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Lookup NU author(s): Dr James BenthamORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. Background: Nutrition is a critical determinant of tuberculosis (TB), providing a protective effect at high body mass index (BMI) and incurring an increased risk of TB disease at low BMI. Global nutritional transition and interventions to end hunger could directly affect the TB epidemic in high TB burden countries. Methods: We constructed dynamic TB transmission models for 12 high TB burden countries with low HIV prevalence. We explicitly accounted for the effects of BMI on TB disease progression and treatment outcomes using a meta-analysis of longitudinal cohort studies, incorporating the effect of BMI mediated through diabetes. The models were calibrated to historical trends in TB epidemiology and mean BMI. We estimated potential changes in TB incidence and mortality between 2015 and 2030 under different scenarios of population nutrition. Findings: Compared with a scenario where mean BMI remained at 2015 levels, if past trends in mean BMI continued then by 2030 TB incidence and mortality would decline by a cumulative 14.7% (95% credible interval: 12.7%–16.7%) and 15.6% (12.5%–19.2%), respectively. In comparison, achieving zero hunger by 2030 would reduce incidence and mortality by 32.0% (20.0%–43.8%) and 37.3% (26.1%–49.6%), respectively. If past trends continued and zero hunger was also achieved, incidence and mortality would be reduced by 38.2% (27.0%–49.1%) and 42.4% (32.1%–53.5%), respectively, equivalent to preventing 20.6million people developing TB disease and averting 5.4million TB deaths over 15 years in the 12 high-burden countries. Conclusions: Nutrition transitions and interventions to end hunger could have a major impact on the future epidemiology of TB in high-burden countries. Investment is urgently required to implement and scale up nutritional interventions.
Author(s): Wu C-Y, Ku C-C, McQuaid CF, Lonnroth K, Cegielski JP, Bentham J, Ezzati M, Lin H-H
Publication type: Article
Publication status: Published
Journal: BMJ Global Health
Year: 2025
Volume: 10
Issue: 12
Online publication date: 25/12/2025
Acceptance date: 12/11/2025
Date deposited: 12/01/2026
ISSN (electronic): 2059-7908
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/bmjgh-2024-018839
DOI: 10.1136/bmjgh-2024-018839
Data Access Statement: Data are available on reasonable request.
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