RATIONS Study
The RATIONS (Reducing Activation of Tuberculosis by Improvement Of Nutritional Status) study: A cluster randomized trial of nutritional support (food rations) to reduce TB incidence in household contacts of patients with microbiologically confirmed PTB in communities with a high prevalence of undernutrition.
The RATIONS study is supported by the Indian Council of Medical Research. It is led by the Yenepoya (Deemed to be University) with faculty from Center for Nutrition Studies and in collaboration with National Institute of Research in Tuberculosis (NIRT), Chennai, National Institute of Nutrition (NIN), Hyderabad and State TB Cell,
Jharkhand and Central TB Division. It is being conducted in 4 districts of Jharkhand with 2800 patients and their household contact.
It is registered with clinical trial registry of India (CTRI/2019/08/020490)(http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=34822&EncHid=&userName=Anurag)
It is a clinical trial to study the effect of food rations on the occurrence of new cases of tuberculosis in household contacts of patients suffering from TB. The intervention is dry food rations and micronutrients to patients with microbiologically confirmed pulmonary TB in control as well as intervention arm. And in the intervention arm, the household contacts will also get the dry food rations. The primary outcome is the number of new cases of TB that occur in the household contacts during a two year follow-up period.
It is first of its kind project with largest sample size in the field of TB and Nutrition.
Karnataka State RNTCP Operational Research Project
Feasibility study to implement select components of Guidance Document: Nutritional care and support for patients with Tuberculosis in Dakshina Kannada district, India.
This state operational research project was done done in collaboration Department of Community Medicine, Yenepoya Medical College, State TB Cell and ESI Post Graduate Institute of Medical Science and Research, Bengaluru.We conducted training of medical officers and staff nurse of Primary Health Centres of Mangalore and Bantwal Taluk in the use of BMI charts for nutritional screening and appropriate nutrition counselling for them. This project was supported by State Revised National Tuberculosis Control Program.
This state operational research project was done done in collaboration Department of Community Medicine, Yenepoya Medical College, State TB Cell and ESI Post Graduate Institute of Medical Science and Research, Bengaluru.We conducted training of medical officers and staff nurse of Primary Health Centres of Mangalore and Bantwal Taluk in the use of BMI charts for nutritional screening and appropriate nutrition counselling for them. This project was supported by State Revised National Tuberculosis Control Program.
N-TB Mobile App
On World TB Day (24 March), the Center for Nutrition Studies, Yenepoya University, Mangalore in association with McGill International TB Centre, Montreal is pleased to announce the public release of N-TB. N-TB App is an android mobile based application for the nutritional assessment and counselling of adult patients with TB.
This app, endorsed by the Revised National Tuberculosis Control Programme and WHO India, was included in the new initiatives unveiled by Prime Minister Narendra Modi during the Delhi End TB Summit on March 13th 2018.
This app, endorsed by the Revised National Tuberculosis Control Programme and WHO India, was included in the new initiatives unveiled by Prime Minister Narendra Modi during the Delhi End TB Summit on March 13th 2018.
Undernutrition in TB patients is now considered a medical condition like co-existing diabetes, or HIV infection. WHO recommends that nutritional assessment, counselling and support should be considered an integral part of TB care. The RNTCP released a Guidance document on Nutritional Care and Support for patients with tuberculosis in India in 2017, one of the first countries to do so. The Union Government also announced a direct benefit transfer of Rs. 500 per month, to be made operational from April 2018, to enable nutritional support for TB patients.
All these initiatives will require healthcare providers to be skilled in nutritional assessment and counselling. The N-TB is the first of its kind app for healthcare providers. It enables the classification of the nutritional status of the patient by calculating the BMI. If the BMI is very low, it red-flags this and provides an overview of management of severe undernutrition. The app also provides the weight gain required during treatment to achieve a desirable weight, and the recommended daily caloric and protein intake (screen shots on the next page). It has counselling tips on diet with an emphasis on the value of locally available foods in contrast to costly nutritional supplements, activity and lifestyle.
All these initiatives will require healthcare providers to be skilled in nutritional assessment and counselling. The N-TB is the first of its kind app for healthcare providers. It enables the classification of the nutritional status of the patient by calculating the BMI. If the BMI is very low, it red-flags this and provides an overview of management of severe undernutrition. The app also provides the weight gain required during treatment to achieve a desirable weight, and the recommended daily caloric and protein intake (screen shots on the next page). It has counselling tips on diet with an emphasis on the value of locally available foods in contrast to costly nutritional supplements, activity and lifestyle.
Maternal Nutrition Implementation Project
Maternal Nutrition implementation project to test the operational feasibility of the maternal nutrition algorithm (developed by the NCEARD, Lady Irwin College, New Delhi).
Maternal Nutrition Algorithm ( http://nceard.roshni-cwcsa.co.in/ToolkitFrame.aspx?flag=9) has been developed by National Centre of Excellence and Advanced Research on Diets (NCEARD) to strengthen the available Antenatal Care platforms in public health facilities and in community for assessing, classifying and providing services to pregnant women as per nutritional risk.
