Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting,” The American

Background: Nutritional support is often recommended as part of the treatment of tuberculosis, but it has never been properly tested. Objective: We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting. Design: Patients who started antituberculous therapy within the previous 2 wk were randomly assigned to receive standard nutri-tional counseling (control group) or nutritional counseling to in-crease their intake through diet and high-energy supplements (nu-tritional supplement group) for 6 wk. Body composition was measured by dual-energy X-ray absorptiometry, and physical func-tion was assessed by maximum grip strength. Results: Patients in the nutritional supplement group (n 19) had a significantly greater increase in body weight (2.57 1.78 com-pared with 0.84 0.89 kg, P 0.001), total lean mass (1.17 0.93 compared with 0.04 1.26 kg, P 0.006), and grip strength (2.79 3.11 compared with0.65 4.48 kg, P 0.016) than did the control subjects (n 17) at week 6. During subsequent follow-up, the increase in body weight remained greater in the nutritional supplement group, but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group. Conclusions: Early intervention to increase nutritional intake in-creases lean mass and physical function. This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that de-serve investigation in large-scale trials. Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat. Am J Clin Nutr 2004;80:460–5. KEY WORDS Tuberculosis, wasting, nutritional supple-ments, body composition, physical functio