title: Nutritional Supplementation Is a Necessary Complement to Dietary Counseling among Tuberculosis and Tuberculosis-HIV Patients.
abstract: The Brazilian Ministry of Health and the World Health Organization recommend dietary counseling for patients with malnutrition during tuberculosis treatment. Patients under tuberculosis therapy (infected and not infected with HIV) were followed-up to evaluate the effectiveness of dietary counseling.
  
  
  OBJECTIVE
  describe the nutritional status of patients with tuberculosis.
  
  
  METHODS
  an observational follow-up study over a 180-day period of tuberculosis therapy in adults was conducted. Subjects were assessed for body composition (using BMI, TSF and MUAC parameters), serum biomarkers and offered dietary counseling. The data obtained at each visit (D15, D30, D60, D90, D120, D150, and D180) were analyzed, showing trajectories over time and central tendencies each time.
  
  
  RESULTS
  at baseline, the mean age was 41.1 (± 13.4) years; they were predominantly male, with income lower than a local minimum wage and at least six years of schooling. Patients showed predominantly pulmonary tuberculosis. At baseline, all patients suffered from malnutrition. The overall energy malnutrition prevalence was of 70.6%. Anemia at baseline was observed in both groups (63.2%), however, it was significantly more pronounced in the HIV+. At the end, energy malnutrition was reduced to 57.1% (42.9% of HIV- and 71.4% of the HIV+). Micronutrients malnutrition was evident in 71.4% of the HIV- patients and 85.7% of HIV+ patients at the end of tuberculosis therapy. Using BMI (≤ 18.5 kg/m2cutoff) as an index of malnutrition, it was detected in 23.9% of the HIV- and 27.3% of the HIV+ patients at baseline, with no evident improvement over time; using TSF (≤ 11.4mm as cutoff) or MUAC (≤ 28.5cm as cutoff), malnutrition was detected in 70.1% and 85.3% of all patients, respectively. Nevertheless, combining all biomarkers, at the end of follow-up, all patients suffered from malnutrition.
  
  
  CONCLUSIONS
  Although with a limited number of patients, the evidence does not support that dietary counseling is effective to recover from malnutrition in our population.
authors: Nutrition Service, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.
authors: Adriana Costa
authors: AC
authors: Bacelo
authors: Josué de Castro Institute, UFRJ, Rio de Janeiro/RJ, Brazil.
authors: Andrea
authors: A
authors: Ramalho
authors: Clinical Reasearch Laboratory on Chagas Disease, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.
authors: Pedro Emmanuel
authors: PE
authors: Brasil
authors: Institute of Nutrition, UERJ, Rio de Janeiro/RJ, Brazil.
authors: Cláudia Dos Santos
authors: Cdos S
authors: Cople-Rodrigues
authors: Diagnostics Activities Coordinating, Immunodiagnostic Section, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.
authors: Ingebourg
authors: I
authors: Georg
authors: Department of Nutrition, UNISUAM, Rio de Janeiro/RJ, Brazil.
authors: Eliane
authors: E
authors: Paiva
authors: Sergio Franco Laboratory, Caxias/RJ, Brazil.
authors: Sheila Vasques Leandro
authors: SV
authors: Argolo
authors: Clinical Research Laboratory on Mycobacteria, National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro/RJ, Brazil.
authors: Valeria Cavalcanti
authors: VC
authors: Rolla
authors: Valeria Cavalcante
authors: VC
authors: Rolla
mesh_terms: D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D001938:Brazil; D003376:Counseling / Q000592:standards*; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000209:etiology; D044623:Nutrition Therapy / Q000592:standards*; D009752:Nutritional Status; D014376:Tuberculosis / Q000150:complications*