Grobler L, Durao S, Van der Merwe S M, Wessels J, Naude C E
Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2017 Dec 13;108(1):16-18. doi: 10.7196/SAMJ.2017.v108i1.12839.
Tuberculosis and nutrition are intrinsically linked in a complex relationship. Altered metabolism and loss of appetite associated with tuberculosis may result in undernutrition, which in turn may worsen the disease or delay recovery. We highlight an updated Cochrane review assessing the effects of oral nutritional supplements in people with active tuberculosis who are receiving antituberculosis drug therapy. The review authors conducted a comprehensive search (February 2016) for all randomised controlled trials comparing any oral nutritional supplement, given for at least 4 weeks, with no nutritional intervention, placebo or dietary advice only in people receiving antituberculosis treatment. Of the 35 trials (N=8 283 participants) included, seven assessed the provision of free food or high-energy supplements, six assessed multi-micronutrient supplementation, and 21 assessed single- or dual-micronutrient supplementation. There is currently insufficient evidence to indicate whether routinely providing free food or high-energy supplements improves antituberculosis treatment outcomes (i.e. reduced death and increased cure rates at 6 and 12 months), but it probably improves weight gain in some settings. Plasma levels of zinc, vitamin D, vitamin E and selenium probably improve with supplementation, but currently no reliable evidence demonstrates that routine supplementation with multi-, single or dual micronutrients above the recommended daily intake has clinical benefits (i.e. reduced death, increased cure rate at 6 and 12 months, improved nutritional status) in patients receiving antituberculosis treatment. In South Africa, most provinces implement a supplementation protocol based on nutritional assessment and classification of individuals rather than on disease diagnosis or treatment status.
结核病与营养之间存在着内在的复杂联系。与结核病相关的新陈代谢改变和食欲不振可能导致营养不良，而营养不良反过来又可能使病情恶化或延迟康复。我们重点介绍一项最新的Cochrane综述，该综述评估了口服营养补充剂对正在接受抗结核药物治疗的活动性结核病患者的影响。综述作者进行了全面检索（2016年2月），以查找所有随机对照试验，这些试验比较了在接受抗结核治疗的患者中，给予至少4周的任何口服营养补充剂与不进行营养干预、安慰剂或仅给予饮食建议的情况。在纳入的35项试验（N = 8283名参与者）中，7项评估了提供免费食物或高能量补充剂，6项评估了多种微量营养素补充，21项评估了单一或双重微量营养素补充。目前尚无足够证据表明常规提供免费食物或高能量补充剂是否能改善抗结核治疗效果（即降低死亡率以及提高6个月和12个月时的治愈率），但在某些情况下可能会促进体重增加。补充后血浆锌、维生素D、维生素E和硒水平可能会提高，但目前没有可靠证据表明在接受抗结核治疗的患者中，常规补充高于推荐每日摄入量的多种、单一或双重微量营养素具有临床益处（即降低死亡率、提高6个月和12个月时的治愈率、改善营养状况）。在南非，大多数省份实施的补充方案是基于对个体的营养评估和分类，而非疾病诊断或治疗状况。
