Modelling the effect of a nutritional shock on tuberculosis in India
Abstract Background Environmental or social changes and shocks that reduce access to adequate nutrition have potential consequences for tuberculosis (TB), as undernutrition is a major driver of TB incidence and poor TB treatment outcomes. Methods We developed a transmission model of TB in India with...
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2025-06-01
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| Series: | BMC Global and Public Health |
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| Online Access: | https://doi.org/10.1186/s44263-025-00153-x |
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| author | Rebecca A. Clark Roel Bakker Peter Alexander Roslyn Henry Richard G. White Pranay Sinha Rein M. G. J. Houben C. Finn McQuaid |
| author_facet | Rebecca A. Clark Roel Bakker Peter Alexander Roslyn Henry Richard G. White Pranay Sinha Rein M. G. J. Houben C. Finn McQuaid |
| author_sort | Rebecca A. Clark |
| collection | DOAJ |
| description | Abstract Background Environmental or social changes and shocks that reduce access to adequate nutrition have potential consequences for tuberculosis (TB), as undernutrition is a major driver of TB incidence and poor TB treatment outcomes. Methods We developed a transmission model of TB in India with an explicit body mass index (BMI) strata linked to disease progression and treatment outcomes, calibrated to country-specific TB estimates. We projected nutritional shock scenarios affecting supply chains, similar to those experienced at the beginning of the war in Ukraine, using the LandSyMM food system model, compared to a continuation of previous food system trends. Within each scenario, increases in food, fertiliser, and energy prices were linked to changes in the population BMI distribution by food availability and prices. We estimated the impact on TB incidence and mortality in India between 2022 and 2035 of these nutritional shock scenarios compared to maintenance of prior trends. Results The worst-case scenario, involving sustained increases in food, fertiliser, and energy prices, predicted that shocks increasing undernutrition could result in a 5.0% (95% uncertainty interval = 4.4, 5.9) and 4.9% (4.2, 5.9) increase in TB incidence and mortality respectively in India in 2035 compared to continuation of previous food system trends. In this scenario, an additional 1.1 million (0.9, 1.3) TB episodes and 177.5 thousand (144.7, 224.3) TB deaths were predicted to occur between 2022 and 2035. Conclusions Shocks affecting the population-level BMI distribution could lead to changes in the burden of TB disease. Our findings suggest that the impact of crises on TB disease may be underestimated if the impacts of external shocks on nutrition are not explicitly considered. |
| format | Article |
| id | doaj-art-fd31705e7f7547ebbd71f5d52d951acc |
| institution | DOAJ |
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| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
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| series | BMC Global and Public Health |
| spelling | doaj-art-fd31705e7f7547ebbd71f5d52d951acc2025-08-20T03:14:47ZengBMCBMC Global and Public Health2731-913X2025-06-01311810.1186/s44263-025-00153-xModelling the effect of a nutritional shock on tuberculosis in IndiaRebecca A. Clark0Roel Bakker1Peter Alexander2Roslyn Henry3Richard G. White4Pranay Sinha5Rein M. G. J. Houben6C. Finn McQuaid7Department of Infectious Disease Epidemiology, TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical MedicineDepartment of Infectious Disease Epidemiology, TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical MedicineSchool of Geosciences, University of EdinburghSchool of Biological Sciences, University of Aberdeen, King’s CollegeDepartment of Infectious Disease Epidemiology, TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical MedicineDepartment of Medicine, Section of Infectious Diseases, Boston University Chobanian & Avedisian, School of MedicineDepartment of Infectious Disease Epidemiology, TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical MedicineDepartment of Infectious Disease Epidemiology, TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical MedicineAbstract Background Environmental or social changes and shocks that reduce access to adequate nutrition have potential consequences for tuberculosis (TB), as undernutrition is a major driver of TB incidence and poor TB treatment outcomes. Methods We developed a transmission model of TB in India with an explicit body mass index (BMI) strata linked to disease progression and treatment outcomes, calibrated to country-specific TB estimates. We projected nutritional shock scenarios affecting supply chains, similar to those experienced at the beginning of the war in Ukraine, using the LandSyMM food system model, compared to a continuation of previous food system trends. Within each scenario, increases in food, fertiliser, and energy prices were linked to changes in the population BMI distribution by food availability and prices. We estimated the impact on TB incidence and mortality in India between 2022 and 2035 of these nutritional shock scenarios compared to maintenance of prior trends. Results The worst-case scenario, involving sustained increases in food, fertiliser, and energy prices, predicted that shocks increasing undernutrition could result in a 5.0% (95% uncertainty interval = 4.4, 5.9) and 4.9% (4.2, 5.9) increase in TB incidence and mortality respectively in India in 2035 compared to continuation of previous food system trends. In this scenario, an additional 1.1 million (0.9, 1.3) TB episodes and 177.5 thousand (144.7, 224.3) TB deaths were predicted to occur between 2022 and 2035. Conclusions Shocks affecting the population-level BMI distribution could lead to changes in the burden of TB disease. Our findings suggest that the impact of crises on TB disease may be underestimated if the impacts of external shocks on nutrition are not explicitly considered.https://doi.org/10.1186/s44263-025-00153-xTuberculosisNutritional shockMathematical modelling |
| spellingShingle | Rebecca A. Clark Roel Bakker Peter Alexander Roslyn Henry Richard G. White Pranay Sinha Rein M. G. J. Houben C. Finn McQuaid Modelling the effect of a nutritional shock on tuberculosis in India BMC Global and Public Health Tuberculosis Nutritional shock Mathematical modelling |
| title | Modelling the effect of a nutritional shock on tuberculosis in India |
| title_full | Modelling the effect of a nutritional shock on tuberculosis in India |
| title_fullStr | Modelling the effect of a nutritional shock on tuberculosis in India |
| title_full_unstemmed | Modelling the effect of a nutritional shock on tuberculosis in India |
| title_short | Modelling the effect of a nutritional shock on tuberculosis in India |
| title_sort | modelling the effect of a nutritional shock on tuberculosis in india |
| topic | Tuberculosis Nutritional shock Mathematical modelling |
| url | https://doi.org/10.1186/s44263-025-00153-x |
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