Nutritional assessment, counseling and support are integral parts of TB care. Undernutrition is an established risk factor for progression of latent TB infection to active TB, increases the risk of severe disease, death, drug toxicity, drug malabsorption & relapse after cure. Moreover, TB leads to weight loss, wasting and worsening of nutritional status. Therefore, Undernutrition and tuberculosis (TB) have a bidirectional relationship.
No single food group contains all nutrients. Not all foods in the same group have the same nutritive value. a balanced diet therefore combines different food groups and different types of foods. Encourage intake of locally available cereals, millets, pulses, nuts, fruits and green leafy vegetables, dairy products, fish and flesh foods (if culturally acceptable).
Nutritional Value Of Common Foods
Cereals include rice, wheat and maize and millets include sorghum (jowar), pearl millet (bajra), finger millet (ragi), etc. Use foods containing whole grains as much as possible.
- Nutritive value : Main source of energy: about 350 kcal per 100 gm on an average. They also provide proteins, ranging from 7 gm to 12 gm %, B vitamins, fiber and potassium. Cereal proteins are deficient in some amino acids and combining them with pulses can help provide a good quality protein for vegetarians.
- Special mention : Pearl millet (Bajra) has higher fat content. Finger millet (Ragi) is rich in calcium and a good source of iron.
The common pulses are Bengal gram (chana), red gram (tuvar/arhar), green gram (mung), black gram (urad), lentils (masur) and soya bean.
- Nutritive value : They are high in protein (20 to 25 gm %.) and of special value to vegetarians.
- Special mention : Germination of pulses(sprouting) improves nutritive value and can decrease cooking time. Soya bean has 20% fat and up to 37% protein making it a high calorie and high protein food.
These include groundnuts, coconut, mustard seeds, sesame seeds, cashew nut, almonds, sunflower seeds and many others from which cooking oil is extracted.
- Nutritive value : Contain high amount of fats(40-60%) and proteins (absent when oil is extracted). Excellent as an energy and protein rich snack for patients with undernutrition. Of special value to vegetarians as a source of protein.
- Special mention : Groundnuts are as good as costlier forms of nuts, but should preferably be taken in a roasted and a deskinned form to reduce the risks due to contamination. Some persons may be allergic to nuts and these should be then avoided.
Vegetables include leafy vegetables, roots and tubers (e.g. potatoes), other vegetables such as gourds, brinjal, tomatoes,beans, peas, cauliflowers, onions, etc. They can be taken generously in diet and seasonal vegetables should be eaten as much as possible.
- Nutritive value : They contain carbohydrates (content varies from 4-25%), and are protective foods and good sources of vitamins A and C, folate, iron and magnesium, fibre.
- Special mention : Green leafy vegetables like spinach, amaranth, fenugreek are high in fibre Vitamin A and C, calcium and iron. Potatoes are energy rich & a good source of vitamin C.
Fruits include Bananas, mango, papaya, guava, citrus fruits (including lemon, oranges), melons, apples and pears, berries.
- Nutritive value : Fruits are good source of vitamins A and C and potassium.
- Special mention : Bananas are a good source of energy (about 100 kcal per banana), magnesium and potassium (deficient in patients with severe undernutrition). Gooseberry and guavas have high vitamin C content, while all yellow fruits are good sources of vitamin A (low levels are seen in TB patients, while low levels in household contacts might increase TB risk).
These include milk, curds, cottage cheese (paneer), processed cheese.
- Nutritive value : They are a source of protein, fat, calcium, vitamins A and D, B vitamins (including B12). Depending on the source (human, buffalo, goat), the protein content ranges from 3-4 gm per 100 gm, fat content is 4 – 8%. Protein, fat content of cheese is higher. 100 ml of milk provides 70 to 110 kcal.
- Special mention : Some persons have lactose intolerance and may have flatulence and diarrhoea after consumption of milk and dairy products.
These include milk, curds, cottage cheese (paneer), processed cheese.
- Nutritive value : One egg weighing about 60 gm provides 6 gm of proteins, 6 gm of fat and supplies about 90 kcal. Meat and fish have 15 – 25% protein of good quality, iron and zinc. Fish fat is rich in unsaturated fatty acids and Vitamin A and D.
- Special mention : Egg protein is of high biological value and is the reference protein to which proteins (plant, meat, fish) are compared. One egg can substitute for 50% of pulse consumption in terms of protein intake.
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