This is designed so as to deliver nutritional care within the available human resources, equipment and supplies, reporting and review of the ANC services. The operational feasibility of the algorithm was tested across country. UNICEF Hyderabad Field Office along with National Institute of Nutrition (NIN), Hyderabad, Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore supported the testing of the algorithm across the two sites in Dakshina Kannada, Karnataka and three sites in Telangana.
This was conducted in collaboration with the Department of Community Medicine, Obstetrics and Gynaecology and Yenepoya Nursing College.
Adolescent Nutrition
Adolescence as an age-group does not receive adequate attention in national surveys. They form an important segment but get combined with the adults as far as the National Family Health Surveys are concerned or in the National TB Programs globally.
Information on adolescent nutrition is scant. NFHS has data on boys and girls only in the 15-19 age group, but clubs them with adults and has applied BMI cut-offs inappropriate for this age group. A reanalysis of NFHS-3 &4 using appropriate age and gender specific cut-offs for 15-19 year olds found that thinness may have been overestimated more than two-fold.
Information on adolescent nutrition is scant. NFHS has data on boys and girls only in the 15-19 age group, but clubs them with adults and has applied BMI cut-offs inappropriate for this age group. A reanalysis of NFHS-3 &4 using appropriate age and gender specific cut-offs for 15-19 year olds found that thinness may have been overestimated more than two-fold.
Stunting (low height for age) in 15-19 year olds has hitherto remained hidden in the data of NFHS-3 &4. Stunting was found in > 30% of boys and girls in NFHS-4, with a disturbing increase in NFHS-4 compared to NFHS-3. These findings are corroborated by the recent CNNS report (2016-2018).
Growth potential is spread across first 1000 and the next 7000 days, and adolescence is the last window of opportunity. Stunting affects cognitive development, learning ability, work performance and incomes, and is also a risk factor for obesity, diabetes, and hypertension in adult life. The demographic dividend of a young population in India is in jeopardy with these levels of stunting.
Moreover, to highlight the problem of nutrition and tuberculosis in this age group, we used secondary data from NFHS-4 to estimate the prevalence of self-reported TB disease and household exposure among adolescents. The prevalence was 136/100 000 with poverty, urban residence as strong predictors and there was high prevalence of undernutrition and stunting in this population.
Growth potential is spread across first 1000 and the next 7000 days, and adolescence is the last window of opportunity. Stunting affects cognitive development, learning ability, work performance and incomes, and is also a risk factor for obesity, diabetes, and hypertension in adult life. The demographic dividend of a young population in India is in jeopardy with these levels of stunting.
Moreover, to highlight the problem of nutrition and tuberculosis in this age group, we used secondary data from NFHS-4 to estimate the prevalence of self-reported TB disease and household exposure among adolescents. The prevalence was 136/100 000 with poverty, urban residence as strong predictors and there was high prevalence of undernutrition and stunting in this population.
NAT-COURSE: Nutritional Assessment Techniques – Short Course
To bring nutrition at the center stage in research, service and academia, capacity building, skill building and mutual learning is the most way to go.
A 4- day short course on nutritional assessment techniques was organized by the Center for Nutrition Studies with support from UNICEF (GRANT REFERENCE NO: SSFA/2019/07). There were a total of 12 resource persons with eight of them from leading national and international institutions. These included National Institute of Nutrition, Hyderabad, St John’s Research Institute, Bangalore, National Centre for Excellence and Advanced Research in Diets (NCEARD), Lady Irwin College and AIIMS in New Delhi, National Institute of Health and Welfare and University of Tampere in Finland.
A 4- day short course on nutritional assessment techniques was organized by the Center for Nutrition Studies with support from UNICEF (GRANT REFERENCE NO: SSFA/2019/07). There were a total of 12 resource persons with eight of them from leading national and international institutions. These included National Institute of Nutrition, Hyderabad, St John’s Research Institute, Bangalore, National Centre for Excellence and Advanced Research in Diets (NCEARD), Lady Irwin College and AIIMS in New Delhi, National Institute of Health and Welfare and University of Tampere in Finland.
Thirty-two participants were trained over 4 days in this course at Lecture Hall, EMD building. The participants comprised of nutritionists from Mangalore, Mysore, Chennai, Manipal, Hyderabad, public health specialists from medical colleges in Mangalore, Mumbai, Davangere; programme officers from the Tata Trusts, representatives of voluntary organisations based in Odisha and Telangana, doctoral students, nursing faculty, UNICEF and NCEARD consultants.
The topics covered included theory and practical sessions on various methods of dietary assessments, basic and advanced anthropometry and body composition, maternal nutrition, physical activity and functional assessment. There were lectures on dietary policy at population level, recommendations on dietary intakes and biomarkers in nutrition.
The topics covered included theory and practical sessions on various methods of dietary assessments, basic and advanced anthropometry and body composition, maternal nutrition, physical activity and functional assessment. There were lectures on dietary policy at population level, recommendations on dietary intakes and biomarkers in nutrition.