Addressing undernutrition could prevent nearly one in four adult tuberculosis (TB) cases worldwide, with India projected to gain the most if nutrition gaps are closed, according to a new modelling analysis published in The Lancet Global Health. The study estimates that eliminating all forms of undernutrition could avert 2.3 million TB episodes globally, representing a 23.7 per cent reduction in adult TB incidence in 2023. Researchers found that India, followed by Indonesia, the Philippines and Pakistan, would see the largest absolute declines in TB burden if undernutrition is effectively tackled.
The authors modelled different scenarios and reported that even a more modest target, eliminating moderate-to-severe undernutrition, could avert 1.4 million TB cases, corresponding to a 14.6 per cent reduction in global adult TB incidence. The findings reinforce growing evidence that undernutrition is not just a background social determinant, but a primary driver of TB risk in many high-burden countries, where large sections of the population live with low body mass index and food insecurity.
The study’s estimates come at a critical time for TB programmes that are struggling to meet End TB Strategy milestones, particularly after setbacks during the Covid-19 pandemic. While global efforts have historically prioritised diagnostics, drugs and vaccines, the new analysis suggests that nutrition-focused interventions could yield substantial epidemiological gains at the population level, complementing biomedical tools.
For India, where undernutrition has been identified as the single largest risk factor for developing active TB, the results provide quantitative backing for integrating nutrition more centrally into the National Tuberculosis Elimination Programme. Previous modelling from India has shown that reducing undernutrition in vulnerable states could cut TB incidence and mortality by more than 40 per cent over two decades, underscoring the potential of food and income support schemes to shift the trajectory of the epidemic.
Experts say the Lancet Global Health analysis adds urgency to calls for sustained investments in social protection, dietary support and poverty alleviation as part of TB control strategies, rather than viewing them as peripheral add-ons. They argue that without systematic action on undernutrition, high-burden countries are unlikely to achieve the steep annual declines in TB incidence needed to meet global targets, even if diagnostics and treatment coverage continue to expand.
