This seminar will discuss The Reducing Activation of Tuberculosis by Improvement Of Nutritional Status (RATIONS) trial. This was a multi-institutional cluster randomised trial, supported by the Indian Council of Medical Research, conducted between 2019 -2022 in four districts of Jharkhand. It was the first trial globally to aim for a reduction of tuberculosis (TB) incidence by improving the nutritional status of those at risk, and it was the largest cohort study of patients with TB who were given nutritional support to improve TB treatment outcomes.