undernutrition or lack of adequate food is the biggest cause of latent tb infection progressing to active tuberculosis in india adding over a million cases of the 23 million new cases each year if endemic hiv infection is what drives the tb epidemic in africa in india endemic undernutrition in adolescents and adults is what drives it this was revealed in a paper published on friday in the national medical journal of india by researchers from the himalayan institute of medical sciences in uttarakhand and the mcgill international tb centre mcgill university in canada according to the paper more than half of all cases of tb every year twothirds of new cases in people 1519 years old could be prevented by ensuring that people get enough to eat in terms of calories and proteins india has the highest number of new cases of tuberculosis and of tbrelated deaths in the world with 23 million new cases and an estimated 320000 deaths annually in india an estimated 400 million people a number larger than the entire population of the usa are infected with the tb bacillus but are asymptomatic though at risk of developing active tb this infection can be contained if the immune system functions normally undernutrition which suppresses the immune system is the major factor driving the progression of infection in these people to active tuberculosis in india rather than hiv which accounts for only 7 of new cases diabetes or smoking said the lead author dr anurag bhargav of the himalayan institute of medical sciencesa boy suffering from tb with his mother who is also a victim of the disease undernutrition is endemic in india with 34 of men and 36 of women aged 1549 undernourished according to national family health survey nfhs3 estimates these people are up to four times more likely to develop tb than healthy people are as undernutrition the leading cause of immunodeficiency globally weakens resistance to the tb bacillus scheduled castes scheduled tribes other backward classes and the poorest onefifth of the population are at greatest risk of tb disease women are at greater risk than men we must strive to improve the quantity and quality of food indians especially the poor those in rural india and those belonging to disadvantaged social groups eat there is clear evidence that tuberculosis underwent a significant decline in the western world even before the first tb drugs or the bcg vaccine was introduced because of improvements in living conditions particularly nutrition the india human development report 2011 of the planning commission has drawn attention to the decline in the per capita intake of calories as well as proteins in indians in successive nutritional surveys over the past 25 years which is very worrisome said dr bhargavaa tb patient takes an antitb medicine at a government health centre while another waits for his turn an article published in the journal plos one in october last year had revealed the state of wasting