Undernutrition and tuberculosis (TB) are a vital issue in most developing countries of the world. Both of these medical problems tend to have interacted with each other and bidirectional. The undernutrition creates a more significant problem in patients with active TB rather than among healthy individuals. Despite that, there is no protocol available on nutritional support in Malaysia to tackle on this issue. The objective of this review is to explore the nutrition burden of TB disease and the management available in Malaysia. The treatment for TB lasts for six months and above. Hence, it causes a financial burden not only for the healthcare provider but for the patient and the family members. If treatment is not successful and extends to a few months, it will increase the cost of the treatment. Malnutrition in TB patients will cause a problem in the outcome of TB treatment. It includes worsening of the disease, delayed sputum conversion, and increased risk of mortality. Other problems include malabsorption of Rifampicin, drug-induced hepatotoxicity, increased rate of relapse, and persistent of positive cultures in MDR-TB. Benefits of nutritional support for tuberculosis patients include improved body weight, increase in adherence/ compliance to the tuberculosis treatment and increase in the success of the treatment. Implementation of nutritional support protocol by the government and Non-profit organization (NGO) will be beneficial and improve the quality of life of tuberculosis patients.
Keywords: Malnutrition; nutritional status; tuberculosis; Malaysia
Beslenme yetersizliği ve tüberküloz (TB) dünyanın gelişmekte olan birçok ülkesinde hayati bir konudur. Bu tıbbi sorunların her ikisi de birbirleriyle etkileşime girme ve çift yönlü olma eğilimindedir. Beslenme yetersizliği, sağlıklı bireylerden ziyade aktif TB'li hastalarda daha önemli bir problem yaratır. Buna rağmen, Malezya'da bu konuda mücadele edecek beslenme desteği konusunda protokol bulunmamaktadır. Bu derlemenin amacı TB hastalığının beslenme yükünü ve Malezya'da bulunan yönetimi araştırmaktır. TB tedavisi altı ay ve daha uzun sürer. Dolayısıyla, sadece sağlık hizmeti sağlayıcısı için değil, hasta ve aile üyeleri için finansal bir yüke neden olmaktadır. Eğer tedavi başarılı olmaz ve birkaç aya kadar uzarsa, tedavinin maliyetini yükseltir. TB hastalarındaki yetersiz beslenme, TB tedavisinin sonucunda bir soruna neden olacaktır. Hastalığın kötüleşmesini, balgam dönüşümünü geciktirmeyi ve ölüm riskini arttırmayı içerir. Diğer problemler arasında Rifampisin salgılanması, ilaca bağlı hepatotoksisite, artmış nüks oranı ve MDR-TB'de pozitif kültürlerin kalıcılığı bulunur. Tüberküloz hastaları için beslenme desteğinin faydaları arasında vücut ağırlığının iyileştirilmesi, tüberküloz tedavisine uyumun artması ve tedavinin başarısının artması yer alır. Devlet ve sivil toplum kuruluşları (STK) tarafından beslenme destek protokolünün uygulanması yararlı olacak ve tüberküloz hastalarının yaşam kalitesini artıracaktır.
Anahtar Kelimeler: Kötü beslenme; beslenme durumu; tüberküloz; Malezya
- Karyadi E, Schultink W, Nelwan RH, Gross R, Amin Z, Dolmans WM, et al. Poor micronutrient status of active pulmonary tuberculosis patients in Indonesia. J Nutr. 2000;130(12):2953-8. [Crossref] [PubMed]
- Chan J, Tanaka K, Mannion C, Carroll D, Tsang M, Xing Y, et al. Effects of protein calorie malnutrition on mice infected with BCG. Journal of Nutritional Immunology. 1997;5(1):11-9. [Crossref]
- Paton NI, Castello-Branco LR, Jennings G, Ortigao-de-Sampaio MB, Elia M, Costa S, et al. Impact of tuberculosis on the body composition of HIV-infected men in Brazil. J Acquir Immune Defic Syndr Hum Retrovirol. 1999;20(3):265-71. [Crossref] [PubMed]
- Gupta KB, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis and nutrition. Lung India. 2009;26(1):9-16. [Crossref] [PubMed] [PMC]
- Zachariah R, Spielmann MP, Harries AD, Salaniponi FM. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg. 2002;96(3):291-4. [Crossref]
- Karyadi E, West CE, Schultink W, Nelwan RH, Gross R, Amin Z, et al. A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status. Am J Clin Nutr. 2002;75(4):720-7. [Crossref] [PubMed]
- Safarian MD, Karagezian KG, Karapetian ET, Avanesian NA. [The efficacy of antioxidant therapy in patients with tuberculosis of the lungs and the correction of lipid peroxidation processes]. Probl Tuberk. 1990;(5):40-4.
