Management of moderate undernutrition in individuals with active tuberculosis
In 2012 there were an estimated 8.6 million new cases of tuberculosis (TB) globally. TB morbidity and mortality are highest in developing countries.
Undernutrition increases the risk of tuberculosis and vice-versa and, as a result, undernutrition is highly prevalent among people with tuberculosis. Young children and pregnant women are particularly vulnerable to the effects of undernutrition and TB. Women with TB may be at higher risk for pre-eclampsia and other complications during pregnancy. TB also increases the risk of premature birth, low birth weight and perinatal death.
Moderate undernutrition, specifically moderate acute malnutrition, is defined by a low weight-for-height without visible oedema. Those suffering from moderate acute malnutrition are at a heightened susceptibility to the negative health effects of tuberculosis.
WHO recommendations
Children who are under 5 years of age with active TB and moderate undernutrition should be managed as any other children with moderate undernutrition, including provision of supplementary foods*, in order to restore appropriate weight-for-height.
Pregnant women with active TB and moderate undernutrition, or with inadequate weight gain, should be provided with supplementary foods*, as necessary to achieve an average weekly minimum weight gain of approximately 300 g in the second and third trimesters.
Patients with active multi-drug resistant TB (MDR-TB) and moderate undernutrition should be provided with supplementary foods*, as necessary to restore normal nutritional status.
* locally available nutrient-rich or fortified supplementary foods
This is a summary of one of several WHO recommendations on nutritional care of individuals with TB. The full set of recommendations can be found in 'Full set of recommendations' and in the guidelines, under ‘WHO documents’ below.
WHO documents
GRC-approved guidelines
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Nutritional care and support for patients with tuberculosis
Publication date: 2013 -
Guidance for national tuberculosis programmes on the management of tuberculosis in children: second edition
Publication date: 2014
Other guidance documents
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Technical note: Supplementary foods for the management of moderate acute malnutrition in infants and children 6–59 months of age
Publication date: 2012 -
IMAI district clinician manual: hospital care for adolescents and adults. Guidelines for the management of common illnesses with limited resources, volumes 1 and 2
Publication date: 2011
Evidence
Systematic reviews used to develop the guidelines
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Nutritional supplements for people being treated for active tuberculosis
Sinclair D, Abba K, Grobler L, Sudarsanam TD.
Cochrane Database of Systematic Reviews. 2011; Issue 11. Art. No.: CD006086.
Related Cochrane reviews
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Nutritional supplements for people being treated for active tuberculosis
Grobler L, Nagpal S, Sudarsanam TD, Sinclair D.
Cochrane Database of Systematic Reviews. 2016; Issue 6. Art. No.: CD006086. -
Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries
Lazzerini M, Rubert L, Pani P.
Cochrane Database of Systematic Reviews. 2013; Issue 6. Art. No.: CD009584. - Summary of this review
