Tuberculosis ranks second among the leading infectious killer disease (WHO, 2021). In 2020, out of 10 million people, including 1.1 million children and adolescents, who fell ill with TB, around 1.5 million people died globally (WHO, 2021). Approximately one-third of the world population currently has latent TB – among which 10% will progress into active TB disease. TB costs 3.5 billion dollars to the US every year (WHO, 2022).

Cholesterol is a type of lipid (fat) found in the blood. It is an essential component of cell membranes. It plays a role in many bodily processes, including the production of hormones and the synthesis of vitamin D. The biological mechanism by which cholesterol may affect the development of tuberculosis (TB) is not well-understood. Some studies have suggested that low cholesterol levels may be associated with a decreased risk of developing TB, while others have found no such association.

A report published by Jo et al. in 2021 observed the negative association between the total cholesterol level and tuberculosis risk in the nationally representative sample in South Korea. Another study also presented lower levels of high-density lipoproteins (HDL), low-density lipoproteins (LDL), and low serum levels among patients with active tuberculosis (Rao et al., 2009). On the contrary, Akpovi et al. (2013) provide a different perspective on this association, demonstrating high cholesterol levels among patients with tuberculosis treatment.

There is no robust study among children and adults in the US observing similar associations. The need for quality TB data has refrained researchers from identifying the significant risk factors associated with TB infections in the United States.

This project examines the association between the total cholesterol level in the human body and tuberculosis in US children and adolescents. This project aims to add to the existing research used by the WHO to formulate their End TB actions by identifying one of the potential risk factors, i.e., cholesterol. We hypothesize that high cholesterol level in the blood interferes with the body’s immune system, increasing the odds of tuberculosis. If our hypothesis stands, we could impact TB elimination globally with a people-focused approach. The interventions recommended through this research could inform formidable action to monitor people’s cholesterol levels, increasing the immune response against TB.