4 min readJul 8, 2026 05:23 PM IST
First published on: Jul 8, 2026 at 05:23 PM IST
By Urvashi B Singh
Every year, more than 26 lakh Indians are diagnosed with TB. The conversation that follows is almost always about which drugs, for how long, and whether the strain is resistant. I have witnessed patients with an accurate diagnosis and drugs lose ground, week by week, because a body without adequate nutrition cannot fight this disease. We have shortened treatment regimens, extended social support to patients on treatment, and tracked the treatment journey in real time digitally. In the Indian context, research shows that a severely undernourished TB patient is four times more likely to die during treatment.
India has not ignored this critical overlap. The TB Mukt Bharat Abhiyaan has made a meaningful conceptual shift: Individuals with a BMI below 18.5 are identified as vulnerable and prioritised for TB screening and offered X-rays — even for those without symptoms. Once a person is diagnosed with TB, tailored and individualised care is built into the treatment pathway.
Since 2018, the Nikshay Poshan Yojana has provided direct cash transfers to every notified TB patient, a benefit doubled to Rs. 1,000 per month two years ago, with over Rs. 4,590 crore disbursed to 1.39 crore patients till March. Over 7.16 lakh Nikshay Mitras, including citizens, corporates, and community organisations, have stepped forward with food baskets (for both the patient and the family) and psychosocial support for patients. On this count, India is ahead of most countries. The government has also committed to providing energy-dense nutritional supplements (EDNS) to undernourished patients. A trial conducted in Faridabad found that TB patients who received energy-dense nutritional supplements were twice as likely to gain the weight they needed in the first two months of treatment, and patients who do not gain that weight are far more likely to face treatment failure and death. Providing nutrition support to patients with a BMI of less than 18.5 could benefit nearly half of all diagnosed TB patients in India each year.
The next frontier is addressing the condition that makes people vulnerable to TB in the first place. According to the WHO, undernutrition is the single largest risk factor for TB globally. The evidence now is asking us to look at nutrition as a critical preventive strategy. A modelling study in The Lancet Global Health this year found that eliminating undernutrition could prevent one in four adult TB cases globally, with India standing to gain the most. The authors argue that current estimates of undernutrition’s role in driving TB have been underestimated. The findings are a challenge to how we prioritise our TB prevention response.
The new evidence also validates what we have known by instinct, and an argument for scaling nutrition as a preventive strategy with greater urgency: Find people who are undernourished and at elevated TB risk, provide meaningful nutrition support and counselling. The benefits extend beyond TB and reduce vulnerability to a wide range of infectious and non-infectious diseases, making the case for nutrition as a foundational public health infrastructure.
TB is a disease of circumstance as much as infection — that includes what and how much people eat. The commitment to nutritional supplementation during treatment is already on the books; the evidence for prevention is now impossible to ignore. A commentary in The Lancet put it aptly: Food is the tuberculosis vaccine we already have.
The writer is professor and in-charge, Tuberculosis Division, Department of Microbiology, AIIMS Delhi
The new evidence also validates what we have known by instinct, and an argument for scaling nutrition as a preventive strategy with greater urgency. (File Photo) 
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