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

Abstract Objective To evaluate the association of oral nutritional supplementation on nutritional, immune, and bacteriological outcomes in hospitalized patients with tuberculosis (TB) and malnutrition. Methods This retrospective real-world study included 118 inpatients aged 18–90 years with TB and malnutrition. Of these, 78 received general dietary advice without oral nutritional supplementation, and 40 received a high-protein mixed-nutrient formula providing an additional 15 g of protein and 240 kcal daily. Changes in nutritional, immune, and sputum outcomes were evaluated using generalized estimating equations. Results Oral nutritional supplementation was associated with consistent improvements in nutritional and immune parameters, including albumin, prognostic nutritional index, neutrophil count, T-cell subsets (CD3 + , CD4 + , CD8 + ), as well as a greater reduction in the platelet-to-lymphocyte ratio and lower odds of immune dysfunction (OR = 0.14, 95% CI: 0.03–0.56; P = 0.006). These associations were robust across sensitivity analyses. The overall association with sputum culture positivity was not statistically significant (OR = 0.34, 95% CI: 0.09–1.23; P = 0.100). Exploratory analyses revealed associations with reduced sputum culture positivity among non-smokers, participants without hyperuricemia, and in the follow-up duration-matched analysis, providing hypothesis-generating evidence for a potential bacteriological benefit. Conclusion In hospitalized patients with TB and malnutrition, oral nutritional supplementation was associated with improved nutritional status and immune recovery, supporting its potential role as an adjunct to routine TB treatment. The overall bacteriological association was not statistically significant, but exploratory findings suggest a possible benefit that warrants confirmation in prospective randomized trials.