Nutritional supplementation is a necessary complement to dietary counseling among tuberculosis and tuberculosis-HIV patients

Abstract

The Brazilian Ministry of Health and theWorld Health Organization recommend dietary counseling for patients withmalnutrition during tuberculosis treatment. Patients under tuberculosis therapy (infected and not infected with HIV) were followed-up to evaluate the effectiveness of dietary counseling. Objective: describe the nutritional status of patients with tuberculosis. Methods: an observational follow-up study over a 180-day period of tuberculosis therapy in adults was conducted. Subjects were assessed for body composition (using BMI, TSF and MUAC parameters), serumbiomarkers and offered dietary counseling. The data obtained at each visit (D15, D30, D60, D90, D120, D150, and D180) were analyzed, showing trajectories over time and central tendencies each time. Results: at baseline, themean age was 41.1 (±13.4) years; they were predominantlymale, with income lower than a local minimum wage and at least six years of schooling. Patients showed predominantly pulmonary tuberculosis. At baseline, all patients suffered frommalnutrition. The overall energymalnutrition prevalence was of 70.6%. Anemia at baseline was observed in both groups (63.2%), however, it was significantlymore pronounced in the HIV+. At the end, energy malnutrition was reduced to 57.1% (42.9% of HIVand 71.4% of the HIV+). Micronutrientsmalnutrition was evident in 71.4%of the HIV- patients and 85.7% of HIV+ patients at the end of tuberculosis therapy. Using BMI (≤18.5 kg/m2cutoff) as an index of malnutrition, it was detected in 23.9% of the HIV- and 27.3% of the HIV+ patients at baseline, with no evident improvement over time; using TSF (≤11.4mm as cutoff) or MUAC (≤28.5cm as cutoff),malnutrition was detected in 70.1% and 85.3% of all patients, respectively. Nevertheless, combining all biomarkers, at the end of follow-up, all patients suffered from malnutrition. Conclusion: Although with a limited number of patients, the evidence does not support that dietary counseling is effective to recover frommalnutrition in our population.