Feasibility and safety of a structured nutritional intervention in underweight patients with nontuberculous mycobacterial pulmonary disease: a pilot study

Poor nutritional status in nontuberculous mycobacterial pulmonary disease (NTM-PD) is associated with increased mortality and reduced treatment tolerance. In this 12-week prospective, single-arm pilot study, we assessed the feasibility and safety of a structured nutritional program in patients with NTM-PD who are underweight. Patients with NTM-PD with body mass index (BMI) < 19 kg/m 2 , unintentional weight loss within the past year, or anorexia were included. The intervention involved individualized nutritional counseling delivered by a registered dietitian, biweekly follow-up assessments, and daily oral nutritional supplementation (two packs; 200 kcal/200 mL per pack). Eleven patients were enrolled, and 10 completed the study (median age 69.5 years [interquartile range 58.0–72.0]; 90% female; BMI 16.5 kg/m 2 [16.2–18.6]). The intervention was well tolerated, and most participants achieved the predefined adherence threshold. Mild gastrointestinal symptoms were reported (abdominal fullness 30%, indigestion 10%), with no serious adverse events. Total daily energy intake increased from 1354 to 1950 kcal/day ( P = 0.002), and body weight increased from 43.0 to 45.6 kg ( P = 0.018). This pilot trial supports the feasibility and safety of a structured nutritional program in patients with NTM-PD who are underweight and provides a basis for progression to a larger, adequately powered definitive trial.