A prospective cohort study assessed whether undernutrition increased risk of TB infection and TB disease among household contacts of persons with TB in India. Participants were recruited within 2 months of index TB diagnosis from 5 diverse RePORT India sites and followed for a median of 24 months.
The study enrolled 857 household contacts after excluding those with microbiologically confirmed prevalent TB at baseline. Undernutrition was defined as BMI <18.5 kg/m². Incident TB was diagnosed microbiologically or clinically during follow-up, with a stricter analysis excluding cases diagnosed within 90 days. IGRA conversion was assessed among baseline IGRA-negative participants using Quantiferon Gold Plus, with standard (>0.35) and stringent (>0.70) conversion thresholds.
Among 857 participants, 239 (27.9%) were undernourished. There were 18 incident TB cases, including 10 among undernourished participants. Undernutrition was associated with higher TB disease risk (HR 3.16, 95% CI 1.25 to 8.02), but this weakened under the stricter TB definition (HR 1.88, 95% CI 0.65 to 5.43). Each 1 kg/m² higher BMI was associated with lower TB incidence risk (adjusted HR 0.85, 95% CI 0.73 to 0.98). Among 377 baseline IGRA-negative contacts, 264 had repeat testing; 56 had standard IGRA conversion and 43 had stringent conversion. BMI was not significantly associated with IGRA conversion.
Lower BMI was associated with progression to TB disease, but not clearly with new TB infection. Key limitations include few incident TB cases, possible co-prevalent disease despite sensitivity analysis, and incomplete repeat IGRA testing, which may limit precision and generalizability.
Source: Sinha P, Ezhumalai K, Du X, Ponnuraja C, Dauphinais MR, Gupte N, Sarkar S, Gupta A, Gaikwad S, Thangakunam B, Paradkar M. Undernourished household contacts are at increased risk of tuberculosis (TB) disease, but not TB infection—a multicenter prospective cohort analysis. Clinical Infectious Diseases. 2024 Jul 15;79(1):233-6.
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