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India could avert nearly 900,000 cases of tuberculosis (TB) and prevent over 350,000 deaths by 2035 with an unlikely tool: Food. New research suggests nutrition could be the game-changer in ending the country's TB epidemic.
The research, published in The Lancet Global Health’s March 2025 edition, found that if half of all Indian TB patients and their families received a modest food basket and vitamin supplements, the country could prevent around 361,200 deaths and 880,700 cases of TB in India between 2023 and 2035. The numbers translate to 4.5 per cent of TB-related deaths and over 2 per cent of new cases over the next decade.
This food support of 1,200 calories for patients and 750 calories for each household contact would cost about $1.3 billion (around Rs 11,122 crore) and is considered highly cost-effective. The study is evidence that food should be part of standard TB care.
Undernutrition is a major driver of TB in India, responsible for over a third of all new cases, the researchers stated. The findings build on results from the RATIONS trial in Jharkhand, which showed that improved nutrition led to better treatment outcomes and fewer new TB infections among family members.
“People with TB and their households are often a marginalised group, frequently already experiencing food insecurity and exposed to further harm by the presence of TB disease,” Finn McQuaid, an associate professor at London School of Hygiene & Tropical Medicine (LSHTM) and study co-author, said in a statement.
Rebecca Clark, a Research Fellow at LSHTM and co-author of the study, added: “International and national decision-makers could use our findings to advocate for better, as well as more targeted and relevant, interventions when it comes to support for TB patients and their families.”
India has the world’s highest TB burden, despite declining figures. In 2024, the country reported 2.6 million cases and 2.55 million cases were reported in 2023. According to the central government, the incidence rate of TB cases fell by nearly 17.7 per cent, from 237 cases per million people in 2015 to 195 in 2023 under the National Tuberculosis Elimination Programme (NTEP). TB-related deaths also declined, dropping from 28 to 22 per million people over the same period.
India has also rolled out improved treatments for drug-resistant TB, including a safer, shorter all-oral Bedaquiline regimen, which increased treatment success rates from 68 per cent in 2020 to 75 per cent in 2022 under NTEP, according to the Centre.
However, the growing resistance to bedaquiline is posing a new, silent threat to public health, according to another study published in March 2025.
A second study, published in the journal Clinical Infectious Diseases, has cast a troubling shadow over these gains. Researchers found that more than one-third of patients previously treated with bedaquiline had developed resistance to it.
Of 117 patients across clinics in Delhi and Mumbai, 42 showed resistance to bedaquiline. Worse, nearly 9 out of 10 of these patients had poor treatment outcomes: 40 per cent died, another 40 per cent saw treatment failure and some dropped out altogether.
Patients with resistant strains were more likely to have lung cavities (which can make it harder for drugs to reach infected areas) and showed cross-resistance with clofazimine, another key TB drug, the research stated.
This finding is especially worrying as India is now scaling up newer all-oral drug regimens that depend heavily on bedaquiline. Without access to timely drug-susceptibility testing, clinicians may continue prescribing ineffective drugs, worsening outcomes and allowing resistant strains to spread.