New Delhi: Addressing undernutrition could prevent up to 2.3 million tuberculosis cases worldwide, representing 23.7 per cent of infections among adults in 2023, according to a modelling study published in The Lancet Global Health journal.
India could have seen the highest reduction in tuberculosis (TB) cases if undernutrition was addressed, followed by Indonesia, the Philippines and Pakistan, researchers, including those from London School of Hygiene and Tropical Medicine, estimated.
“We estimated that eliminating moderate-to-severe undernutrition could avert 1·4 million tuberculosis episodes globally, representing 14.6 per cent of global adult incidence in 2023, while eliminating all undernutrition could avert 2.3 million episodes, representing a reduction in global tuberculosis incidence of 23.7 per cent,” the authors wrote.
The findings highlight the urgent need to scale up population-level nutritional interventions, social and health benefits from which could extend beyond tuberculosis, alongside research to assess implementation strategies and impacts, they said.
This study is the first to estimate the implications of one’s nutritional status on tuberculosis infection, the team said.
Undernutrition, defined in the study as a body mass index (BMI) under 18.5 in an adult, is a modifiable, socially determined risk factor for the bacterial infection.
In August 2023, findings of a ‘RATIONS’ trial from India published in The Lancet showed that providing nutritional support — a monthly food basket of adequate proteins and multi-vitamins — to members of TB-affected households could be a cost-effective intervention to reduce incidence among members by about 40 per cent.
A 2024 systematic review and meta-analysis (an analysis of analyses), involving more than 26 million people from 43 study cohorts from high and low TB burden countries, provided estimates on how TB risk varies non-linearly with BMI.
“Available evidence shows that undernutrition is a fundamental driver of the global tuberculosis epidemic, with current WHO (World Health Organization) estimates substantially underestimating its importance,” the authors said.
The ‘End-TB Strategy’, adopted by the World Health Assembly in 2014, is a blueprint aimed at ending the TB epidemic by 2035, focussed on reducing deaths by 95 per cent and new cases by 90 per cent, compared to 2015 levels.
The researchers said achieving global tuberculosis targets requires an integration of bio-social interventions for modifiable risk factors, alongside a continued development and equitable expansion of biomedical interventions for tuberculosis prevention, diagnosis, and treatment.
They added that urgent research is needed to establish optimal design and implementation strategies for population-level nutritional interventions beyond tuberculosis-affected households, and to evaluate their health and economic impacts.
The interventions could accelerate progress towards eradication of tuberculosis while yielding substantial wider social and health benefits, the team said. PTI
