Tuberculosis (TB) and undernutrition are two of our key issues at Results. Both have a devastating impact on the lives of the poor in developing countries, yet both have a worryingly low profile in the aid and development discourse in donor countries. They are also two issues that are closely intertwined.
It has long been known that there is an association between TB and malnutrition, although it is difficult to determine what the nutritional status of individuals with TB was before the onset of the disease. Malnutrition makes people more susceptible to the development of active TB, and active TB contributes to the development of malnutrition. This vicious circle impacts not only on individuals but can easily transfer to their families and their communities.
Tuberculosis patients have lower Body Mass Index (BMI), muscle mass and subcutaneous stores of fat than control groups. A study in Malawi found that the differences can amount to as much as 20% between healthy individuals and those with active TB. This may be because some participants in the study suffered malnutrition before contracting TB, but the disease also increases demand for energy which contribute to increased weight loss if that demand cannot be met.
In full treatment, TB patients can quickly recover the weight that they have lost, but researchers have consistently found that muscle-mass and protein levels are much slower to recover. Even in patients deemed to be ‘cured’ of TB, these nutrient deficiencies can persist. This is one reason that comprehensive care for TB patients is vital long after the body has been cleared of bacteria.
There is also evidence to suggest that malnutrition, and the consequential weakness in immune function, makes it more likely that exposure to TB bacteria will result in full tuberculosis, rather than development of the latent form of the disease that is found in 2 billion people around the world. Therefore, improvements in nutrition for people who are most at risk of developing TB should directly decrease the number of TB infections, improve treatment prognoses and save lives.
On 8th June the UK and CIFF will host a global summit called Nutrition for Growth to raise attention, and funding for long-term nutrition programmes, prioritising at first 20 countries that have a high-burden of undernutrition. RESULTS is calling on the UK to make a pledge of £150million a year, or £750million over five years. A multi-year pledge is important to give stability to developing countries and allow for long-term planning and scaling up of nutrition-specific programming within stronger health systems. An improved global investment in nutrition will not only lead to a reduction in child deaths but will have an important long-term impact in reducing diseases as adults.
Good nutrition won’t definitely stop you getting tuberculosis, but it certainly gives you a better chance of fighting it successfully. If the world truly wants to see a reduction in the burden of global diseases like TB, ensuring good nutrition for all would be an excellent first step.
Note: For a more comprehensive review of evidence linking TB and undernutrition, click here