Salt Composition: -
N acetylcysteine 250 Mg
Pyridoxin Hydrochloride: -50 Mg
Ascorbic Acid (Vitamin C): - 75 Mg
Vitamin E: - 200 IU
Vitamin A: - 900 IU
Zinc: - 8 Mg
Folic Acid; - 5 Mg
Introduction: Tuberculosis Challenges: Ahead
- As per the Global TB report 2017 the estimated incidence of TB in India was approximately 28,00,000 accounting for about a quarter of the world’s TB cases.
- India continues to have the highest number of tuberculosis (TB) cases in the world
- Tuberculosis is probably associated with more severe malnutrition than other chronic illnesses
- A less than ideal weight gain during TB treatment also increases the risk of long-term relapse even after initial cure. Under nutrition has also been associated with malabsorption of key anti TB drugs.
- Majority of TB patients notified are from the age group of 15-45 years and they are from the lower socio-economic strata of the society.
- Also, since they are from working group age, TB disease affects the income of the family also while patients are on care.
- There is increasing evidence that under nutrition in patients with active TB is associated with an increased frequency and severity of disease and indeed a two-to-four-fold increase in mortality. There is also a fivefold risk of drug induced liver damage.
- Peripheral neuropathy is a well-known adverse effect of Isoniazid.
- Anti-tuberculosis drug-induced liver injury (TB DILI) is a leading cause of DILI and drug-induced acute liver failure (DIALF) in India and much of the developing world.
- Marked oxidative stresses were seen in the TB population as compared to the healthy cohort.
- 20% of patients develop asymptomatic elevation of liver enzymes which is self-limiting (as a result of adaptation or discontinuance) in a majority of patients (1)
- Anorexia is also a contributing factor for wasting in tuberculosis.
- Malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. (8)
- TB and under nutrition can cause a vicious cycle of worsening disease and under nutrition.
- Disease: Increased severity & higher mortality
- Treatment: Increased adverse effects (liver toxicity), malabsorption of drugs such as rifampicin, increased relapse after cure, delayed sputum conversion
- TB transmission in household: Increased risk of TB incidence in undernourished contacts.
TB Nutritional Care & Support
In more developed countries, only a few people with TB will need nutritional care & support as part of their TB treatment and care. In other countries, such as India, the majority of people with TB may need nutritional care & support.
There are a number of principles for providing nutritional care and support as a necessary part of TB care and prevention and these include.
- When under nutrition is identified at the time of TB diagnosis, TB must be considered a key cause that needs to be addressed.
- An adequate diet is necessary for the well-being and health of all people, including those with TB infection or TB disease.
- Because of the clear two-way link between under nutrition and active TB, nutritional assessment and counselling are vital parts of TB treatment and care.
- Poverty and food insecurity are both causes and consequences of TB, and those involved in TB care therefore play an important role in recognizing and addressing these wider socioeconomic issues.
- TB is commonly accompanied by co-morbidities such as HIV, diabetes, smoking and alcohol or substance abuse, which has their own nutritional implications and these, should be fully considered during nutrition assessment and counselling.
N-Acetylcysteine (NAC) 250 Mg: -
- Protective effects seen in Anti-TB drug induced hepatotoxicity.
- The Antioxidant role of glutathione supplements seen in reducing oxidative stress
- Nac is strong mucolytic and helps in expectoration
Pyridoxin HCL:-
- Prevent the development of peripheral neuropathy caused by Isoniazid
Ascorbic Acid: -
- Washington, DC – January 3, 2018 – Studies in mice and in tissue cultures suggest that giving vitamin C with tuberculosis drugs could reduce the unusually long time it takes these drugs to eradicate this pathogen.
Vitamin E: -
- Currently, micronutrient deficiencies are thought to be the most common cause of secondary immunodeficiency and the most prominent risk factor for infection-related morbidity, which potentially affect individuals’ susceptibility to tuberculosis and may alter the natural course of this disease (4).
Zinc & Vitamin A
- "The effectiveness of anti-tuberculosis treatment was improved during the first two months by vitamin A and zinc supplementation," Dr. Clive E. West, a professor in the department of nutrition at Wageningen University in the Netherlands, and colleagues write in the April issue of the American Journal of Clinical Nutrition (2002;75:720-727).
Reference
