A Cochrane review [Abstract] 1 included 35 studies with a total of 8 283 subjects. 6 trials assessed macronutrient supplementation. 6 trials assessed the provision of free food, or high energy supplements, although none were shown to provide a total daily kilocalorie intake above the current daily recommended intake for the non-infected population.The available trials were too small to reliably prove or exclude clinically important benefits on mortality, cure, or treatment completion. The provision of free food or high-energy nutritional products probably does produce a modest increase in weight gain during treatment for active tuberculosis.
24 trials assessed single, dual or multi-micronutrient supplementation. There is insufficient evidence to judge whether multi-micronutrients have a beneficial effect on mortality in HIV-negative patients with tuberculosis, but the available studies show that multi-micronutrients probably have little or no effect on mortality in HIV-positive patients with tuberculosis. No studies have assessed the effects of multi-micronutrients on cure, or treatment completion.Multi-micronutrient supplements may have little or no effect on the proportion of tuberculosis patients remaining sputum positive during the first eight weeks, and probably have no effect on weight gain during treatment. No studies have assessed quality of life.Plasma levels of vitamin A appear to increase following initiation of tuberculosis treatment regardless of supplementation. In contrast, plasma levels of zinc, vitamin D and E, and selenium may be improved by supplementation during the early stages of tuberculosis treatment, but a consistent benefit on tuberculosis treatment outcomes or nutritional recovery has not been demonstrated.
Comment: The quality of evidence is downgraded by limitations in study quality (inadequate or unclear allocation concealment), by inconsistency (variability in interventions and results) and by imprecise results (limited study size for each comparison).
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