diabetes). There are well-established categories of severe, moderate and mild undernutrition. Undernutrition, for example, weakens the body's defences against microbes, making it difficult for patients undergoing treatment to recover.

What can undernutrition mean for tuberculosis patients?

Undernutrition (including macronutrient and micronutrient deficiencies) resulting from undernutrition and disease-related undernutrition are widespread among people living with HIV (PLHIV), and are often life-threatening.Poor nutritional status is associated with increased severity of TB disease:

Higher bacillary loads in sputum, with greater lung involvement and a greater risk of cavitation.Undernourished people have an 11% higher risk of pulmonary tuberculosis. This has implications for chronic post-tuberculosis lung disease with high transmission potential.

The pharmacodynamics of anti-tuberculosis drugs may also be affected in undernourished people, as the absorption of some drugs may be reduced and the toxicity of others increased.The intestinal absorption zone is reduced, which can have an impact on drug absorption.

For these reasons, nutritional status at the start of anti-tuberculosis treatment is an important predictor of mortality.

How does the program support TB patients who have difficulty feeding themselves during treatment?

The country, with the support of its Global Fund and WFP partners, is still organizing nutritional support for patients suffering from the severe form of TB, commonly known as bedridden patients, as well as for resistant TB patients and certain destitute patients.The National Solidarity Agency also provides support in the form of a few food kits, but the needs are enormous, and many patients requiring nutritional support are not covered. This situation increases therapeutic failures and deaths during treatment.

Unfortunately, there is no factual data on the extent of undernutrition among tuberculosis patients in the sub-region.

This justifies the elaboration of a study entitled "Appui nutritionnel au patients tuberculeux : Impact sur l'état nutritionnel et les résultats de traitement antituberculeux". The study is being conducted by 04 organizations: the Togo National Tuberculosis Control Program, the Benin National Tuberculosis Control Program, the International Union Against Tuberculosis and Lung Disease and the Sorbonne Community of Universities and Institutions, the Boston Medical Center and the Boston University School of Medicine in the United States.

The study is financed by the French Development Agency (AFD). This study will assess the impact of nutritional support on tuberculosis treatment outcomes, and estimate the impact of this support on the nutritional status of tuberculosis patients at the end of treatment on 1,050 patients with the contagious form of tuberculosis who will receive care in the tuberculosis diagnosis and treatment centers of the National Tuberculosis Control Programs of Togo and Benin, in West Africa.

What is the purpose of this study?

This study gives us the opportunity to demonstrate the impact of nutritional support on tuberculosis treatment outcomes in West Africa. This will help us catalyze change and make a strong case for robust nutritional support for all TB patients in Togo, Africa and the world.

What can we concretely expect from this study?

First of all, for the authorities and the Program's coordination, the study should provide factual elements that will be used to: plan nutritional support for other tuberculosis patients, and lobby for additional funding to ensure nutritional support in the country. For the players providing the services, it will enable them to better address services to the population in terms of accompaniment, support and advice.  For the population, it will help improve the care of tuberculosis patients.

A good diet helps prevent people from becoming infected with tuberculosis, and if they are already infected, from falling ill, and if they are ill, from recovering rapidly with treatment.The parents of tuberculosis patients must therefore accompany the patients by providing them with psychosocial and emotional support, as well as nutritional support.

Source : PNLT