Undernutrition as a risk factor for tuberculosis disease

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Nutritional Science

Background:

• Tuberculosis (TB) remains a major global cause of death, with 10.6 million new cases in 2022.
• Undernutrition is a significant risk factor, contributing to 2.2 million TB episodes in 2022.

Purpose of the Study:

• To evaluate the prognostic value of undernutrition in predicting tuberculosis disease.
• To assess this risk across diverse populations including adults, adolescents, and children.

Main Methods:

• A systematic review and meta-analysis of 51 cohort studies involving over 27 million participants.
• Studies were assessed for bias using the Quality In Prognosis Studies (QUIPS) tool.
• Random-effects meta-analysis was used to calculate hazard ratios (HR), risk ratios (RR), and odds ratios (OR).

Main Results:

• Undernutrition was associated with an increased risk of TB disease (HR 2.23).
• The risk was more consistent and moderate for follow-up periods under 10 years (HR 2.02).
• Evidence certainty was generally low to moderate due to bias and inconsistency across studies.

Conclusions:

• Undernutrition likely increases TB risk twofold in the short term (<10 years) and may also increase long-term risk.
• Policies reducing undernutrition are vital for ending the TB epidemic by 2030.
• High-quality cohort studies are needed to refine risk estimates, especially in low-income countries and for pediatric populations.