Barriers to Nutritional Rehabilitation

Many barriers to successful nutritional rehabilitation do not include the disturbed metabolism or pathological processes of the disease. The following cognitive and behavioral factors may play important roles in promoting or impeding nutritional rehabilitation:

• Education for health care workers: It is necessary to promote education related to the nutrition of TB patients to health care workers in virtually every country, but especially in regions with a high TB incidence. These workers will be responsible for planning and implementing the nutritional program, and their participation is critical.

• Information/education for patients: Information and education for patients about the principles of good nutrition and dietary strategies is also lacking. We found no published data on TB patients' knowledge about nutrition/nutritional status or the role of nutrition in treating TB.

• Resources: TB mainly occurs among the poorest people in both industrialized and developing countries. A primary problem is the lack of resources for treatment other than the essential anti-TB drugs. The resource deficiency exceeds the capacity of international donor groups. In addition, the resource deficiency includes the unavailability of food, a common problem for people in low- and middle-income countries.

• Cultural and individual food preferences: Specific food preferences in different regions and among different people strongly affect willingness to eat and drink. Traditions regarding food are among the strongest ties with one's culture. This is particularly relevant to immigrants, refugees, displaced people, and other migrating populations that comprise important risk groups for TB. In addition to primary factors (e.g., availability of food), secondary factors may be responsible for the apparent lack or misuse of food. One may determine which secondary factors in the person's environment have been responsible for inadequate nutrient consumption and rectify them to the extent possible.

Nutritional support is an important component of the comprehensive care of people with TB. In theory, a nutritionist-dietician can tailor a specific dietary prescription for each TB patient based on a careful nutritional assessment and the patient's clinical status, including any comorbidities. In low- and middle-income countries, however, this degree of effort may not be possible and it may not be necessary, given the sparse data reviewed in this article. Virtually all TB patients should be given nutritional support and recommendations, but a generally healthful standardized diet with adequate protein, energy, essential fats, and micronutrients may suffice for the large majority of patients to achieve the potential benefits. A deeper understanding of the essential role of nutrition in TB pathogenesis and resolution may help improve treatment practices and improve outcomes of TB patients.

The extent of nutritional deficits among TB patients is reason enough for intensified nutritional support. The association of malnutrition with worse clinical outcomes and the possibility of favorably influencing the course of treatment add to the impetus for further work to be carried out to identify the optimal strategies for nutritional intervention.

See also: Anemia: Iron-Deficiency Anemia. Lung Diseases. Malnutrition: Primary, Causes Epidemiology and Prevention; Secondary, Diagnosis and Management. Tuberculosis: Nutrition and Susceptibility. Vitamin B6. Weight Management: Approaches.

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