Tuberculosis: a chronic fever
Tuberculosis is a chronic infection by Mycobacterium tuberculosis with low evening fever and wasting. Diet is high in energy, protein, calcium and vitamins to rebuild lost weight.
At a glance
Why nutrition matters in TB
- Two-way link: undernutrition weakens immunity and raises the risk of active TB; TB in turn causes poor appetite, fever and wasting.
- Chronic fever raises energy needs for months, and protein is lost through tissue breakdown.
- Isoniazid, a key drug, causes pyridoxine (vitamin B6) deficiency and nerve damage (peripheral neuropathy), so B6 is given with it.
- Anti-TB drugs can harm the liver; if jaundice appears, the diet follows hepatitis principles and the doctor reviews the drugs.
- Nikshay Poshan Yojana (2018) gives monthly cash support for nutrition to notified TB patients; community donors (Ni-kshay Mitras) can also give food baskets.
Dietary principles
| Nutrient | Recommendation | Why |
|---|---|---|
| Energy | High: about 35-40 kcal/kg, to regain lost weight | Chronic fever and wasting; weight gain shows recovery |
| Protein | High: about 1.2-1.5 g/kg; milk, curd, egg, dal, soya, groundnuts, fish, meat | Rebuilds tissue and antibodies |
| Fat | Moderate; enough oil or ghee to add energy | Energy-dense, but too much fat spoils the appetite |
| Calcium | High: milk and milk products, ragi, sesame | Helps healing of TB lesions by calcification |
| Vitamins | Vitamins A, C and D; B-complex; pyridoxine (B6) with isoniazid | Immunity, tissue repair, prevention of drug-induced neuropathy |
| Iron and zinc | Greens, dals, meat, eggs, millets | Anaemia is common; zinc supports immunity |
| Alcohol and tobacco | None | Alcohol adds liver damage with anti-TB drugs; smoking harms the lungs |
| Meal pattern | 5-6 small, tasty meals a day | Appetite is poor; small meals are easier to finish |
Foods to include and avoid
| Food group | Include | Avoid or limit |
|---|---|---|
| Cereals and millets | Rice, wheat, ragi, oats, rice flakes, dosa, chapati | Only refined bakery snacks in place of meals |
| Protein foods | Milk, curd, paneer, egg, chicken, fish, dals, soya chunks, groundnuts, roasted Bengal gram | Raw or under-cooked meat and eggs |
| Vegetables and fruits | Green leafy vegetables, carrot, pumpkin, amla, guava, orange, banana | None, if well washed |
| Others | Groundnut chikki, sesame laddu, dates, nuts | Alcohol, tobacco, very spicy food if it hurts |
Sample one-day menu (high-calorie, high-protein)
| Meal | Menu |
|---|---|
| Early morning | Milk (1 glass) with 4-5 almonds or dates |
| Breakfast | Ragi dosa (3) with groundnut chutney and sambar; boiled egg (2) |
| Mid-morning | Banana; roasted Bengal gram |
| Lunch | Rice, dal, fish curry or paneer curry, spinach poriyal, carrot salad, curd |
| Evening | Soya-vegetable upma; amla or guava; tea with milk |
| Dinner | Chapati (3) with ghee, chicken or rajma curry, mixed vegetables |
| Bedtime | Milk with ragi malt; sesame laddu |
At every TB clinic visit the patient is weighed: failure to gain weight on treatment is a warning sign. The dietitian links the family to Nikshay Poshan Yojana and shows cheap protein foods such as groundnuts, roasted gram, soya and eggs.
2 marks: “Why is pyridoxine given to TB patients?” Isoniazid causes vitamin B6 deficiency and peripheral neuropathy; pyridoxine prevents it.
5 marks: “Write on the relationship between tuberculosis and nutrition.” Undernutrition raises TB risk; TB causes wasting; higher energy and protein needs; drug-nutrient interactions; national nutrition support.
10 marks: “Discuss the causes, symptoms and dietary management of tuberculosis with a sample menu.” Define, cause and spread, risk factors, symptoms, TB-nutrition link, principles table, foods, high-calorie high-protein menu.
TB diet = 'Milk, Meat-or-dal, More meals': high energy, high protein, high calcium, and B6 with isoniazid.