Diet and nutrition status of adult multidrug-resistant tuberculosis cases, household controls, and community controls in Mumbai, India

India accounts for the largest national proportion of global multi-drug resistant (MDR-TB) cases and TB mortality. However, evidence on the role of diet and nutrition in MDR-TB infection remains limited. This study aimed to multifacetedly evaluate and compare diet and nutrition status of MDR-TB cases and controls in high TB-burden slum areas of Mumbai. We recruited 352 pulmonary MDR-TB cases receiving domiciliary treatment, household controls, and age-, sex-, and area-matched community controls 18-60 years of age. Participants were assessed for habitual food and nutrient intake using a validated semi-quantitative food-frequency questionnaire, other food consumption-related habits, diet quality metrics, anthropometry, biochemical measurements, and diet-related non-communicable diseases. Measures of diet and nutrition status were compared within and between study arms using hypothesis tests and multiple regression. The prevalence of dietary adequacy was < 50% for 18 of 24 assessed nutrients among cases and 12/24 nutrients among controls. Compared to both household and community controls, cases had significantly (p < 0.05) higher prevalence of underweight (66% vs. 23% and 15%, respectively), anemia (22% vs. 9% and 10%), and diabetes (18% vs. 4% and 5%); lower consumption of major healthy food groups including non-tuberous vegetables, deep orange vegetables, legumes, whole grains, and nuts and seeds; lower Global Diet Quality Score (GDQS); and higher prevalence of nutrient inadequacies including protein, thiamine, folate, and vitamins A, C, and E. Women had significantly poorer adequacy of most nutrients than men in all three study arms, and intake of most nutrients declined with asset index and age in models adjusted for age, sex, study arm, and asset index. Results indicate an urgent need to improve diet and nutrition in Mumbai slum dwellers - particularly among the MDR-TB-infected population, women, the elderly, and the poorest households - and highlights the potentially key role of nutrition interventions in reducing MDR-TB burden in urban India.