Nutrition, Inflammation, and the Gut Microbiota among Outpatients with Active Tuberculosis Disease in India

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  • 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York;
  • | 2 Division of Infectious Diseases, Weill Cornell Medical College, New York, New York;
  • | 3 Arogyavaram Medical Centre, Madanapalle, Andhra Pradesh, India;
  • | 4 Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York;
  • | 5 Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, New York

India has the highest rates of tuberculosis (TB) globally and a high prevalence of malnutrition; however, the interplay between host nutritional status, inflammation, and the gut microbiome in active tuberculosis disease (ATBD) is less well-studied. We examined differences in gut microbial composition and diversity based on undernutrition and inflammation status among outpatients with ATBD at the time of treatment initiation. During this exploratory cross-sectional study, outpatients (N = 32) with ATBD (confirmed by Xpert MTB/RIF) were enrolled in anti-TB treatment initiated at a hospital in rural southern India. The 16S rRNA sequencing was used to assess the composition of the gut microbiome. We assessed multiple markers of nutritional status, including micronutrient status concentrations (vitamin D [25(OH)D], vitamin B12, ferritin), anthropometry (body mass index, mid-upper arm circumference, and height), and C-reactive protein (CRP), as indicators of inflammation. We found that 25(OH)D was positively associated with the relative abundance of Oscillospira spp., a butyrate-producing genus linked with anti-inflammation effects, and that ferritin was positively associated with Proteobacteria taxa, which have been associated with worse inflammation in other studies. Finally, we found a greater abundance of inflammation-associated taxa from the Proteobacteria phylum and lower alpha-diversity indices among those who were underweight or who had low mid-upper arm circumference or short stature. In summary, we found differences in the gut microbiota composition and diversity among those with undernutrition compared with those with adequate nutrition status at the time of initiation of treatment among patients with ATBD in India. Clinical implications of these findings will need to be examined by larger longitudinal studies.

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Author Notes

Address correspondence to Saurabh Mehta, 314 Savage Hall, Cornell University, Ithaca, NY 14853. E-mail:

These authors contributed equally to this work.

Financial support: Research reported in this publication was supported by Cornell University (Division of Nutritional Sciences), Arogyavaram Medical Centre, and the National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Diseases; T32-DK007158 award; to E. A. Y.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) or the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors’ addresses: Samantha L. Huey, Julia L. Finkelstein, Patsy M. Brannon, and Saurabh Mehta, Division of Nutritional Sciences, Cornell University, Ithaca, NY, E-mails:,,, and Elaine A. Yu, Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, E-mail: Marshall J. Glesby, Center for Special Studies (HIV/AIDS), Weill Cornell Medicine, New York City, NY, E-mail: Wesley Bonam, Arogayavaram Medical Center Tuberculoses Santorium, Madanapalle, Andhra Pradesh, India, E-mail: David G. Russell, Department of Microbiology and Immunology, Cornell University College of Veterinary Medicine, Ithaca, NY, E-mail: