Nutritional supplementation linked to immune improvements in malnourished tuberculosis patients

Oral nutritional supplementation was associated with improved nutritional and immune measures in a retrospective real-world study of 118 adults hospitalized with tuberculosis and malnutrition. Among the participants, 40 received a high-protein mixed-nutrient formula, while 78 received general dietary advice without supplementation. The overall association with sputum culture positivity was not statistically significant, although exploratory analyses suggested a possible bacteriological benefit in selected analyses.

The supplemented formula provided an additional 15 g of protein and 240 kcal each day. Investigators compared changes in nutritional, immune and sputum outcomes between the two groups using generalized estimating equations. Because this was a retrospective observational study, the results show associations and do not establish that nutritional supplementation caused the observed differences.

Nutritional outcomes consistently favored supplementation. The analysis found improvements in blood albumin and the prognostic nutritional index. Immune-related measures also showed favorable associations, including neutrophil counts and the proportions of CD3-positive, CD4-positive and CD8-positive T cells. The platelet-to-lymphocyte ratio declined more among supplemented patients. Supplementation was also associated with lower odds of immune dysfunction, with an odds ratio of 0.14, a 95% confidence interval of 0.03–0.56 and a P value of 0.006. The researchers reported that these associations remained consistent in sensitivity analyses.

The full-cohort bacteriological finding was less conclusive. Although sputum culture positivity was less common among supplemented patients, the overall association did not reach statistical significance: the odds ratio was 0.34, the 95% confidence interval was 0.09–1.23 and the P value was 0.100. Exploratory analyses found associations with reduced sputum culture positivity among non-smokers, participants without hyperuricemia, and in a follow-up duration-matched analysis. The authors characterized these subgroup and matched analyses as hypothesis-generating evidence that requires confirmation in prospective randomized trials.

Overall, the study links oral nutritional supplementation with better nutritional indicators and aspects of immune recovery among hospitalized patients with tuberculosis and malnutrition. It does not demonstrate a general reduction in positive sputum cultures, and the exploratory bacteriological findings remain uncertain. The evidence supports further prospective evaluation of supplementation as a possible adjunct to routine tuberculosis treatment, rather than a claim that it has been proven to improve bacteriological outcomes or clinical recovery.

Subject of Research: Associations of oral nutritional supplementation with nutritional, immune and bacteriological outcomes in hospitalized adults with tuberculosis and malnutrition

Article Title: Oral nutritional supplementation and nutritional, immune, and bacteriological outcomes in hospitalized patients with tuberculosis: a retrospective real-world study

Article References: Lu, C., Li, Y., Xu, Y., Yan, L., Li, X., Huang, Z., & Fan, J. (2026). Oral nutritional supplementation and nutritional, immune, and bacteriological outcomes in hospitalized patients with tuberculosis: a retrospective real-world study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14310-6

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14310-6

Keywords: tuberculosis, malnutrition, oral supplementation, nutritional status, immune dysfunction, sputum culture, retrospective study, hospitalized patients, Oral, nutritional, supplementation, immune