Giving supplies of food and nutrients to households affected by tuberculosis (TB) could prevent more than 350,000 deaths in India over the next decade, according to a new modelling study.

The research, led by the London School of Hygiene & Tropical Medicine (LSHTM) with partners including Yenepoya University in India, suggests that giving regular nutritional support to just half of adults on TB treatment and the people they live with could prevent 361,200 deaths and 880,700 cases in India from 2023-2035.

Approximately 20% of TB cases throughout the world are caused by undernutrition, a number which increases to over a third in India. Concerns about TB caused by undernutrition have increased as the number of people globally who face food insecurity has increased in recent years.

Nutritional care, which involves providing TB patients and their households with food baskets for the duration of TB treatment, is often limited to giving a small amount of money from either the government or from crowd-funding initiatives.

In the publication in The Lancet Global Health, researchers estimated the health benefits and financial costs of nutritional care programmes for TB patients based on the recent, widely acclaimed RATIONS trial. This supplied rations of food and vitamin and mineral pills on a monthly basis to adults being treated with TB and their household contacts.

The study used mathematical modelling to look at the impact and cost-effectiveness of providing nutritional support based on the programme in the RATIONS trial.

Within a 50% coverage for adults with TB and their household contacts, the nutritional care package was estimated to prevent between 318,000–437,700 deaths (with a mean of 361,200 deaths, approximately ~5% of deaths) and 802,700-974,900 cases of TB (with a mean of 880,700). The paper also estimates that provision of this support is very likely to be cost-effective.

The researchers say these results show how nutritional care programmes could have a significant impact on curtailing the TB epidemic (alongside other potential health benefits) in India in an affordable way.

Finn McQuaid, an Associate Professor at LSHTM and study co-author, said: “People with TB and their households are often a marginalised group, frequently already experiencing food insecurity and exposed to further harm by the presence of TB disease.

“Providing these households with nutritional support looks to be an underused approach that could make a significant difference in improving their health and livelihood, and preventing future TB disease. Our work showed that this intervention is also highly likely to be cost-effective for the TB programme.

"This paper could provide guidance for policymakers selecting TB interventions, highlighting the importance of nutritional support in addressing the TB epidemic, and the real benefits this is likely to provide not just to affected households but at a national level.”

Rebecca Clark, a Research Fellow at LSHTM and another of the study’s authors, added: “International and national decision-makers could use our findings to advocate for better, as well as more targeted and relevant, interventions when it comes to support for TB patients and their families.

“I would like to see research funders and national TB programmes use this study to motivate for further setting-specific research to identify where nutritional support could be a useful tool to reduce TB burden, and what the composition of such support should look like.”

Limitations

The authors acknowledge some limitations of the study, including that the intervention was assumed to be scaled up immediately across both the public and private sector, which might not be possible in practice.

Additionally, as the nutritional trial the study modelled was run in India, this study was limited in its focus to just one country. However, the risk of further TB disease and death in TB-affected households means this intervention could also be cost-effective in other settings.

Publication

Finn McQuaid et al. Estimating the epidemiological and economic impact of providing nutritional care for tuberculosis-affected households across India: a modelling study. The Lancet Global Health. https://doi.org/10.1016/ S2214-109X(24)00505-9