Addressing undernutrition could prevent up to 2.3 million cases of Tuberculosis worldwide, accounting for nearly 23.7 per cent of adult infections reported in 2023, according to a modelling study published in The Lancet Global Health.
Researchers, including experts from the London School of Hygiene and Tropical Medicine, found that India could have recorded the largest reduction in TB cases if undernutrition had been effectively addressed. Indonesia, the Philippines, and Pakistan followed closely behind.
Study Highlights Strong Link Between Nutrition and TB
The researchers estimated that eliminating moderate-to-severe undernutrition could prevent nearly 14 million tuberculosis episodes globally. This would represent a 14.6 per cent reduction in global adult TB incidence in 2023.
Furthermore, eliminating all forms of undernutrition could prevent up to 2.3 million TB episodes, reducing global tuberculosis incidence by 23.7 per cent.
As reported by Business Standard, the authors stated, “We estimated that eliminating moderate-to-severe undernutrition could avert 1.4 million tuberculosis episodes globally, while eliminating all undernutrition could avert 2.3 million episodes.”
Researchers Call for Urgent Nutritional Interventions
The findings underscore the urgent need to expand population-level nutritional interventions. According to the researchers, such measures could deliver health and social benefits that extend beyond tuberculosis prevention.
They also stressed the importance of further research to evaluate implementation strategies and assess the broader impact of nutrition-based interventions.
Importantly, the team described the study as the first to estimate how an individual’s nutritional status influences tuberculosis infection risk.
Undernutrition Identified as a Major Risk Factor
The study defined undernutrition as a body mass index (BMI) below 18.5 in adults. Researchers identified it as a modifiable and socially determined risk factor for tuberculosis, a bacterial infectious disease.
Additionally, the authors noted that existing evidence suggests undernutrition plays a much larger role in the global TB epidemic than current estimates by the World Health Organization (WHO) indicate.
“Available evidence shows that undernutrition is a fundamental driver of the global tuberculosis epidemic, with current WHO estimates substantially underestimating its importance,” the authors wrote.
Earlier Indian Trial Showed Benefits of Nutritional Support
The study also referred to findings from the ‘RATIONS’ trial conducted in India and published in The Lancet in August 2023.
The trial showed that providing nutritional support, including monthly food baskets containing adequate protein and multivitamins, to TB-affected households reduced tuberculosis incidence among family members by nearly 40 per cent.
Researchers described the intervention as both effective and cost-efficient.
Meta-Analysis Further Strengthens Evidence
Moreover, a 2024 systematic review and meta-analysis involving more than 26 million people from 43 study cohorts across high- and low-TB-burden countries further supported the findings.
The analysis demonstrated that the risk of tuberculosis varies significantly with BMI, strengthening evidence linking poor nutrition to higher TB risk.
Achieving Global TB Targets Requires Broader Action
The researchers emphasised that achieving the goals of the WHO’s ‘End-TB Strategy’ will require a combination of biomedical and bio-social interventions.
Adopted by the World Health Assembly in 2014, the strategy aims to end the TB epidemic by 2035 by reducing deaths by 95 per cent and new TB cases by 90 per cent compared to 2015 levels.
According to the authors, governments and health systems must integrate nutrition-focused strategies with existing TB prevention, diagnosis, and treatment programmes.
Experts Urge Further Research and Policy Support
Finally, the researchers called for urgent studies to determine the most effective ways to design and implement large-scale nutritional interventions beyond TB-affected households.
They added that such interventions could accelerate global progress toward TB eradication while also delivering substantial long-term health, social, and economic benefits.