Oral Nutritional Supplementation and Weight Changes During Therapy in Malnourished Patients With Resistant Tuberculosis: A Clinical Trial

Tuberculosis increases energy demands and protein breakdown, leading to muscle wasting. Malnutrition and minimal weight gain less than 5% in first two months predict treatment failure. Malnutrition is defined as weight loss more than 5% in three months and Body Mass Index (BMI) ≤ 20 kg/m². This study assesses weight changes with high-energy, high-protein oral nutritional supplementation (ONS).

Study Overview

• Status: Completed
• Conditions: Tuberculosis Multi Drug Resistant Active; Rifampin-Resistant Pulmonary Tuberculosis; Pre-xdr tb
• Intervention / Treatment: Dietary supplement: Oral nutritional supplementation

Detailed Description

Tuberculosis (TB) is linked to poverty, malnutrition, and reduced immunity, with malnutrition both contributing to and resulting from TB.1-3 Active TB increases energy needs, causes protein breakdown, and leads to muscle wasting. Malnutrition, which is common in TB patients, worsens clinical outcomes and increases the risk of death.1 TB treatments can also cause nausea and vomiting, further contributing to malnutrition.4 Thus integrated management is essential for successful treatment.

In India, 68.6% of MDR-TB patients without HIV infection are malnourished, a prevalence comparable to that observed among MDR-TB patients at Persahabatan General Hospital, Jakarta, Indonesia (51.8%).5,6 Malnourished MDR TB patients have worse clinical outcomes, more side effects, and a higher risk of death.7 A BMI under 18.5 kg/m2 and inadequate weight gain during treatment indicate a poor response and increased risk of recurrence.1 Failure to gain weight (≤ 5%) in the first two months of treatment has been demonstrated to be linked to TB recurrence.8 Oral nutritional supplements have demonstrated the potential to improve nutritional status, muscle strength, and immunity, thus potentially facilitating an accelerated treatment process. Studies have also shown that nutritional supplements can improve BMI and gamma interferon levels.9 However, some studies have indicated that despite increased macronutrient intake, MDR TB patients may still experience a decline in body weight.10 This study aims to evaluate whether oral nutritional supplements providing 705 kcal and 30.5 grams of protein daily during the first two months can increase body weight and improve other clinical outcomes of MDR TB patients, including the impact of supplementation on albumin, globulin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels.

• Study Type: Interventional
• Enrollment (Actual): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Indonesia
  • DKI Jakarta
    • Jakarta, DKI Jakarta, Indonesia, 13230
      • Rumah Sakit Umum Pusat Persahabatan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Who had access to electronic devices (e.g., mobile phones) for adherence monitoring
• individuals newly diagnosed with rifampicin-resistant pulmonary tuberculosis (RR-TB), multidrug-resistant tuberculosis (MDR-TB), or pre-extensively drug-resistant tuberculosis (Pre-XDR-TB) at the drug-resistant tuberculosis outpatient clinic of Persahabatan General Hospital, Jakarta, Indonesia.
• BMI of 13-20 kg/m²
• had received standardized or individualized treatment regimens for seven days
• had no severe drug-induced hepatitis indicated by elevated liver enzymes >5 times the normal upper limit

Exclusion Criteria:

• individuals with HIV infection,
• end-stage renal failure,
• severe anemia (hemoglobin <8 g/dL),
• severe hypoalbuminemia (albumin <2.5 g/dL),
• acute or chronic liver diseases (including hepatitis, cirrhosis, or jaundice),
• cancer,
• interstitial lung disease (ILD),
• anatomical gastrointestinal disorders (either congenital or post-surgical),
• diabetes mellitus,
• long-term corticosteroid or immunosuppressant therapy
• other acute pulmonary infections such as pneumonia,
• exacerbations of chronic obstructive pulmonary disease (COPD), or asthma

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; standard Oral Nutritional Supplement (ONS) in the form of a soy-based drink (235 kcal/200mL: 10.34 g protein, 7.9 g fat, 30.61 g carbohydrate; Protein; Otsuka) with the instruction to consume three (3) sachets per day (total of 705 kcal and 31 grams of protein) plus standard treatment.	Dietary supplement: Oral nutritional supplementation; Oral Nutritional Supplement (ONS) in the form of a soy-based drink (235 kcal/200mL: 10.34 g protein, 7.9 g fat, 30.61 g carbohydrate; Protein)
No Intervention: Control group; standard treatment only

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body weight	A change in body weight in kg	Pre intervention and post intervention (at 60 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Daily food intake	Daily food intake of total energy, protein, fat, and carbohydrates. The subjects were given a form to record food intake 3 times a week (2 working days and 1 day off) for 8 weeks including the type and amount of food measured using standard units of spoons, glasses, etc. Furthermore, the intake data was converted into grams using a food ingredient analysis list and then analyzed using the 2007 nutrisurvey.	From enrollment to 60 days after enrollment
Albumin	Serum albumin is measured by taking peripheral venous blood samples with units of g/dL.	Pre intervention and post intervention (at 60 days)
CRP	CRP is measured by taking peripheral venous blood samples in mg/dL units.	Pre intervention and post intervention (at 60 days)
Total protein	Total protein is measured using a peripheral venous blood sample in g/dL units.	Pre intervention and post intervention (at 60 days)
ESR	Erythrocyte sedimentation rate is measured using a peripheral venous blood sample in mm/hour units.	Pre intervention and post intervention (at 60 days)

Collaborators and Investigators

• Sponsor: RSUP Persahabatan
• Collaborators: Otsuka Holdings Co., Ltd.
• Investigators: Study Chair: Fathiyah Isbaniah Sp.P(K), Dr., dr., Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas Indonesia, Persahabatan General Hospital, Jakarta

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2022
• Primary Completion (Actual): December 30, 2022
• Study Completion (Actual): December 30, 2022

Study Registration Dates

• First Submitted: June 19, 2025
• First Submitted That Met QC Criteria: June 30, 2025
• First Posted (Actual): July 10, 2025

Study Record Updates

• Last Update Posted (Actual): July 10, 2025
• Last Update Submitted That Met QC Criteria: June 30, 2025
• Last Verified: December 1, 2022

More Information

Terms related to this study

• Keywords: malnutrition; Drug-resistant tuberculosis; total protein; oral nutritional supplementation; globuline
• Additional Relevant MeSH Terms: Body Weight; Respiratory Tract Infections; Infections; Respiratory Tract Diseases; Lung Diseases; Gram-Positive Bacterial Infections; Bacterial Infections; Bacterial Infections and Mycoses; Actinomycetales Infections; Mycobacterium Infections; Body Weight Changes; Tuberculosis; Tuberculosis, Pulmonary
• Other Study ID Numbers: 25/UN2.F1/ETIK/PPM.00.02/2022; Otsuka Holding (Other Identifier: Oral Nutritional Supplementation); Global Fund to Fight AIDS, TB (Other Identifier: Infection Disease)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No