Bhargava Anurag
Department of Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India.
Department of Medicine, McGill University, Montreal, Canada.
PLOS Glob Public Health. 2025 Jun 24;5(6):e0004719. doi: 10.1371/journal.pgph.0004719. eCollection 2025.
Nutrition is essential to survival, health, and protection from disease across the lifespan. In the 1970s, an adequate diet was described as the most effective vaccine available for respiratory, diarrheal, and other common infections, as nutritional supplementation reduced these in the setting of undernutrition. Recently, the RATIONS (Reducing Activation of Tuberculosis through Improvement Of Nutritional Status) trial showed the efficacy of nutritional supplementation in reducing TB incidence in households by up to 50%, and an editorial used the metaphor of food as a vaccine for tuberculosis. This essay provides a historical overview of nutrition and TB prevention, with reports of reduced TB incidence from nutritional supplementation in World War II prisoner-of-war camps. This essay discusses additional evidence supporting McKeown's proposition that the historical decline of TB in countries like the UK was related to improvements in nutrition. Undernutrition is the leading risk for tuberculosis incidence globally, the underlying cause of 45% of 4.9 million deaths in children under five years annually. Undernutrition in early life is a risk factor for many non-communicable diseases, and its effect on cognition and growth perpetuates both undernutrition and poverty intergenerationally. The essay broadens the vaccine metaphor to describe adequate balanced food (ABF) as a vaccine for TB and many public health problems, with a unique product profile. It concludes with a reminder that nutrition acts by optimizing immune function - the most powerful system/vaccine we have for TB prevention; draws attention to emerging threats to food security like climate change and conflicts, and proposes that the answer to the prevention of TB may lie in better population health rather than only a war on the bacillus.
营养对于人一生的生存、健康以及预防疾病至关重要。在20世纪70年代，充足的饮食被描述为预防呼吸道、腹泻及其他常见感染的最有效疫苗，因为营养补充在营养不良的情况下可减少这些感染。最近，“定量配给（通过改善营养状况减少结核病激活）”试验表明，营养补充在家庭中降低结核病发病率的功效高达50%，一篇社论将食物比作结核病疫苗。本文提供了营养与结核病预防的历史概述，其中报告了二战战俘营中通过营养补充使结核病发病率降低的情况。本文讨论了更多证据，支持麦克基翁的观点，即英国等国家结核病发病率的历史性下降与营养改善有关。营养不良是全球结核病发病的主要风险因素，每年导致490万五岁以下儿童死亡中有45%的根本原因是营养不良。生命早期的营养不良是许多非传染性疾病的风险因素，其对认知和生长的影响使营养不良和贫困在代际间持续存在。本文拓展了疫苗这一比喻，将充足的均衡饮食（ABF）描述为预防结核病及许多公共卫生问题的疫苗，具有独特的产品特性。文章最后提醒人们，营养通过优化免疫功能发挥作用——免疫功能是我们预防结核病最强大的系统/疫苗；提请人们关注气候变化和冲突等对粮食安全的新威胁，并提出预防结核病的答案可能在于改善人群健康，而不仅仅是与结核杆菌作斗争。
