Global burden of tuberculosis attributable to high body mass index in young adults：2000– 2021

Background High body mass index (BMI) is a significant factor affecting health and is closely associated with the risk of tuberculosis (TB). Research on this topic is quite limited. Understanding the TB epidemic trend caused by the risk of high BMI is crucial for disease prevention and patient support. Methods Using data from the Global Burden of Disease 2021 study, we analyzed age-standardized death rates and disability-adjusted life years for tuberculosis (TB) and its subtypes [drug-susceptible TB, multidrug-resistant tuberculosis (MDR-TB) without extensive drug resistance, and extensively drug-resistant tuberculosis (XDR-TB)] linked to high body mass index (≥ 25 kg/m²) in individuals aged 25 to 39. We assessed temporal trends with Joinpoint regression and projected future disease burden using Bayesian Age-Period-Cohort modeling. Socioeconomic disparities were explored using the socio-demographic index and concentration index. Results Globally, the age-standardized death rate (ASDR) for tuberculosis (TB) linked to high body mass index (BMI) showed a U-shaped trend, decreasing until 2016 and rising to 14.66 per 100,000 by 2021. The 35–39 age group had the highest rate at 34.95 per 100,000, with males more affected. XDR-TB saw the largest rise, with an average annual percentage change of 4.1. Low socio-demographic index (SDI) regions faced the highest burden, with rates of 22.67 per 100,000 versus 2.02 in high-SDI areas, and disparities widened, as shown by a concentration index of − 0.41 by 2020. TB cases are projected to increase fivefold by 2050, reaching 2.26 million, mainly due to MDR-TB without extensive drug resistance and XDR-TB. Conclusion High body mass index significantly impacts tuberculosis (TB) rates in young adults, with notable differences across socio-demographic index levels and increasing drug-resistant TB. Urgent integrated strategies targeting obesity and TB, especially in low-resource areas, are needed to reduce future health issues.