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Review
. 2022 Mar 17:27:100311.
doi: 10.1016/j.jctube.2022.100311. eCollection 2022 May.

Undernutrition is feeding the tuberculosis pandemic: A perspective

Madeline E Carwile  1 , Natasha S Hochberg  1   2   3 , Pranay Sinha  1   2
Affiliations
Review

Undernutrition is feeding the tuberculosis pandemic: A perspective

Madeline E Carwile et al. J Clin Tuberc Other Mycobact Dis. .

Abstract

Tuberculosis (TB) is a major cause of death worldwide, with 1.5 million deaths in 2020. While TB incidence and mortality had previously been on a downwards trend, in 2020, TB mortality actually rose for the first time in a decade, largely due to the COVID-19 pandemic. Undernutrition is the leading risk factor for TB, with a population attributable fraction (PAF) of 15%, compared to 7.6% for HIV. Individuals who are undernourished are more likely to develop active TB compared to those with a healthy bodyweight. They are also more likely to have greater severity of TB, and less likely to have successful TB treatment outcomes. The likelihood of TB mortality significantly increases as weight decreases. Nutritional interventions are likely to improve both nutritional status and TB treatment success, thereby decreasing TB mortality. However, many previous studies focusing on nutritional interventions have provided insufficient calories or been underpowered. Nutritional supplementation will be particularly important as factors such as the COVID-19 pandemic, climate change, and political conflict further threaten food security. The global TB elimination effort can no longer afford to ignore undernutrition.

Keywords: BMI; Nutritional interventions; Tuberculosis; Undernutrition.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Tuberculosis mortality in Amsterdam during World War II. Data derived from Daniels, 1949 .
Fig. 2
Fig. 2
Relationship between TB incidence and prevalence adapted with permission from Global Tuberculosis Report 2021 (license: CC BY-NC-SA 3.0 IGO) .
See this image and copyright information in PMC

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