A new report published in The Lancet Global Health is shining a spotlight on a major gap in health care across low- and middle-income countries (LMICs) where millions of people are affected by undernutrition and diet-related diseases.
The paper, titled ‘A roadmap for integrating nutritional assessment, counselling, and support into the care of people with tuberculosis’, argues that nutrition is often overlooked in clinical settings even though it plays a vital role in preventing and treating illness. The authors say that simple steps like measuring weight, tracking growth, or asking about diet are often skipped, and as a result, many people don’t get the help they need.
Dr Kobto Ghislain Koura, Director of TB at The Union and study co-author, said: "Despite the well-established role of nutrition in determining health outcomes, nutritional assessment remains inconsistently implemented in primary care across LMICs. This roadmap provides a structured, evidence-informed approach to facilitate systemic integration."
Lead authors argue that while nutrition is a fundamental aspect of good health, it remains neglected in routine clinical settings across LMICs. This oversight, they say, leads to missed diagnoses, inadequate treatment, and poorer health outcomes particularly for vulnerable groups like children, pregnant women, and the elderly.
To address this gap, the authors propose clear strategies to integrate nutritional assessment and support at three critical points in TB care: treatment initiation, the end of the intensive phase, and treatment completion.
Dr Pranay Sinha, one of the Leaders of The Union’s Nutrition Working Group and co-author of the study, said: “To treat tuberculosis without addressing undernutrition is to provide incomplete care. It is both a clinical oversight and a moral failure. This roadmap offers pragmatic, scalable steps to ensure that no person with TB is left to recover without the nutritional support they need. It is time we stop treating nutrition as optional and start recognising it as essential to health care.”
The roadmap outlines essential actions to help countries embed nutrition into routine healthcare, including: better training for health workers, more consistent tools and equipment, stronger data systems, sustainable funding, government support, and getting communities involved from the start.
The paper states: “we need new tools to assess and measure the nutritional status of patients with tuberculosis that are scalable, cost-effective, validated against clinical outcomes...”
Dr Koura continues: “Integrating routine nutritional assessment into health care can significantly improve tuberculosis (TB) diagnosis, as undernutrition is a well-documented risk factor for TB progression and poor treatment outcomes.
“By identifying nutritional deficiencies early, health workers can better flag individuals at higher risk, support timely diagnosis, and strengthen the overall management of TB cases.”
Dr Koura added: "This roadmap is the result of an excellent collaborative effort. This work reflects the strong partnership between the Nutrition Working Group and The Union’s TB Department, demonstrating how cross-disciplinary collaboration can lead to impactful, actionable solutions. I look forward to continuing such synergies and encourage other working groups to join forces with us in addressing critical public health challenges."
Experts hope this paper will encourage more governments and global health organisations to act and invest so that nutrition becomes a standard part of health care everywhere.
“This roadmap offers a clear, actionable path forward,” said the authors. “With political will, collaboration, and investment, we can ensure that no patient is overlooked because their nutritional needs were never assessed.”
The paper is now available online here: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00021-X/fulltext