Malnutrition patterns among people with TB in Kampala

Malnutrition is a major danger for people with tuberculosis (TB), contributing to illness and death, but we know less about why some people with TB become underweight while others become overweight. To address this gap, Jonathan Izudi and colleagues carried out an analytic cross-sectional study in Kampala, Uganda. They worked with adults aged 18 years and older who had bacteriologically confirmed pulmonary TB and were receiving care at five health facilities in the city. In total, the research included 818 participants. The team set out to measure how common different forms of malnutrition were in this group and to identify factors beyond purely clinical measures that might be linked to being underweight or overweight. By focusing on an urban setting and using clear definitions of nutritional status, the study aimed to give practical information that TB programs could use to spot and respond to nutrition problems among people with TB. Jonathan Izudi is listed as the corresponding author for this study, which highlights the importance of looking beyond the infection itself to the social and economic conditions that affect people’s weight and health during TB treatment.

The researchers assessed nutritional status with body mass index (BMI, kg/m2), categorizing participants as underweight (BMI <18.5), normal weight (BMI 18.5–24.9) or overweight/obese (BMI ≥25.0). They treated normal weight as the reference group and used multi-nomial logistic regression to look for factors independently associated with being underweight or overweight/obese. The analysis adjusted for multiple covariates and accounted for clustering at the health facility level. The main measure of association was the adjusted relative risk ratio (aRRR) with 95% confidence intervals. Among the 818 participants, 13.2% had normal weight, 36.9% were underweight, and 12.1% were overweight or obese. In adjusted analysis, household food insecurity was associated with being underweight (aRRR 2.04, 95% CI: 1.48–2.80). Overweight or obesity was associated with being self-employed (aRRR 2.26, 95% CI: 1.35–3.79) and with being newly diagnosed with TB (aRRR 2.10, 95% CI: 1.30–3.41).

These findings show that both ends of the nutritional spectrum — underweight and overweight — are common among people with bacteriologically confirmed pulmonary TB in this urban Ugandan setting. The link between household food insecurity and underweight underscores how lack of reliable access to food can worsen vulnerability among people with TB. The associations of overweight and obesity with self-employment and with being newly diagnosed suggest that social and temporal factors around work and the early phase of illness may also influence weight, though the study design identifies associations rather than direct causes. For TB control programs, the results point to the value of routinely checking nutritional status using simple measures like BMI and of asking about food security and work circumstances. Identifying people who are underweight or overweight at the start of care could help health teams offer targeted nutrition support or counseling that may improve treatment outcomes and reduce the risk of complications during TB therapy.