Macronutrient-based interventions and TB treatment outcomes: a scoping review

<sec><title>INTRODUCTION</title>Macronutrients may influence TB outcomes through biological and clinical mechanisms. We conducted a scoping review to map evidence on macronutrient-based nutritional interventions during TB treatment and their associations with treatment outcomes and clinical recovery.</sec><sec><title>METHODS</title>Following Joanna Briggs Institute guidelines, a protocol was prospectively registered. We systematically searched MEDLINE, Embase, Global Health, Food Science and Technology Abstracts, and Web of Science from inception to March 2026. Eligible peer-reviewed studies included participants with active TB, evaluated macronutrient-based interventions, and reported treatment outcomes. Findings were summarised narratively and in tables.</sec><sec><title>RESULTS</title>Of 5,578 records screened, 14 studies involving 7,298 adults (17–82 years) met inclusion criteria. Interventions included food baskets or household rations, ready-to-use nutritional supplements, nutritional counselling, or combinations thereof. Protein was the most commonly targeted macronutrient. Outcomes assessed included treatment completion (n = 8), mortality (n = 7), treatment failure (n = 6), loss to follow-up (n = 6), treatment success (n = 4), cure (n = 4), sputum smear or culture conversion (n = 4), and adherence (n = 4).</sec><sec><title>CONCLUSION</title>Macronutrient-based interventions may improve TB treatment outcomes and support clinical recovery, but evidence remains heterogeneous in design and outcome reporting. Further well-designed studies using standardised outcome measures are needed to inform integration of nutritional support into TB care.</sec>