Dr Anurag Bhargava, from the Himalayan Institute of Medical Science, wrote in the BMJ that undernutrition in adults is an under-recognised driver of TB epidemics, which are declining only slowly in high burden countries despite treatment programmes.
“Large cohort studies have consistently shown a strong, inverse, and exponential relation between body mass index and incidence of TB,” he wrote.
“In the most recent study, new cases of TB were 12 times higher in people with a low body mass index (BMI<18.5), relative to those with normal BMI (18.5-25) after other factors were adjusted.”
He added undernourished people in countries with a high burden of TB and battling food inflation, needed “urgent access to the oral ‘vaccine’ of a balanced adequate diet.”
Around 55% of the 2m TB cases in India can be attributed to undernutrition. Bhargava pointed out that modelling suggests that reducing adult undernutrition could cut new cases by up to 71% in certain Indian states.
He called for larger trials to now assess to what extent food supplementation approves treatment outcomes.
“The World Health Organization’s recent guideline made recommendations for nutritional support in patients with TB,and these need to be acted on by those managing TB treatment programmes,” he said.
“Although a systematic review published this year found that there was insufficient research to judge whether food supplementation improves treatment outcomes, the summary risk ratio for death in supplemented patients who were HIV negative is promising, and larger pragmatic trials are urgently needed.”
He argued that nutrition could not be ignored if the WHO was to meet its targets of cutting global TB cases.
“In many cases, TB is a nutritional disease that can be prevented by placing nutrition (including adult nutrition) at the heart of the global developmental and public health agenda and implementing appropriate economic and agricultural policies, social protection measures, and targeted nutritional interventions,” he said.
“It’s time for the new vision of TB control to also focus on this measurable, preventable, and reversible coepidemic of undernutrition.”
BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i5407
“Undernutrition, nutritionally acquired immunodeficiency, and tuberculosis control.”
Author: Dr Anurag Bhargava