Unveiling the hidden burden of malnutrition in tuberculosis: A multifaceted evaluation using malnutrition universal screening tool and patient-generated subjective global assessment

<h2>Abstract</h2><h3>Problem considered</h3> Tuberculosis (TB) remains a significant public health burden, especially in resource-limited countries. Malnutrition is a significant concern among TB patients, exacerbating symptoms and impeding recovery. Despite this, standardised nutritional screening remains underutilised in TB care programs. Accurate and routine nutritional assessment is essential to guide timely interventions and improve treatment outcomes among TB patients. This study aimed to assess malnutrition risk in TB patients using MUST and PG-SGA, evaluate disagreement between screening tools, and determine the limitations of Body Mass Index (BMI) based assessments. <h3>Methods</h3> A cross-sectional study was conducted among 194 adult TB patients receiving anti-TB therapy in Bihar, India. Nutritional risk was evaluated using MUST and PG-SGA, along with demographic, clinical, and anthropometric data. Statistical analyses included ANOVA, Bonferroni post hoc tests, chi-square tests, and Cohen's kappa to assess agreement between tools. <h3>Results</h3> The study revealed a high prevalence of malnutrition risk, with MUST detecting 74.2% and PG-SGA detecting 88.1% of the overall population. Underweight patients were disproportionately affected, with MUST identifying 96.5% and PG-SGA identifying 88.3% as high-risk. This study emphasises the limitations of BMI alone in assessing malnutrition risk and reveals near-random agreement (κ = 0.010, p < 0.001), suggesting BMI alone inadequately captures malnutrition risk in TB patients. <h3>Conclusion</h3> This study highlights a critical gap in malnutrition screening for TB patients, with MUST and PG-SGA detecting high but discordant risk levels. Given PG-SGA's higher sensitivity, policymakers in resource-limited settings should consider integrating it into TB programs for early nutritional intervention, while further research validates optimal screening approaches.