Undernutrition and Tuberculosis: Public Health Implications

Pranay Sinha, Juliana Davis, Lauren Saag, Christine Wanke, Padmini Salgame, Jackson Mesick, C Robert Horsburgh, Natasha S Hochberg
Journal of Infectious Diseases 2018 November 22
Almost 800 million people are chronically undernourished worldwide, 98% of them in low and middle-income countries where tuberculosis (TB) is endemic. In many TB-endemic countries, undernutrition is a driver of TB incidence and associated with a high population attributable fraction of TB and poor treatment outcomes. Data suggest that undernutrition impairs innate and adaptive immune responses needed to control Mycobacterium tuberculosis (Mtb) infection and may affect responses to live vaccines such as Bacillus Calmette-Guérin (BCG). Given its impact on TB, addressing undernutrition will be a vital component of the End-TB strategy. This narrative review describes the effect of undernutrition on the immune response, vaccine response, and TB incidence, severity, and treatment outcomes.

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