Published in PLOS One on 2026-02-13, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Simon Kyazze, Saidi Appeli, Joseph Baruch Baluku, Jonathan Izudi, Paul Obeng
Source: PLOS One • DOI 10.1371/journal.pone.0324584
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Malnutrition significantly contributes to mortality among people with tuberculosis (TB). However, evidence on factors associated with the specific forms of malnutrition, specifically underweight and overweight/obesity, beyond clinical determinants, remains limited in many settings. We investigated the prevalence and determinants of underweight and overweight/obesity among people with pulmonary TB across five health facilities in Kampala, Uganda.
This analytic cross-sectional study involved people with pulmonary TB, either clinically diagnosed or bacteriologically confirmed, aged ≥18 years sampled across five health facilities in Kampala, Uganda. Nutritional status was assessed using body mass index (BMI, kg/m²) and categorized as underweight (<18.5), normal weight (18.5–24.9), and overweight/obese (≥25.0). To identify factors independently associated with nutritional status, normal weight was considered as the reference category in a multinomial logistic regression analysis, adjusting for multiple covariates and clustering at the health facility level. The measure of association was the adjusted relative risk ratios (aRRR) and the corresponding 95% confidence intervals (CI).
Of the 818 participants studied, 417 (51.0%) had normal weight, 302 (36.9%) were underweight, and 99 (12.1%) were overweight or obese. Adjusted analysis showed that being underweight was associated with household food insecurity (aRRR 2.04, 95% CI: 1.48–2.80) while being overweight or obese was associated with self-employment (aRRR 2.26, 95% CI: 1.35–3.79) and being newly diagnosed with TB (aRRR 2.10, 95% CI: 1.30–3.41).
This study, conducted among people with pulmonary TB in an urban setting in Uganda, showed that underweight and overweight/obesity are prevalent. Furthermore, the study showed that food insecurity is associated with being underweight, while being overweight or obese is associated with being self-employed or newly diagnosed with TB. Therefore, TB control programs need to regularly assess the nutritional status of people with TB to mitigate the effect of being underweight or overweight on treatment outcomes.
Introduction
Malnutrition is prevalent among people with tuberculosis (TB), and it negatively impacts treatment outcomes [1–3]. For instance, people with TB who are malnourished are more likely to experience delayed sputum smear conversion, reduced treatment success, and higher mortality when compared with those who are well-nourished [4,5]. Furthermore, malnutrition, particularly underweight, contributes to higher mortality rates among people with TB [6]. The rising prevalence of both underweight and overweight/obesity among people with TB further compounds mortality. Therefore, understanding the full scope of malnutrition—underweight and overweight or obesity—is important for improving treatment outcomes among people with TB.
In low-income countries such as Uganda, TB and malnutrition are common. A systematic review and meta-analysis that involved 48,598 people with TB reported a 48.0% pooled prevalence of malnutrition, with factors such as testing positive for Mycobacterium TB, low income, and rural residence being strongly associated with malnutrition [7]. Observational epidemiological studies further show that undernutrition, particularly underweight, is prevalent among people with TB and that it reduces treatment success and increases mortality [5,8]. A case-control study found that household contacts of people with multi-drug-resistant TB who are malnourished are more likely to develop TB when compared with household contacts of those with multi-drug-resistant TB who are well-nourished [9], highlighting the broader public health implications of malnutrition. Additionally, malnourished household contacts are more likely to get infected with TB than well-nourished household contacts [10]. This highlights the importance of nutrition supplementation, not just to people with TB, but also to their household contacts. However, the majority of the existing research evidence around malnutrition among people with TB has focused predominantly on undernutrition and the associated factors, with few studies investigating its effect on treatment outcomes.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Simon Kyazze, Saidi Appeli, Joseph Baruch Baluku, Jonathan Izudi, Paul Obeng. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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