Finding proof for an axiom - that nutrition aids in health care recoveries

Nutrition essential for body to recuperate; RATIONS trial by Anurag Bhargava et al studies effect of food basket & micronutrients on TB recovery. Sub-optimal diet a risk factor for non-communicable diseases; food as formal part of patient care & treatment being experimented. WFP initiated nutrition supplements & counselling for PLHIV in TN; mid-term assessment showed improvements in BMI & HB. Govt must ensure adequate nutrition status.

It would seem that optimal nutrition, essential for all biochemical processes to function properly, is an axiom. Naturally, it will then also be an accepted truth that appropriate nutrition will have to be consumed, in order for the body to recuperate and heal even as it is treated by medicines when under assault. Strangely though, nothing can be as far apart in practise, as this axiom and its corollary. 

The nutritional and environmental factors that influence disease and wellness are now part of a solid study of the human body. While conventional medicine treats and advances cure by drugs and/or surgery, the doctor seldom forgets to mention an appropriate diet to be followed. The problem, however, occurs when there’s a piecemeal handling of the condition, with no insight into the patient’s culture or affordability (for food). Which is why studies validating the cruciality of nutrition in the recovery process of the human body are conducted from time to time.

Latest in this trend, is the RATIONS trial by Anurag Bhargava et al, which tries to address nutrition and tuberculosis within a syndemics framework. The researchers studied the effect of improving nutrition with a combination of a food basket and micronutrients on recovery of patients with TB, and preventing TB in close family members of those who are infected. Prof. Bhargava explains: “There is a backstory to this trial. We [my wife Madhavi and I] copied on this email) worked in a non-profit Jan Swasthya Sahyog that we co-founded in the rural Bilaspur district. We ran a TB treatment program where we realised that undernutrition was the blind spot in TB care and prevention. We finally published a study in 2013 on how low weights in Indian patients were a risk factor for TB mortality.” This was followed by a paper in 2014 where we showed that undernutrition was the leading risk factor for TB Incidence in India and addressing it could lead to substantial decline in TB incidence.

“In the current RATIONS trial, conducted with the NTEP in 28 tuberculosis units in 4 districts of Jharkhand, we had two populations of interest, the household members living in contact with a patient with pulmonary tuberculosis, and the patients themselves undergoing treatment.” 

In the study, he adds further, the household members in 14 TB units were randomised into an intervention group that was given a 6.5 kg food basket ( 5 kg rice + 1.5 kg pulses/per head/month). The control group living in the other 14 TB Units lived on their usual PDS-based diet. Dr. Bhargava says: “The patients were not randomised since it was considered unethical to deprive them of a food basket which was a 10 kg /month combination of rice, milk powder, and oil. All the participants were followed up for 2 years in this first-of-its-kind trial that was sponsored by the ICMR and led by us at Yenepoya Medical College, with other investigators from National Institute of Research on Tuberculosis -Chennai.” 

Prevalence of undernutrition in household members was high and one-third were undernourished, in the study. In patients, he adds: “We had some of the lowest weights documented in the TB literature, with 1 in 2 patients below a BMI less than 16”. Dr. Madhavi and Dr. Bhargava explain that the results found that early weight gain of about 5% of body weight in the first 2 months was associated with a 60% reduction in the hazard of death. The weight gain observed in the RATIONS patients was higher, the mortality lower and only 1% of patients dropped out of treatment. “Most importantly there was a return to work in 75% of patients after treatment in a situation where over 5% were able to work at the start of treatment,” she said.

It is also believed that a sub-optimal diet is also an important risk factor, preventable in good measure, for non communicable diseases, an epidemic of which seems to be holding India in its grip. A 2017 study that was done by GBD Diet Collaborators and published in Pubmed, estimated that in that year, 11 million deaths and 255 million Disability Adjusted Life Years were attributable to dietary risk factors..