- Meier R, Stratton R. Basic concepts in nutrition: epidemiology of malnutrition. Clin Nutr ESPEN. 2008;3(4):e167-70. [Crossref]
- Papathakis P, Piwoz E. Nutrition and Tuberculosis: A Review of the Literature and Considerations for TB Control Programs; 2008. p.40.
- Gupta V. Clinicoepidemiological study of vesiculobullous disorders in the pediatric age group. Indian Journal of Paediatric Dermatology. 2009;26(1):9-16. [Crossref]
- Phan MN, Guy ES, Nickson RN, Kao CC. Predictors and patterns of weight gain during treatment for tuberculosis in the United States of America. Int J Infect Dis. 2016;53:1-5. [Crossref] [PubMed]
- Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis. 2004;8(3):286-98.
- Snowden FM. Emerging and reemerging diseases: a historical perspective. Immunol Rev. 2008;225(1):9-26. [Crossref] [PubMed]
- Benatar SR, Upshur R. Tuberculosis and poverty: what could (and should) be done? Int J Tuberc Lung Dis. 2010;14(10):1215-21.
- Tanimura T, Jaramillo E, Weil D, Raviglione M, Lönnroth K. Financial burden for tuberculosis patients in low-and middle-income countries: a systematic review. Eur Respir J. 2014;43(6):1763-75. [Crossref] [PubMed] [PMC]
- Barter DM, Agboola SO, Murray MB, Bärnighausen T. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa--a systematic review. BMC Public Health. 2012;12(1):980. [Crossref] [PubMed] [PMC]
- Samuel B, Volkmann T, Cornelius S, Mukhopadhay S, MejoJose, Mitra K, et al. Relationship between Nutritional Support and Tuberculosis Treatment Outcomes in West Bengal, India. J Tuberc Res. 2016;4(4):213-9. [Crossref] [PubMed] [PMC]
- Ukwaja KN, Modebe O, Igwenyi C, Alobu I. The economic burden of tuberculosis care for patients and households in Africa: a systematic review. Int J Tuberc Lung Dis. 2012;16(6):733-9. [Crossref] [PubMed]
- Elamin EI, Ibrahim MI, Sulaiman SA, Muttalif AR. Cost of illness of tuberculosis in Penang, Malaysia. Pharm World Sci. 2008;30(3):281-6. [Crossref] [PubMed]
- Macallan D. Infection and malnutrition. Medicine. 2009;37(10):525-8. [Crossref]
- Macallan DC, McNurlan MA, Kurpad AV, de Souza G, Shetty PS, Calder AG, et al. Whole body protein metabolism in human pulmonary tuberculosis and undernutrition: evidence for anabolic block in tuberculosis. Clin Sci (Lond). 1998;94(3):321-31. [Crossref] [PubMed]
- Ismail IS, Bebakar W, Kamaruddin NJPMoHM. Clinical practice guidelines on management of obesity. Academy of Medicine of Malaysia, Malaysian Association for the Study of Obesity, Malaysian Endocrine, Society M; 2004. p.57.
- Mohamed-Hussein A, Salama S, Khalil M, Eid S. Malnutrition in tuberculosis: value of fat-free mass and creatinine-height index. Pulmonary Infections. 2016;10(1):58-63. [Crossref]
- Paton NI, Chua YK, Earnest A, Chee CB. Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Am J Clin Nutr. 2004;80(2):460-5. [Crossref] [PubMed]
- Kassu A, Yabutani T, Mahmud ZH, Mohammad A, Nguyen N, Huong BT, et al. Alterations in serum levels of trace elements in tuberculosis and HIV infections. Eur J Clin Nutr. 2005;60(5):580-6. [Crossref] [PubMed]
- Visvanathan R, Penhall R, Chapman I. Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes. Age Ageing. 2004;33(3):260-5. [Crossref] [PubMed]
- Ismail MN, Chee SS, Nawawi H, Yusoff K, Lim TO, James WP. Obesity in Malaysia. Obes Rev. 2002;3(3):203-8. [Crossref] [PubMed]
- Dargie B, Tesfaye G, Worku AJBN. Prevalence and associated factors of undernutrition among adult tuberculosis patients in some selected public health facilities of Addis Ababa, Ethiopia: a cross-sectional study. BMC Nutr. 2016;2(1):7. [Crossref]
- Gurung LM, Bhatt LD, Karmacharya I, Yadav DK. Dietary practice and nutritional status of tuberculosis patients in Pokhara: a cross sectional study. Front Nutr. 2018;5:63. [Crossref] [PubMed] [PMC]
- World Health Organization (WHO). Guideline: nutritional care and support for patients with tuberculosis. Geneva: WHO Press; 2013. p.55.
