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Nearly 7 lakh TB cases in India could have been prevented in 2023: Lancet study flags the reason

A major new study in The Lancet links undernutrition to almost 29% of adult tuberculosis cases, strengthening calls to make nutrition central to India’s TB elimination strategy.

4 min readMay 12, 2026 12:35 PM IST

TB is caused by the bacterium Mycobacterium tuberculosis, but infection alone does not always lead to disease. (File photo/Canva)

Eliminating undernutrition could have prevented nearly seven lakh tuberculosis (TB) cases in India in 2023 alone, according to a major new modelling study that underscores what public health experts have long argued: India cannot eliminate tuberculosis without tackling hunger and poor nutrition.

Published in The Lancet Global Health, the study estimates that if all adult undernutrition — defined as a body mass index (BMI) below 18.5, the threshold used to classify an adult as underweight — was eliminated, 28.6 per cent of adult TB episodes in India could have been avoided.

“With India’s huge population, this amounts to approximately 7,12,000 adult TB episodes in 2023,” Prof Pete Dodd, Professor of Mathematical Modelling and Epidemiology at the University of Sheffield, told The Indian Express. The study used mathematical modelling — a method that combines known disease patterns with population-level data to estimate how changing one risk factor affects overall disease burden. In this case, researchers modelled what would happen if undernutrition, one of the strongest known risk factors for tuberculosis, were reduced or eliminated.

How undernutrition is linked to TB

TB is caused by the bacterium Mycobacterium tuberculosis, but infection alone does not always lead to disease. Many people carry the bacterium without falling ill because their immune systems keep it in check. Undernutrition changes that equation. When the body lacks sufficient calories, protein and essential micronutrients, the immune system weakens, making it harder to contain latent TB infection and easier for active disease to develop.

The impact of under-nutrition

Their estimates suggest that globally, eliminating moderate-to-severe undernutrition could prevent 1.4 million TB cases, or about 15 per cent of adult tuberculosis worldwide. Eliminating all undernutrition could avert 2.3 million cases, equivalent to nearly a quarter of global adult TB incidence in 2023. Prof Dodd acknowledged that these represent best-case estimates.

“This is the upper limit of what is theoretically possible, much like estimates for smoking or diabetes-related TB risk. But it allows us to compare risk factors, and these numbers show that undernutrition is an enormously important driver of TB in India,” he said.

“More than 40 per cent of TB in India is attributable to undernutrition,” said Dr Soumya Swaminathan, former chief scientist at the World Health Organization and currently Chairperson of the M S Swaminathan Research Foundation, who was not associated with the present study.

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Why nutrition is the key pillar of TB prevention strategy

Dr Swaminathan pointed to the landmark Indian Council of Medical Research-backed RATIONS trial — short for Reducing Activation of Tuberculosis by Improvement of Nutritional Status — which offered some of the strongest real-world evidence yet. The study found that providing a modest monthly food basket containing pulses, oil, rice and micronutrients to household contacts of TB patients reduced the risk of developing active tuberculosis by 49 per cent.

In the trial, adults with TB received food baskets providing approximately 1,200 calories and 52 grams of protein daily, along with micronutrient supplementation and the government’s direct benefit transfer support. The basket included rice, chickpea flour, milk powder and vegetable oil — simple staples designed to meet basic nutritional needs.

“The evidence is now compelling,” Dr Swaminathan said. “We need to identify districts and families with high undernutrition burden and strengthen the Public Distribution System, both in terms of quality and quantity.”

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Dr Anurag Bhargava, who led the RATIONS trial at Kasturba Medical College, believes a strengthened PDS, particularly one that expands access to protein-rich pulses, could transform both TB prevention and broader public health outcomes. “TB deaths can be prevented by systematically assessing and addressing undernutrition in patients,” he said.

Writing recently in PLOS Global Public Health, Dr Bhargava further argued that proper nutrition can function as a “vaccine” by preventing disease onset, reducing deaths during treatment and lowering recurrence after recovery.

India carries the world’s largest TB burden, even as progress has accelerated. According to government data, annual new TB cases in India declined by 21 per cent between 2015 and 2024, while TB mortality fell by 28 per cent during the same period. Yet India still accounts for a substantial share of the global TB burden. “TB control has to move beyond the language of war against a bacterium,” Dr Bhargava wrote, “and towards improving the underlying health and social conditions that make people vulnerable in the first place.”

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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