Authors: Dr Anurag Bhargava, MD, MSc and Dr Madhavi Bhargava, MD
Number of pages: 8
Download (2018, pdf, 0.24mb)
Overview: Nutritional care is considered fundamental to clinical practice and recognised to be an integral part of TB care, by the WHO and the Revised National Tuberculosis Control Programme(RNTCP). Undernutrition is a comorbidity which is widely prevalent, severe, and persistent even after cure in Indian patients, in the absence of nutritional support. This increases their risk of mortality, drug-induced hepatotoxicity, malabsorption of key drugs like rifampicin, performance status, and relapse even after successful treatment. Providers need to assess weight, height, edema, estimate BMI & measure haemoglobin. BMI < 14 kg/m2, edema, severe anaemia, inability to stand, are red-flag features which mandate referral for initial inpatient care. Patients should be counselled on an appropriate balanced diet with 3 meals and at least 2 snacks. The RNTCP has evolved food assistance packages consisting of cereals, groundnuts or pulses, milk powder or oil for provision of around 1000 calories and up to 50 gram proteins to patients during treatment, suggests provision of 1 recommended daily allowance of micronutrients and an enhanced quantum of food rations through the public distribution system to TB affected households.
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Nutritional Care and Support of Patients With Tuberculosis in India
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Question 1 of 6
1. Question
Which of the following is true of undernutrition and TB?
Correct
The correct answer is (e).
Incorrect
The correct answer is (e).
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Question 2 of 6
2. Question
A patient with a height of 170 cm has a weight of 45 kg. His calculated BMI would indicate
Correct
The correct answer is (c). BMI is calculated as weight in kg/(height in metre). The BMI in this patient would be 45/(1.7)2= 15. 57 kg/m2. This is less than 16.0 kg/m2 and indicates severe undernutrition.
Incorrect
The correct answer is (c). BMI is calculated as weight in kg/(height in metre). The BMI in this patient would be 45/(1.7)2= 15. 57 kg/m2. This is less than 16.0 kg/m2 and indicates severe undernutrition.
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Question 3 of 6
3. Question
Which of the following drug/s should be given on an empty stomach for better bioavailability?
Correct
The correct answer is (d). The bioavailability and peak serum concentrations of both isoniazid and rifampicin is affected by food.
Incorrect
The correct answer is (d). The bioavailability and peak serum concentrations of both isoniazid and rifampicin is affected by food.
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Question 4 of 6
4. Question
A labourer with TB has signs of hypoproteinaemia. What would be an appropriate dietary advice?
Correct
The correct answer is (c): The commercial protein supplement may contain 40 gm protein in a 200-gm pack, but is costly and inappropriate, as are tonics with amino acids. Mutton and chicken are more expensive than eggs and the labourer is more likely to afford additional pulses or eggs, than eat chicken or mutton on a daily basis. The protein content per 100 gm, does not differ between eggs and chicken.
Incorrect
The correct answer is (c): The commercial protein supplement may contain 40 gm protein in a 200-gm pack, but is costly and inappropriate, as are tonics with amino acids. Mutton and chicken are more expensive than eggs and the labourer is more likely to afford additional pulses or eggs, than eat chicken or mutton on a daily basis. The protein content per 100 gm, does not differ between eggs and chicken.
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Question 5 of 6
5. Question
Pyridoxine deficiency can occur due to treatment of which anti-TB drug?
Correct
The correct answer is (b). Isoniazid interferes competitively with pyridoxine metabolism by inhibiting the formation of the active form of the vitamin, and hence often results in peripher¬al neuropathy. This is especially marked in malnutrition, pregnancy, lactation, HIV infection, diabetes and hypertension. This effect can be prevented by giving pyridoxine 10 mg per day.
Incorrect
The correct answer is (b). Isoniazid interferes competitively with pyridoxine metabolism by inhibiting the formation of the active form of the vitamin, and hence often results in peripher¬al neuropathy. This is especially marked in malnutrition, pregnancy, lactation, HIV infection, diabetes and hypertension. This effect can be prevented by giving pyridoxine 10 mg per day.
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Question 6 of 6
6. Question
The following are true for inpatient care of patient with red-flag features in the first week, except
Correct
The correct answer is (a). In a patient with very low BMI and who has probably been eating little for many days, vigorous feeding may result in refeeding syndrome which can be danger¬ous. The feeding should start at 50% of the dietary requirement or even lower in the first few days, along with the other measures mentioned.
Incorrect
The correct answer is (a). In a patient with very low BMI and who has probably been eating little for many days, vigorous feeding may result in refeeding syndrome which can be danger¬ous. The feeding should start at 50% of the dietary requirement or even lower in the first few days, along with the other measures mentioned.
