Macro and micro-nutrient deficiencies and diminished nutritional status are common features of pulmonary tuberculosis. To determine the association of nutritional factors with pulmonary tuberculosis treatment outcome in newly diagnosed patients. A hospital based prospective follow-up cohort study design. Two urban Directly Observed Treatment Short-course (DOTS) centers in Lucknow District of Uttar Pradesh, India. Newly diagnosed sputum smear-positive cases for Acid-fast Bacilli (AFB) before and after treatment were included in the study. Outcomes were evaluated by clinical, radiological and mycobacterial culture and drug-susceptibility testing in sputum smear positive patients. The parameters used to assess the nutritional status were body mass index (BMI) and mid upper arm circumference (MUAC). Nutrients intake was assessed by 24- hour dietary recall method. A total of 185 newly diagnosed patients with pulmonary tuberculosis were recruited. Out of these, 14 patients were lost to follow up after treatment and remaining 171 patients were analyzed. The mean (±SD) age of the study population was 29 (±12) years. Significant (p<0. 0001) increase was observed in nutrients intake with the clinical, radiological and bacteriological outcomes at six month treatment. Protein (p=0. 04) and retinol (p=0. 01) intake were significantly associated with the conversion of clinical outcomes, i. e. symptomatic to asymptomatic. Intake of energy (p=0. 04), protein (p=0. 04) and fat (p=0. 008) were significantly associated with complete radiological clearance. In case of drug-related outcomes, energy (p=0. 01) and protein (p=0. 02) intakes were associated significantly with drug resistance. Among all the nutrients, protein intake was closely associated with clinical, radiological and bacteriological outcomes. Protein intake was related with different clinical, radiological and bacteriological outcomes. Increased intake of protein was probably associated with rapid clinical recovery and weight gain, complete radiological clearing and early bacteriological conversion.

1. World Health Organization, 2012. Available at: http://www. who. int/topics/tuberculosis/en/
2. ATS/CDC. (2000) Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection. Am J Resp Crit Care Med. 161(4):S221-S247. http://ajrccm. atsjournals. org/cgi/content/full/161/4/S1/S221
3. Perronne C. (1999) Tuberculosis, HIV infection, and malnutrition: an infernal trio in central Africa. Nutrition. 15(4), 321-322.
4. Chandra RK. (1991) McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr. 53(5), 1087-1101.
5. Karien Cilliers. (2011) The Pharmacokinetics and Toxicity of Antituberculosis Agents and other Co-Administered Drugs in Children with Tuberculosis, with and Without HIV Infection, and their Relationship to Nutritional Status. Available at:http://scholar. sun. ac. za/bitstream/handle/10019. 1/6864/cilliers_pharmacokinetics_2011. pdf?sequence=1
6. Cegielski JP, Mc. Murray DN. (2004) The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis. 8(3), 218-26.
7. Karyadi E, Schultink W et al. (2000) Poor Micronutrient Status of Active Pulmonar Tuberculosis patients in Indonesia. J. Nutrition. 130, 2953-2958.
8. Paton, N. I. , Ng. (2006) Body composition studies in patients with wasting associated with tuberculosis. Nutrition. 22(3), 245-251.
9. Cegielski JP, Mc. (2004) Murray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis. 8(3), 218-26.
10. Macallan, Margaret A. Mcnurlan, Anura V. Kurpad et al. (1998) Whole body protein metabolism in human pulmonary tuberculosis and undernutrition: evidence for anabolic block in tuberculosis. Clinical Science. 94, 321–331.
11. Van Lettow M, Harries AD et al. (2004) Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi. BMC Infect Dis. 4, 61.
12. McMurray DN, Bartow RA et al. (1990) Micronutrient status and immune function in tuberculosis. Ann N Y Acad Sci. 587, 59-69.
13. Surya Kant, Harshita Gupta. (2011) Nutrition and Tuberculosis. Lucknow Medical Journal. 1, 79-83.
14. Crowle AJ, Ross EJ. (1989). Inhibition of retinal acid of multiplication on virulent tubercle bacilli in cultured human macrophages. Infect Immun. 57:840-4.
15. S S L Parashar. Social, Behavioral and Communication Sciences. Available at: http://www. whoindia. org/LinkFiles/Human_Resources_Section4Textbook_on_Public_Health_and_Community_Medicine. pdf
16. Revised National Tuberculosis Control Programme. Training Module for Medical Practitioners, 2006. Available at: www. tbcindia. nic. in/pdfs/Financial%20Training%20Module. pdf.
17. Revised National TB Control Programme Training Manual for Mycobacterium tuberculosis Culture &amp; Drug susceptibility testing, 2009. Available at: http://www. tbcindia. nic. in/pdfs/Training%20manual%20M%20tuberculosis%20C%20DST. pdf
18. Revised National TB Control Programme. Manual of Standard Operating Procedures (SOPs), 2009. Available at: http://www. tbcindia. nic. in/pdfs/standard%20operating%20procedures%20for%20C&amp;DST%20labs. pdf
19. American Thoracic Society and Centers for Disease Control and Prevention. (2000) Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 161, 1376–1395.
20. Vimlesh Seth, S. K. Kabra. (2008) Essentials of tuberculosis in children. 3rd edition.
21. Rosalind S. Gibson, Elaine L. Ferguson. (2008) An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. Available at: www. ifpri. org/sites/default/files/publications/tech08. pdf
22. National Health and Nutrition Examination Survey 1999-2001. (2010) Available at: http://www. cdc. gov/nchs/nhanes/measuring_guides_dri/measuringguides02. htm
23. Nutrient Requirements and Recommended Dietary Allowances for Indians. (2009) National Institute of Nutrition, Indian Council of Medical Research. Available at: http://icmr. nic. in/final/RDA-2010. pdf
24. National Health and Nutrition Examination Survey III Anthropometric Procedures-Anthropometry procedures manual, 2007. Available at: http://www. cdc. gov/nchs/data/nhanes/nhanes_07_08/manual_an. pdf
25. Macallan DC. (1999) Malnutrition in tuberculosis. Diagn Microbiol Infect Dis. 34(2), 153-157. PolyMedix PMX-30063 Effective Against NDM-

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