A groundbreaking study published in PLOS Global Public Health has highlighted the critical role of nutrition in tuberculosis (TB) care, urging health systems worldwide to integrate nutritional support as a core component of treatment. Conducted in India, the research reveals how malnutrition can significantly impact patient recovery, suggesting that addressing nutritional deficits could enhance treatment outcomes.
The study, led by Catherine Kagemann from the Cornell Joan Klein Jacobs Center for Precision Nutrition and Health, arrives in tandem with the World Health Organization’s (WHO) recent guidelines advocating for the integration of nutritional assessments in TB programs. This marks a pivotal shift in global TB policy.
Metabolic Insights and Treatment Implications
The research team analyzed metabolic changes in patients with mild and severe pulmonary TB over six months of treatment. They discovered distinct patterns that varied with infection severity, offering new insights into how TB and its treatment affect the body. “Even after successful TB treatment, we found that there is still a metabolic scar in these patients,” Kagemann noted, emphasizing the need for nutritional interventions in future studies.
Dr. Saurabh Mehta, a corresponding author and director of the Jacobs Center, highlighted the historical context: “When modern TB treatments emerged in the 1960s, they were so effective that nutrition was often sidelined. However, TB depletes a lifetime of nutritional resources, raising the question of how to restore the body’s systems to prevent relapse or other metabolic diseases.”
The Vicious Cycle of TB and Malnutrition
Malnutrition is both a cause and consequence of TB. Undernourished individuals are more susceptible to the disease, and TB itself can lead to severe wasting. The study aimed to fill the knowledge gap at the molecular level, incorporating chest X-ray imaging and sputum smear tests to provide a comprehensive view of metabolic shifts with disease severity.
Patients with higher bacterial loads exhibited significant metabolic disruptions, potentially identifying biomarkers for future treatment strategies. The WHO’s updated guidelines, released on October 8, emphasize that nutritional support should be a standard part of TB care, reflecting a move towards holistic treatment approaches.
Global and Local Implications
According to the WHO, 8.2 million people were diagnosed with TB in 2023, reaffirming its status as the world’s leading infectious killer. In many low- and middle-income countries, TB and food insecurity are deeply intertwined. In the United States, TB cases reached a 13-year high in 2024, underscoring the global nature of the challenge.
The pilot study in India offers promising evidence that metabolic insights could tailor treatment based on nutritional and disease status, a strategy long absent from TB programs. “In a larger cohort study in China, similar metabolic scarring was observed,” Kagemann stated. “Our next step is to determine whether a general balanced diet or a targeted precision nutrition approach is more effective.”
Broader Impact on TB Care
Expanding this research could reshape how doctors monitor treatment progress and how governments structure nutritional support in TB care, potentially saving lives and improving recovery rates. This builds on recent work by Mehta and colleagues, including a Lancet editorial advocating for food support for TB patients and a paper in Lancet Global Health outlining a roadmap for nutritional support.
“We have been fervently searching for a new vaccine, more effective drugs, and host-directed therapies to prevent TB deaths,” said Dr. Pranay Sinha of Boston Medical Center. “But even as we search for remedies in sophisticated labs, we must not ignore those already available in the local grocery store.”
Future Directions and Challenges
This study, part of the RePORT India program funded by USAID, tracks how metabolic profiles change during TB treatment, revealing distinct patterns in patients with varying disease severity. “These findings provide a window into the biological processes underlying disease severity and treatment response,” said Senbagavalli Prakash Babu, principal investigator of the study.
Dr. Mehta emphasized the broader goal: “Curing the disease or infection is not enough. We also have to reconstitute and rehabilitate the person.” As the global health community grapples with TB’s persistent threat, integrating nutrition into treatment protocols may prove a vital step in improving patient outcomes and combating the disease’s spread.
