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Review
. 2019 Apr 16;219(9):1356-1363.
doi: 10.1093/infdis/jiy675.

Undernutrition and Tuberculosis: Public Health Implications

Pranay Sinha  1 , Juliana Davis  2 , Lauren Saag  3 , Christine Wanke  4 , Padmini Salgame  5 , Jackson Mesick  2   6 , C Robert Horsburgh  1   2   6 , Natasha S Hochberg  1   2
Affiliations
Review

Undernutrition and Tuberculosis: Public Health Implications

Pranay Sinha et al. J Infect Dis. .

Abstract

Almost 800 million people are chronically undernourished worldwide, of whom 98% are in low- and middle-income countries where tuberculosis is endemic. In many tuberculosis-endemic countries, undernutrition is a driver of tuberculosis incidence and associated with a high population attributable fraction of tuberculosis and poor treatment outcomes. Data suggest that undernutrition impairs innate and adaptive immune responses needed to control Mycobacterium tuberculosis infection and may affect responses to live vaccines, such as BCG. Given its impact on tuberculosis, addressing undernutrition will be a vital component of the World Health Organization End TB strategy. This narrative review describes the effect of undernutrition on the immune response, vaccine response, and tuberculosis incidence, severity, and treatment outcomes.

Keywords: Undernutrition; body mass index; latent Mycobacterium tuberculosis infection; nutrition disorders; tuberculosis.

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Figures

Figure 1.
Figure 1.
Undernutrition blunts both adaptive and immune responses against Mycobacterium tuberculosis through multiple mechanisms. IFN-γ, interferon γ; IL-10, interleukin 10; NO, nitric oxide; Th1, T-helper type 1; Th2, T-helper type 2; TGF-β, transforming growth factor β; TNF-α, tumor necrosis factor α.
Figure 2.
Figure 2.
Population attributable fractions (PAFs) of tuberculosis due to undernutrition in 22 countries with a high tuberculosis burden. The map was created using data derived from Lönnroth et al [35].
See this image and copyright information in PMC

Comment in

References

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