Matthew Saunders

Climate change and tuberculosis: an analytical framework Climate change is likely to exacerbate a range of determinants that drive tuberculosis, the world's leading cause of death from a single infectious agent. However, tuberculosis is often neglected in w...

Climate change and tuberculosis: www.thelancet.com/journals/lan.... Podcast with @cfmcquaid.bsky.social here: open.spotify.com/episode/28jr...

Climate change and tuberculosis: an analytical framework Climate change is likely to exacerbate a range of determinants that drive tuberculosis, the world's leading cause of death from a single infectious agent. However, tuberculosis is often neglected in w...

Our framework that informed the @who.int TB & climate change policy brief out now in @lancetrespirmed.bsky.social, exploring the intersections and implications of climate change for the TB epidemic. Key message? TB should be considered a climate-sensitive disease
www.thelancet.com/journals/lan...

Tuberculosis and undernutrition: improving estimates to reinforce the policy imperative Undernutrition is a key driver of the global tuberculosis epidemic, increasing the risk of people developing tuberculosis disease and of poor outcomes in those who do.1 Each year, WHO publishes estima...

New comment:

Tuberculosis and undernutrition: improving estimates to reinforce the policy imperative

www.thelancet.com/journals/lan...

with @cfmcquaid.bsky.social @tbtakenseriously.bsky.social Peter Cegielski @raclark18.bsky.social @jaseddon.bsky.social Leo Martinez Madhavi & Anurag Bhargava @richardwhite321.bsky.social @reinhouben.bsky.social @tb-lshtm.bsky.social @cmmid-lshtm.bsky.social @lshtm-tbmod.bsky.social

Body mass index and tuberculosis risk: an updated systematic literature review and dose–response meta-analysis AbstractBackground. The relationship between nutritional status and tuberculosis is critically important but poorly understood. We extended a 2009 review c

We think our recent review provides a better estimate of the RR leading to a much higher PAF, demonstrating the importance of addressing undernutrition to prevent TB.
academic.oup.com/ije/article/...

Estimating the PAF for a continuous measure is conceptually tricky, but 2024 estimates from WHO use a risk ratio which excludes several large studies, pools together different populations, and uses different comparators.

Tuberculosis and undernutrition: improving estimates to reinforce the policy imperative Undernutrition is a key driver of the global tuberculosis epidemic, increasing the risk of people developing tuberculosis disease and of poor outcomes in those who do.1 Each year, WHO publishes estima...

“Wow, I saw in the last GTB report undernutrition is much less important for TB than we previously thought” I hear you say…
Well, no. We think this is an underestimate, & as much as 28% of TB could be attributable to undernutrition – see our latest comment here: www.thelancet.com/journals/lan...

@cfmcquaid.bsky.social @tbtakenseriously.bsky.social @jaseddon.bsky.social @petedodd24.bsky.social @tb-lshtm.bsky.social #endtb

Key message: Eliminating undernutrition could prevent millions of people from developing TB. Scaling up nutritional interventions (which are likely to have myriad social and health benefits), particularly for
populations in greatest need, should be an integral part of the global TB response.

We estimated that eliminating moderate/severe undernutrition (BMI<17) would avert ~17% of global adult incidence, while eliminating all undernutrition (BMI<18.5) would avert ~27%, three times higher than current estimates.

Global, regional, and national estimates of tuberculosis incidence averted by eliminating undernutrition in adults: a modelling study Background Current efforts to reduce global tuberculosis incidence have proved insufficient, highlighting that urgent action is needed to address underlying modifiable risk factors such as undernutrit...

So...what would happen to the global TB epidemic if we hypothetically "eliminated" undernutrition? In this preprint, we combined estimates from our new review (doi.org/10.1093/ije/...) with population-specific BMI distributions to find out...(doi.org/10.1101/2025...)

We estimated that eliminating moderate/severe undernutrition (BMI<17) would avert ~17% of global adult incidence, while eliminating all undernutrition (BMI<18.5) would avert ~27%, three times higher than current estimates.

Key message: Addressing undernutrition must be central to the global TB response. #EndTB @cfmcquaid.bsky.social @reinhouben.bsky.social @raclark18.bsky.social @tb-lshtm.bsky.social

Based on these results and the global BMI distribution, we estimated a relative risk of tuberculosis associated with undernutrition of 5.0 (95% CI: 4.2–5.9), substantially higher than previous estimates.

Our results show how TB risk is highest at the lowest BMI values and decreases nonlinearly as BMI increases, with the steepest reduction in risk occurring when moving through underweight and normal weight ranges, and more modest reductions continuing through overweight and obese ranges.

We found an inverse, dose-response, nonlinear relationship between BMI and TB risk in the full underweight to obese range, consistent across populations and countries with a high versus lower TB burden.

Body mass index and tuberculosis risk: an updated systematic literature review and dose–response meta-analysis AbstractBackground. The relationship between nutritional status and tuberculosis is critically important but poorly understood. We extended a 2009 review c

Nutritional status is a key determinant of TB. In this updated systematic review and dose-response meta-analysis (43 cohorts inc > 26 million people) we redefined the relationship between body mass index (BMI) and TB. doi.org/10.1093/ije/...

Key message: Interventions to address household poverty and interrelated personal risk factors could substantially reduce TB burden in Peru. Our results inform intervention design; and support more effective implementation of poverty reduction/social protection within the global TB response.

The social determinants of tuberculosis: a case-control study characterising pathways to equitable intervention in Peru - Infectious Diseases of Poverty Background Despite being key components of global tuberculosis policy, poverty reduction and social protection interventions have been inconsistently implemented. We aimed to characterise how poverty ...

The global TB epidemic is driven by social determinants. In this case-control study in Peru, we characterised the associations between multidimensional household poverty, personal risk factors, and TB. @tb-lshtm.bsky.social idpjournal.biomedcentral.com/articles/10....

The Union's TB Undernutrition working group is hosting a webinar with Dr Matthew Saunders.

📅 21 August at 2pm CET

Dr Saunders (@lshtm.bsky.social‬) will share findings from a new analysis that redefines the relationship between BMI and TB incidence.

📧 To join email membership@theunion.org.