Abstract / Summary
ABSTRACT
Background: Nutraceuticals are widely used as adjuncts in tuberculosis (TB) management to improve nutritional status, immunity, and treatment tolerance. However, evidence regarding their safety in TB patients remains limited.
Objective: To systematically assess the adverse effects associated with nutraceutical use in patients diagnosed with tuberculosis and to evaluate causality, severity, and risk of bias of the included studies.
Methods: : This systematic review was registered in PROSPERO (CRD420251235338). Electronic databases including PubMed and Cochrane Library were searched up to December 10, 2025. Eligible studies included randomized controlled trials, quasi- experimental studies, cohort, case-control, cross-sectional studies, case reports, and case series involving TB patients receiving nutraceuticals. Quality assessment was performed using Joanna Briggs Institute (JBI) tools. Causality was assessed using the Naranjo Scale and WHO-UMC criteria, and severity was evaluated using the Hartwig Severity Assessment Scale.
Results: : A total of 19 studies were included in which nutraceuticals such as vitamin D, vitamin A, zinc, multivitamins, and energy-dense nutritional supplements were most commonly evaluated. Several studies reported no significant adverse events with few reported as gastrointestinal disturbances, hypercalcemia, elevated uric acid levels hepatotoxicity, anemia, and rare mortality events. Most adverse reactions were classified as unlikely or possible in causality and mild or severe in severity. All studies were rated as high quality with low risk of bias.
Conclusion: Nutraceutical supplementation in tuberculosis patients appears largely safe; however, certain supplements may be associated with adverse effects. Nutrivigilance is required to establish definitive safety profiles of nutraceuticals.
Keywords: Tuberculosis; Nutraceuticals; Dietary supplements; Adverse effects; Systematic review