Tuberculosis is a chronic infectious disease which is caused by a bacterium – Mycobacterium tuberculosis. It affects the lungs most commonly but calls gel localized in other organs also, like lymph nodes, kidney, bone etc. The most commonly observed form of tuberculosis in India is pulmonary tuberculosis.
The prevalence of tuberculosis earlier was restricted to lower socioeconomic strata being attributed to poor hygiene, sanitation and poor quality of food intake. The present scenario reveals an increasing incidence of tuberculosis in people from higher socioeconomic strata as well. A strong genetic history gets highlighted in most of the cases. This disease presents itself in an acute and a chronic phase.
In the acute stage, the disease is quite similar to that of acute fever and tllc chronic phase to that of chronic fever. The chronic phase is accompanied by low grade fever and therefore increase in metabolic rate is not so marked. The long duration of illness in turn leads to wasting body tissues.
The salient features tuberculosis include
- Wasting of tissues
- Expectoration, and
The acute phase resembles pneumonia with high fever. The chronic phase presents itself with low grade fever ,accompanied with exhaustion, cough, expectoration and loss of weight. The progression of the disease may be slow with gradual worsening of the cough. This can lead to erosion of the blood vessel of lungs. The tubercle bacteria may thus subsequently get access to other body organs, thereby, establishing numerous secondary foci of infection.
The disease can be very effectively treated with the help of antibiotic therapy, rest and nourishing food. The key to the treatment is early detection of the disease.
The antibiotic therapy given should be continued for the stipulated period of time (6 months to 1 year), in spite of the waning of the symptoms. A clinically recovered tuberculosis case can still be a carrier and thus a relapse of the disease is likely if the antibiotic therapy is not followed the right way. Let me now proceed over to the nutritional care of patients suffering from tuberculosis.
It must be evident to you that the majority of the tuberculosis patients are emancipated and malnourished. Proper dietary management during and after the infection is essential to ensure complete treatment, proper rehabilitation and prevention of relapse. Let me review the energy and nutrient requirements of the patient.
The criteria to establish the energy intake is the body weight status coupled with the rise in body temperature. Considering that the BMR is not highly elevated in the chronic stage of the disease the energy intake may be increased by 300-500 Kcal /Day above the normal recommended intake.
Chronic infection is marked by a prolonged duration of fever. This leads to wasting muscles, increased nitrogenous loss and a subsequent decrease in serum albumin levels. Thus, the chronic stage of the disease needs to be supported with a high protein intake. A level of 1.2 to 1.5 g protein kg/ body weight/day should be given. Emphasis should be on energy and protein dense foods coupled with high biological value of protein rich sources to favour its effective utilization. If the disease is observed in the low socioeconomic strata, selection of cheaper options of protein dense foods like pulses, soya, nuts in combination with coarse cereals for mutual supplementation may bc opted for.
Adequacy of carbohydrate will also favor the optimal utilization of proteins. To favour the process of anabolism a total calories to nitrogen ratio of 150:1 should be achieved in a high calorie high protein diet. Carbohydrate being the most preferred substrate of energy by the body has a protein sparing effect.
Fats add to the calorie density of the diet. Digestibility of fats (medium chain triglycerides and emulsified fats should be preferred) and fat based preparations should be considered.
Vitamin – A
The preformed vitamin A or the retinol form of vitamin A Needs to be emphasized in the diet of TB patients as the metabolism of vitamin A Is adversely affected. Carotene appears to be poorly converted to vitamin A. Considering that the retinol form is restricted to milk, milk products, dietary fats and animal foods, vitamin A supplement may be recommended.
Vitamin B complex
The recruitment of the B-complex vitamin increases with an increase in the energy requirement of the tuberculosis patient. The salient ones out of the R complex group are pyridoxine, folic acid and vitamin B Neuritis (inflammation of peripheral nerves) can be prevented by treatment with a 50 to 100 mg/day dose of pyridoxine. Folic acid and vitamin B is also supplemented.
Vitamin C helps in collagen synthesis and helps healing the tubercle lesions. Rich vitamin C food sources like amla, guava, drumsticks, cabbage, capsicum and citrus juice should be included liberally in a tuberculosis patients’ diet.
Calcium intake needs to be increased since it is essential for healing the tuberculosis lesions. Intake of half a litre to 1 litre of milk is recommended in different forms which call be well tolerated by the patient. Calcium supplementation (500 mg / day) with an active form of vitamin D may also be prescribed.
The need for iron may be a concern in case of blood loss associated with expectoration or haemorrhage. The patient’s haemoglobin levels should be monitored. The diet should be tailored as per the needs. Supplementation with iron is recommended in case blood haemoglobin levels are low.
The other minerals of significance are zinc and chromium. These minerals help in boosting the immune system. Losses of these are seen in the patients having tuberculosis.
- The diet should have a good amount of fluid and electrolytes, especially potassium.
- Fibre need not be restricted but the food options should be easy to digest and well tolerated.
- A normal dietary pattern needs to be followed with a wise, balanced and nutritious
- selection of foods.
Foods to be included
- Cereals ( Ragi, jowar, bajra).
- Pulses (black channa, chawli, moth, rajma).
- Nuts and oilseeds. I e Green leafy vegetables like methi, chaulai, mint, spinach, cabbage, drumstick leaves, colocasia and cauliflower greens.
- Citrus fruits (guava, amla, capsicum).
- Milk and milk products.
- Jaggery, sugar.
Foods to be restricted
Excess fat, fried preparations, organ meats (liver, kidney, brain), red meat and refined sugars.