Although nearly 250 000 South Africans develop TB every year – and about 54 000 of them die from it – and the disease itself receives significant research attention, experts say investment in new diagnostics, drugs, vaccines and implementation strategies remains insufficient relative to its global burden, reports The Citizen.
Professor Linda Malan from North-West University’s (NWU) Centre of Excellence for Nutrition, said continued research was vital to develop shorter, safer treatments, better diagnostics, and to improve prevention and patient outcomes.
For this reason, she and her team at NWU are looking beyond the treatment of TB itself. Their question is simple: what if, alongside standard TB treatment, nutrition could help the body respond more effectively to the disease?
This potential is at the heart of their research into omega-3 fatty acids.
The TREAT3 clinical trial, part of the Clinical Nutrition Sub-programme at the NWU Centre of Excellence for Nutrition, Faculty of Health Sciences, builds on 10 years of preclinical research. It is investigating whether adding long-chain omega-3 fatty acids to standard treatment can influence inflammation and the body’s response to TB.
The aim is not to replace TB medication, but to investigate whether omega-3 could help the body cope with the disease and its inflammatory effects.
“TB treatment kills the bacteria, but the body’s immune response also plays a major role in recovery,” Malan said.
Inflammation is a necessary part of fighting TB, but when that response becomes excessive or prolonged, it can damage lung tissue and contribute to ongoing symptoms and impaired recovery, she added.
“That is why we are interested in the balance of the immune response – not simply suppressing inflammation, but helping the body respond appropriately.”
This is where omega-3 comes in.
Exploring new possibilities
Omega-3 fatty acids are essential fats involved in the immune system and regulation of inflammation, which are found in foods like oily fish, seafood, nuts and seeds. The NWU research, however, focuses specifically on long-chain omega-3 fatty acids (EPA and DHA), which are abundant in fish oil.
When consumed, EPA and DHA become incorporated into cell membranes and can influence how immune cells communicate. They also provide building blocks for molecules involved in regulating and resolving inflammation.
The NWU team is investigating whether increasing omega-3 intake alongside standard TB treatment can regulate the immune response, potentially helping the body fight infection while limiting unnecessary inflammation and tissue damage.
Their earlier preclinical work provided encouraging evidence for this approach. In infected mice, omega-3 supplementation reduced excessive inflammation, improved markers of anaemia of infection, and showed inflammation-resolving effects without increasing bacterial load. The effects were particularly evident in animals with low omega-3 status before infection.
“Interestingly, longer-term omega-3 supplementation performed better than the anti-inflammatory drug ibuprofen in some measures, suggesting that this nutrition-based intervention warrants further investigation as a potentially safe and effective way to reduce inflammation,” she said.
“These findings supported the concept of omega-3 as a potential adjunct, or host-directed, therapy alongside standard TB treatment.”
Taking research into practice
The crucial question is whether laboratory findings can benefit people. That is now being tested at the Perinatal HIV Research Unit at Tshepong Hospital in Klerksdorp. The setting is particularly relevant in a country where HIV co-infection remains one of the factors complicating the fight against TB.
The clinical trial began in August this year, and aims to enrol 40 participants, with eight enrolled to date. Participants take two grams of omega-3 fatty acids daily with standard TB medication for two months and are followed until completing treatment at six months. The trial should be completed by the end of 2027.
“The work brings together nutrition, immunology and TB research,” Malan noted
For the researchers, the appeal lies in what the findings could mean beyond the laboratory. If omega-3 improves outcomes, omega-3-rich foods could be incorporated into TB care alongside standard treatment instead of relying solely on supplements.
In South Africa, she highlights affordable oily fish like pilchards because they provide EPA, DHA, high-quality protein and other nutrients that may support recovery.
A food-based approach could potentially be more sustainable and accessible in resource-limited communities.
“What excites us most,” she said, “is the possibility that a simple, affordable nutritional intervention could complement TB treatment while addressing both infection and the patient’s broader nutritional and inflammatory needs.”
See more from MedicalBrief archives:
Studies show little or no benefit from omega-3 supplements and slight risk
Fish oil supplements may increase heart conditions risk – global study
Vitamin D and Omega-3 supplementation reduced autoimmune disease – VITAL trial