- Atif M, Sulaiman SAS, Shafie AA, Ali I, Asif M, Babar Z. Treatment outcome of new smear positive pulmonary tuberculosis patients in Penang, Malaysia. BMC Infect Dis. 2014;14(1):399. [Crossref] [PubMed] [PMC]
- William T, Parameswaran U, Lee WK, Yeo TW, Anstey NM, Ralph AP. Pulmonary tuberculosis in outpatients in Sabah, Malaysia: advanced disease but low incidence of HIV co-infection. BMC Infect Dis. 2015;15:32. [Crossref] [PubMed] [PMC]
- Kennedy N, Ramsay A, Uiso L, Gutmann J, Ngowi FI, Gillespie SH. Nutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania. Trans R Soc Trop Med Hyg. 1996;90(2):162-6. [Crossref]
- Bourke CD, Berkley JA, Prendergast AJ. Immune dysfunction as a cause and consequence of malnutrition. Trends Immunol. 2016;37(6):386-98. [Crossref] [PubMed] [PMC]
- Bass JB Jr, Farer LS, Hopewell PC, O'Brien R, Jacobs RF, Ruben F, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and the Centers for Disease Control and Prevention. Am J Respir Crit Care Med. 1994;149(5):1359-74. [Crossref] [PubMed]
- Schaberg T, Rebhan K, Lode H. Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis. Eur Respir J. 1996;9(10):2026-30. [Crossref] [PubMed]
- Asscher AW, Parr GD, Whitmarsh VB. Towards the safer use of medicines. BMJ. 1995;311(7011):1003-6. [Crossref] [PubMed] [PMC]
- Forget EJ, Menzies D. Adverse reactions to first-line antituberculosis drugs. Expert Opin Drug Saf. 2006;5(2):231-49. [Crossref] [PubMed]
- Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D. Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med. 2003;167(11):1472-7. [Crossref] [PubMed]
- Walter-Sack I, Klotz U. Influence of diet and nutritional status on drug metabolism. Clin Pharmacokinet. 1996;31(1):47-64. [Crossref] [PubMed]
- Ramappa V, Aithal GP. Hepatotoxicity related to anti-tuberculosis drugs: mechanisms and management. J Clin Exp Hepatol. 2013;3(1):37-49. [Crossref] [PubMed] [PMC]
- Mohd Avwar SA, Salmiah MS, Saliluddin SM, Lim PY. Factors delaying sputum conversion in smear positive pulmonary tuberculosis: a systematic review. International Journal of Public Health and Clinical Sciences. 2018;5(3):56-61.
- Kliiman K. Highly Drug-Resistant Tuberculosis in Estonia: Risk Factors and Predictors of Poor Treatment Outcome. Estonia: Council of the Faculty of Medicine, University of Tartu; 2010. p.146.
- Khan A, Sterling TR, Reves R, Vernon A, Horsburgh CR. Lack of weight gain and relapse risk in a large tuberculosis treatment trial. Am J Respir Crit Care Med. 2006;174(3):344-8. [Crossref] [PubMed]
- Van Lettow M, Kumwenda JJ, Harries AD, Whalen CC, Taha TE, Kumwenda N, et al. Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis. 2004;8(2):211-7.
- Waitt CJ, Squire SB. A systematic review of risk factors for death in adults during and after tuberculosis treatment. Int J Tuberc Lung Dis. 2011;15(7):871-85. [Crossref] [PubMed]
- Kant S, Gupta H, Ahluwalia S. Significance of nutrition in pulmonary tuberculosis. Crit Rev Food Sci Nutr. 2015;55(7):955-63. [Crossref] [PubMed]
- Tulsky JP, Hahn JA, Long HL, Chambers DB, Robertson MJ, Chesney MA, et al. Can the poor adhere? Incentives for adherence to TB prevention in homeless adults. Int J Tuberc Lung Dis. 2004;8(1):83-91.
- Davidson H, Schluger NW, Feldman PH, Valentine DP, Telzak EE, Laufer FN. The effects of increasing incentives on adherence to tuberculosis directly observed therapy. Int J Tuberc Lung Dis. 2000;4(9):860-5.
- Cantalice Filho JP. [Food baskets given to tuberculosis patients at a primary health care clinic in the city of Duque de Caxias, Brazil: effect on treatment outcomes]. J Bras Pneumol. 2009;35(10):992-7. [Crossref] [PubMed]
- O'Boyle SJ, Power JJ, Ibrahim MY, Watson JP. Factors affecting patient compliance with anti-tuberculosis chemotherapy using the directly observed treatment, short-course strategy (DOTS). Int J Tuberc Lung Dis. 2002;6(4):307-12.
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