A landmark study in India by the Indian Council of Medical Research (ICMR) has shown that nutritional support can greatly improve the health and survival of tuberculosis (TB) patients. This has led to a major policy update by the World Health Organization (WHO).

• The study, known as RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status), was conducted in the state of Jharkhand and is the first to provide large-scale, conclusive evidence on this topic. 

Key Findings of the RATIONS Study

• Reduced Death Risk: A small weight gain in the first 2 months of TB treatment cut death risk by up to 60%.
• Fewer New Infections: Giving nutrition support to family members reduced new TB cases by 39–48% in households.
• Better Treatment Adherence: Patients receiving food parcels were more likely to complete their long treatment, reducing the risk of drug-resistant TB.
• Economic Benefits: Nutrition helps patients recover faster, return to work, and support their families, reducing the financial burden.

Global Policy Impact

• The World Health Organization (WHO) has now updated its global TB guidelines.
• It calls for regular nutrition screening and support as part of TB care.
• Countries, especially in South-East Asia (where TB is common), are urged to add nutrition to their TB programs.
• The study highlights the two-way link between TB and undernutrition:
  • Undernutrition increases TB risk.
  • TB worsens malnutrition.

Nutrition Support for TB: India’s Multi-Pronged Strategy

• To eliminate Tuberculosis (TB) by 2025, five years ahead of the global target, the Government of India has launched several nutrition-focused initiatives under the Pradhan Mantri TB Mukt Bharat Abhiyaan. 
• These efforts are based on the core recognition that undernutrition is both a cause and consequence of TB, and tackling it is key to prevention, recovery, and control.
• Key Government Initiatives:
  • Nikshay Poshan Yojana (NPY): Launched in 2018, it provides ₹1,000/month (recently increased from ₹500) as Direct Benefit Transfer (DBT) to TB patients during treatment, helping them access nutritious food.
  • Ni-kshay Mitra (Community Support): Launched in 2022 under the TB Mukt Bharat Abhiyaan, this is a Jan Andolan (people’s movement) where individuals, NGOs, and corporates can adopt TB patients to provide:
    • Nutritional kits
    • Diagnostic and vocational support
    • The program now extends support to household contacts of TB patients to reduce within-household transmission.
  • Energy-Dense Nutritional Supplementation (EDNS): Targeted support for underweight TB patients (Body Mass Index <18.5) during the first 2 months of treatment with high-energy food to improve recovery.
  • Community-Based Monitoring: ASHA and Anganwadi workers are mobilized to:
    • Monitor nutrition status
    • Ensure timely support
    • Raise awareness on TB and dietary care
  • Convergence with Welfare Schemes: Linkages with:
    • Integrated Child Development Services (ICDS) (for women and children)
    • Mid-Day Meal Scheme (for children in affected families)
    • PM Garib Kalyan Anna Yojana (PMGKAY) (for household food security)

Why Does It Matters?

• Undernutrition triples the risk of developing active TB.
• Nutritional support improves treatment outcomes, reduces deaths and drug resistance, and helps break the TB–malnutrition cycle.
• These interventions are backed by the ICMR’s RATIONS study, which influenced a global policy update by WHO.

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