Government of India has recently approved the rollout of Energy Dense Nutritional Supplementation (EDNS) for 12 lakh underweight tuberculosis (TB) patients, despite pending trial results on its efficacy. The sachets, containing sweetened peanut paste, milk powder, and oil, will replace traditional food support for two months. However, experts warn this decision may commercialize care and prove costlier than providing a food basket, a proven intervention recommended by a landmark trial.
The RATIONS trial, published in The Lancet last year, demonstrated that a monthly 10 kg food basket along with multivitamins for 6 months significantly improved TB outcomes and reduced mortality. The cost for this intervention was pegged at ₹1,100 per patient monthly in 2019. In contrast, EDNS costs have ballooned to ₹4,300 per patient per month for just 2 months.
Interestingly, EDNS was being considered as an intervention before the RATIONS trial results were released. A small acceptability study conducted in 2018–2019 supported its feasibility, but experts now question its premature implementation.
Dr. Veena Shatrugna, former deputy director of the National Institute of Nutrition, cautioned, “The message of improving home diets in TB patients is not possible if such a programme is launched. It will be a fertile ground for the food processing industry to provide EDNS.”
The efficacy trial for EDNS, involving 329 participants, concluded earlier this year but is yet to be published in a peer-reviewed journal. Experts have raised concerns that the shift from a food basket to EDNS risks undermining the nutritional support critical for TB recovery and cure rates.
