Following a landmark clinical investigation conducted by doctors from Mangaluru, the World Health Organization (WHO) has altered its global policy on tuberculosis (TB) treatment to include stronger nutrition-based measures.
What Changed in the Guidelines
In its revised “consolidated guidelines on tuberculosis and undernutrition,” WHO introduced a novel recommendation: in regions facing food insecurity, household contacts of TB patients should receive food assistance as a preventive measure. This addition is intended to complement existing strategies focused on counselling and supplementation.
The updated document cites evidence from the RATIONS trial (Reducing Activation of Tuberculosis by Improvement of Nutritional Status), carried out by Dr. Anurag and Dr. Madhavi Bhargava of Mangaluru, which underscored the importance of nutritional support in both preventing disease in close contacts and improving outcomes for TB patients.
The Research That Sparked the Shift
The Bhargavas’ ICMR-backed trial was conducted over four districts in Jharkhand and involved around 2,800 TB patients and over 10,000 household contacts. Participating adults received a monthly food basket—typically 5 kg of rice, 1.5 kg of lentils, and multivitamin supplementation. Over the course of the trial, incidence of new pulmonary TB among contacts declined by approximately 48%.
Among TB patients themselves, better nutritional support was associated with statistically significant improvements in survival. The investigators further reported a 35% reduction in TB-related mortality linked to nutrition, and noted that patients who gained weight within two months had a 60% lower risk of death.
Modeling data suggested that if even half of India’s TB-afflicted households adopted food support measures between 2023 and 2035, up to 4 lakh deaths and 9 lakh TB cases could be averted.
Real-World Impacts & Policy Adoption
In response to these findings, several Indian states—including Jharkhand, Tamil Nadu, and Himachal Pradesh—have already begun distributing nutritional baskets to families of TB patients. At the federal level, the government has also upped support to help patients gain access to nutritious food.
India, which experiences the world’s highest burden of TB—with over 28 lakh new cases and 3.2 lakh deaths in 2023—stands to benefit greatly from these changes. In Karnataka alone, TB is responsible for nearly 5,000 deaths annually.
Dr. Anurag Bhargava noted that malnutrition is a central risk factor in India’s TB epidemic, and that enhancing nutritional support could become a transformative approach in controlling the disease.
What makes this change striking is how swiftly a field-based trial has guided global policy. Within a couple of years, WHO not only adopted the evidence but also began incorporating it into textbooks and treatment guidelines.