New Delhi: An estimated 7 lakh adults in India could have avoided tuberculosis (TB) in 2023 simply by eliminating undernutrition, a new study published in The Lancet has said.The study, titled “Global, regional, and national estimates of tuberculosis incidence averted by eliminating undernutrition in adults: a modelling study”, estimated that eliminating all forms of undernutrition could have prevented nearly 2.3 million TB cases globally in 2023 — around 23.7% of total adult incidence. Eliminating moderate-to-severe undernutrition alone could have averted 1.4 million cases worldwide.For India, researchers estimated that removing undernutrition could have prevented nearly 28.6% of adult TB disease episodes in 2023, which translates to 7.12 lakh avoidable cases.“We estimated that for India in 2023 specifically, eliminating all undernutrition (i.e. BMI<18.5kg/m2) would avoid 28.6% (25.3% to 31.8%) of adult TB disease episodes. That means 7,12,000 (4,60,000 to 9,63,000) adult TB disease episodes for 2023,” professor Pete Dodd from Sheffield Centre for Health and Related Research, who is one of the authors of the report, told TOI.Delhi govt officials said several interventions are under way to tackle both — nutrition gap and early detection. These include the CSR-backed Nikshay Mitra “Food Basket” initiative, which provides six months of nutritional support to TB patients, and the Centre-led Energy Dense Nutrition Supplement programme for low-BMI patients.Between 60,000 and 75,000 TB cases are under treatment in Delhi, while more than 2.5 lakh have been screened over recent months. Officials said screening efforts have intensified in hotspot areas.“Abnormal findings are sent for molecular testing. If positive, treatment begins in 24 hours. This is the way to elimination… it’s good that more cases are being reported. That means that screening is robust,” a Delhi govt official said.The report’s findings are significant for Delhi where the latest Economic Survey has identified it as one of the capital’s major public health concerns and estimated that nearly 40% of residents carry the latent TB bacteria.While latent TB does not mean active disease, doctors warn that weak immunity can trigger dormant bacteria. “Better nutrition means better immunity which helps the body fight the TB bacteria. Thus, undernutrition is linked. High population density, people not taking proper treatment and pollution impact immunity that keeps lungs inflamed and makes a person more prone to infection,” said Dr Anubhav Shami, MD, internal medicine, Safdarjung Hospital.“Traditionally, TB was associated with lower socioeconomic groups. However, we are increasingly diagnosing TB in middle-class and affluent populations as well, especially among individuals with weakened immunity, chronic illnesses, or high pollution exposure,” said Dr Avi Kumar, senior consultant, pulmonology, Fortis Escorts Okhla.Experts said the study validates what clinicians have observed for years — that malnutrition significantly weakens immunity and increases the risk of TB activation.“Nearly 40% of Indians are estimated to carry latent TB infection, where the bacteria remains dormant for years without causing disease. The challenge is that TB can reactivate whenever immunity weakens due to malnutrition, diabetes, cancer therapy, poor sleep or other immunosuppressive conditions. Nutrition therefore becomes central to TB control,” said Dr Rajesh Chawla, senior consultant, respiratory and critical care medicine, Apollo Hospitals.“Delhi’s TB burden is also being amplified by overcrowding, air pollution, diabetes, smoking, stress, and delayed diagnosis,” said Dr Vikas Mittal, director and pulmonologist, CK Birla Hospital, Delhi.
