{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:58:22Z","timestamp":1791845902107,"version":"4.3.4"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["CL-2023\u201316-002"],"award-info":[{"award-number":["CL-2023\u201316-002"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gates Foundation","award":["TB MAC OPP1135288"],"award-info":[{"award-number":["TB MAC OPP1135288"]}]},{"name":"Gates Foundation","award":["INV-059518"],"award-info":[{"award-number":["INV-059518"]}]},{"name":"Gates Foundation","award":["INV-001754"],"award-info":[{"award-number":["INV-001754"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R-202309\u201371190"],"award-info":[{"award-number":["R-202309\u201371190"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["G-202303\u201369963"],"award-info":[{"award-number":["G-202303\u201369963"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R-202309\u201371190"],"award-info":[{"award-number":["R-202309\u201371190"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R-202309\u201371190"],"award-info":[{"award-number":["R-202309\u201371190"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100032626","name":"Unitaid","doi-asserted-by":"publisher","award":["20193\u20133-ASCENT"],"award-info":[{"award-number":["20193\u20133-ASCENT"]}],"id":[{"id":"10.13039\/100032626","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["APW 203462345"],"award-info":[{"award-number":["APW 203462345"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"name":"TB Research Advancement Center","award":["P30AI168386"],"award-info":[{"award-number":["P30AI168386"]}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K24AI114444"],"award-info":[{"award-number":["K24AI114444"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The relationship between nutritional status and tuberculosis is critically important but poorly understood. We extended a 2009 review characterizing the relationship between body mass index (BMI) and tuberculosis risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched for new studies published between 2009 and 2024 investigating BMI and tuberculosis risk in adults. We extracted estimates of risk in BMI categories, used resampling to assign a median BMI \u2018dose\u2019 within each category, and included these in one-stage dose\u2013response meta-analyses, stratifying results by population group and country tuberculosis burden. We fitted linear models for comparability with the 2009 review and restricted cubic spline models to investigate nonlinear relationships and piecewise linear models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analyses showed an inverse dose\u2013response relationship between BMI and tuberculosis risk across all populations in the full underweight to obese range (15.0\u201335.0\u2009kg\/m2). The spline and piecewise linear models showed a nonlinear relationship\u2014in 22 general-population cohorts (n\u2009=\u200924\u200a921\u200a531), there was a steep per-unit reduction in risk for BMI of\u2009&amp;lt;25.0\u2009kg\/m2 [18.0%, 95% confidence interval (CI): 16.4\u201319.6], which decreased more gradually for BMI of\u2009\u226525.0\u2009kg\/m2 (6.9%, 95% CI: 4.6\u20139.2). In 18 cohorts of people with HIV (n\u2009=\u2009162\u200a609), the reduction was 15.3% for BMI of\u2009&amp;lt;23.0\u2009kg\/m2 (95% CI: 13.1\u201317.5) and 2.6% (95% CI: \u20133.1\u20137.9) for BMI of\u2009\u226523.0\u2009kg\/m2. In three cohorts of people with diabetes (n\u2009=\u20091\u200a118\u200a424), the reduction was 20.5% for BMI of\u2009&amp;lt;24.0\u2009kg\/m2 (95% CI: 18.4\u201322.6) and 13.4% (95% CI: 3.9\u201322.0) for BMI of\u2009\u226524.0\u2009kg\/m2. Based on the global BMI distribution, we estimated a relative risk of tuberculosis associated with undernutrition (BMI\u2009&amp;lt;\u200918.5\u2009kg\/m2) of 5.0 (95% CI: 4.2\u20135.9).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results highlight the independent importance of nutritional status as a driver of the tuberculosis epidemic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyaf154","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T12:07:06Z","timestamp":1754654826000},"source":"Crossref","is-referenced-by-count":17,"title":["Body mass index and tuberculosis risk: an updated systematic literature review and dose\u2013response meta-analysis"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3033-2367","authenticated-orcid":false,"given":"Matthew J","family":"Saunders","sequence":"first","affiliation":[{"name":"Institute for Infection and Immunity, City St George\u2019s, University of London , London,","place":["United Kingdom"]},{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Peter","family":"Cegielski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene & Tropical Medicine , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4132-7467","authenticated-orcid":false,"given":"Rein M G J","family":"Houben","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene & Tropical Medicine , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-0931","authenticated-orcid":false,"given":"C Finn","family":"McQuaid","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene & Tropical Medicine , London,","place":["United 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