Nutrition and infection · November 7, 2026
Malnutrition affected an estimated 39% of older adults with pulmonary tuberculosis. Across 15 studies, the plausible setting-to-setting range stretched from 13% to 73%
Hospital studies reported roughly twice the prevalence of community cohorts. Yet only one study used the complete modern diagnostic framework, making the headline average less universal than it looks.
Malnutrition and tuberculosis can reinforce each other, particularly in older adults. A new systematic review tried to estimate how often strictly defined malnutrition — rather than a broader screening label of 'nutritional risk' — appears among people aged 60 or older with pulmonary tuberculosis.
The review included 15 studies and 5,346 patients. Its pooled prevalence was 38.8%, with a 95% confidence interval from 30.5% to 47.9%. But studies disagreed sharply: heterogeneity was 96.4%, and the prediction interval for a comparable new setting stretched from 13.2% to 72.6%.
Setting explained part of the spread. Hospital studies pooled at 44.6%, versus 21.7% in community cohorts, although there were only two community studies. Estimates based on GLIM-type definitions and Mini Nutritional Assessment tools looked similar on average, but the MNA interval was very wide and the formal comparison could not establish equivalence.
The diagnostic evidence was thinner than the pooled number suggests. Only one study used the complete GLIM workflow; eleven used low BMI as a compatible shortcut, and three used MNA-based thresholds. Few studies adjusted risk factors well enough to pool them. The review supports routine attention to nutrition in older people receiving tuberculosis care, while warning clinicians not to confuse a risk screen with a diagnosis or assume one global prevalence fits every clinic.
A high average with exceptionally wide variation
15 studies
Studies in the systematic review, representing 5,346 patients
38.8%
Pooled malnutrition prevalence; 95% CI 30.5–47.9%
96.4%
I² heterogeneity, showing large between-study differences
13.2–72.6%
95% prediction interval for a comparable new setting
44.6% vs 21.7%
Pooled hospital versus community prevalence; only two community studies
1 study
Study using the complete GLIM diagnostic workflow
Random-effects prevalence meta-analysis. The pooled percentage is not a universal patient probability: settings and definitions varied substantially. Screening tools identify risk; diagnosis requires the specified clinical assessment.
- GLIM diagnosis combines at least one physical feature, such as weight loss or low muscle mass, with an underlying cause such as reduced intake or inflammation.
- The Mini Nutritional Assessment was designed for older adults and includes food intake, weight, mobility and health questions.
- A prediction interval asks where a future study might land; it is often more informative than the confidence interval around the average.
- Removing four studies focused on people with both tuberculosis and diabetes barely changed the pooled estimate: 39.8%.
- Malnutrition in elderly patients with pulmonary tuberculosis: a systematic review and meta-analysis of prevalence, comparison of prevalence estimates by diagnostic tool, and evidence gapsFrontiers in Nutrition, 4 November 2026 · Primary open-access review; definitions, study and patient counts, pooled estimates, heterogeneity, setting analysis and limitations checked against the article.
- Fruits in bowl — oranges, lime and applesWikimedia Commons · Photograph by Gerardolagunes, CC0; general nutrition illustration only.
General information, not medical advice. Tuberculosis requires prompt medical treatment, and malnutrition diagnosis and support should be provided by the clinical team. Food or supplements do not replace antibiotics.
Analysis by NutroPractic from the sources listed. Written for general readers; it does not replace advice from your own doctor.
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