Undernutrition and Tuberculosis: Public Health Implications

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.

Household food insecurity among patients with pulmonary tuberculosis and its associated factors in South India: a cross-sectional analysis

“…Food insecurity and undernutrition share a bidirectional relationship with TB; both cause TB and could be consequences of TB. Undernutrition in patients with active TB can lead to worsening of disease, drug toxicity, drug malabsorption, and death or relapse of disease 5–7…”

Food for Thought: The Role of Undernutrition and Diabetes in India’s TB Epidemic

“…6 The impaired cell-mediated immunity in individuals with severe malnutrition affects the ability to control the infection and increases likelihood of progression to TB disease. 7,8 Not only does undernutrition increase the risk for TB, it also increases the severity of disease. 8 Changes in body composition also put malnourished individuals at risk of drug-associated toxicities despite weight-based dosing.…”

“…7,8 Not only does undernutrition increase the risk for TB, it also increases the severity of disease. 8 Changes in body composition also put malnourished individuals at risk of drug-associated toxicities despite weight-based dosing. 9 Furthermore, patients with undernutrition are at risk for worse treatment outcomes.…”

Crystal ball: the yesterday and tomorrow of tuberculosis

“…It is difficult to refute the enormity of undernutrition's current impact on the TB epidemic (Sinha et al, 2018). The 2018 global TB report estimated that 18% (or 1.9 million) of the world's 10 million TB cases were attributable to undernutrition in 2017 (WHO, 2018).…”

“…Community health workers may play an important role (Mitnick et al, 2003;Perry et al, 2014). We also need basic information about the caloric needs of TB patients in general, especially for under-researched populations such as children and pregnant women (WHO, 2013;Sinha et al, 2018). Furthermore, while nutritional programs are available in most high burden countries, many of them exist as vertical programs with little integration into TB programs (Padmapriyadarsini et al, 2016).…”