British Journal of Nutrition

Human and Clinical Nutrition

The effect of energy–protein supplementation on weight, body composition and handgrip strength among pulmonary tuberculosis HIV-co-infected patients: randomised controlled trial in Mwanza, Tanzania

George PrayGoda1 c1, Nyagosya Rangea2, Daniel Faurholt-Jepsena3, Kidola Jeremiaha1, Maria Faurholt-Jepsena3, Martine G. Aabyea4a5, Lotte Jensena4, Andreas V. Jensena4, Harleen M. S. Grewala6, Pascal Magnussena7, John Changaluchaa1, Aase Bengaard Andersena4a8 and Henrik Friisa3

a1 National Institute for Medical Research, Mwanza Centre, Box 1462, Mwanza, Tanzania

a2 National Institute for Medical Research, Muhimbili Centre, Tanzania

a3 Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Denmark

a4 Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark

a5 Clinical Research Centre, University of Copenhagen, Hvidovre Hospital, Denmark

a6 The Gade Institute, Section for Microbiology and Immunology, University of Bergen and Department of Microbiology and Immunology, Haukeland University Hospital, Norway

a7 DBL-Centre for Health Research and Development, Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Denmark

a8 Department of Infections Diseases, Odense University Hospital, Denmark

Abstract

Undernutrition is common among smear-positive pulmonary tuberculosis (PTB+) patients. Micronutrient supplementation may improve treatment outcomes, but it is unclear whether additional energy–protein would be beneficial. The present study aimed to assess the effect of energy–protein supplementation on weight, body composition and handgrip strength against a background of high micronutrient intake during tuberculosis (TB) treatment. A total of 377 PTB+ patients co-infected with HIV were randomly allocated one or six biscuits daily for 60 d during TB treatment. Weight, arm fat area, arm muscle area and handgrip strength were assessed at baseline and 2 and 5 months. There were no effects on any outcome at 2 months, but energy–protein supplementation was associated with a 1·3 (95 % CI − 0·1, 2·8) kg marginally significant gain in handgrip strength at 5 months. However, after 2 months, energy–protein supplementation led to a weight gain of 1·9 (95 % CI 0·1, 3·7) kg among patients with cluster of differentiation 4 (CD4) counts ≥ 350 cells/μl, but not among patients with low CD4 counts ( − 0·2 kg; 95 % CI − 1·3, 0·8, Pinteraction = 0·03). Similarly, at 5 months, energy–protein supplementation led to a 2·3 (95 % CI 0·6, 4·1) kg higher handgrip strength gain among patients with CD4 counts < 350 cells/μl, but not in those with high CD4 counts (Pinteraction = 0·04). In conclusion, energy–protein supplementation to PTB+ HIV-co-infected patients had no overall effects on weight and body composition, but was associated with marginally significant gain in handgrip strength. More research is needed to develop an effective supplement, before it is recommended to TB programmes.

(Received August 23 2010)

(Revised February 16 2011)

(Accepted April 19 2011)

(Online publication July 06 2011)

Correspondence:

c1 Corresponding author: Dr G. PrayGod, fax +255 28 2500654, email gpraygod@yahoo.com

Abbreviations: ART, antiretroviral therapy; CD4, cluster of differentiation 4; NTLP, National TB and Leprosy Programme; PTB, pulmonary tuberculosis; TB, tuberculosis

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