Diet, Tuberculosis, and the Paleopathological Record

Abstract

Osseous manifestation of infectious disease is of paramount importance to paleopathologists seeking to interpret ancient health, but the relationships among infectious agent exposure, development of disease, and skeletal involvement are complex. The outcome of an exposure strongly depends on multiple factors, including ecology, diet, nutrition, immune function, and the genetics of pathogen and host. Mycobacterial diseases are often studied in ancient remains but also are especially influenced by these factors; individual and population differences in severity and course are apparent following onset of active disease. The osteological record for these diseases represents the complex interplay of host and pathogen characteristics influencing within- and among-individual skeletal lesion prevalence and distribution. However, many of these characteristics may be assessed independently through the archaeological record. Here, we explore the contributions of dietary protein and iron to immune function, particularly the course and outcome of infection with Mycobacterium tuberculosis. We emphasize how nutrition may influence the dissemination of bacilli to the skeleton and subsequent formation of diagnostic lesions. We then generate models and hypotheses informed by this interplay and apply them to four prehistoric New World areas. Finally, discrepancies between our expectations and the observed record are explored as a basis for new hypotheses.

Old World tuberculosis: Evidence from human remains with a review of current research and future prospects

“…whether they were resistant or not to the bacteria, and will also influence whether bone changes occur, and the diet a person eats is suggested to affect the development of tuberculous bone changes 19 .…”

“…Its has been suggested that nutrition may influence the dissemination of tubercle bacilli to the skeleton and the process of the subsequent formation of lesions that are used by palaeopathologists to diagnose the infection 19 . Furthermore, clinical studies have found an association between iron intake and polymorphisms in the iron transporter gene SLC40A1 and an increased risk for TB 24 The impact of rapid and extensive mobility on the spread of disease is also recognised increasingly today as a key risk factor for TB transmission.…”

Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide

“…However, these analyses cannot provide direct information on the intake of individual micronutrients, such as vitamins and minerals, many of which are essential for maintaining basic metabolic function. As such, the identification of specific diseases of poor micronutritional intake in skeletal remains has the potential to contribute significantly to the creation of a holistic portrait of health, resource use, and human‐environmental interactions in the ancient past (Buckley et al, 2014; Snoddy et al, 2017; Stark, 2014; Wilbur, Farnbach, Knudson, & Buikstra, 2008). …”

Lessons From History of Socioeconomic Improvements: A New Approach to Treating Multi-Drug-Resistant Tuberculosis

“…At present, the World Health Organization estimates that approximately one-third of the world's population are infected with the causative organism, Mycobacterium tuberculosis (World Health Organization, 2012). However, only approximately 10% of all individuals infected, most commonly those with lowered immunity, will ever develop active disease (Wilbur et al, 2008). Signs and symptoms of TB are usually associated with the respiratory system and include coughing, difficulty breathing, bloody sputum, weakness, lethargy, loss of appetite and weight, night sweats, pallor and chest pain.…”