e-Library of Evidence for Nutrition Actions (eLENA)

Micronutrient supplementation 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.

Low circulating concentrations of micronutrients, such as vitamins A, E and D, and iron, zinc and selenium have been reported in some patients, though levels usually return to normal after 2 months of appropriate TB treatment.

WHO recommendations

A daily multiple micronutrient supplement at 1× recommended nutrient intake* should be provided in situations where fortified or supplementary foods should have been provided in accordance with standard management of moderate undernutrition (IAMI manual, Technical note; see 'WHO documents' below), but are unavailable.

All pregnant and lactating women with active TB should receive multiple micronutrient supplements that contain iron and folic acid and other vitamins and minerals, according to the United Nations Multiple Micronutrient Preparation (UNICEF, WHO, UNU joint report; see 'WHO documents' below) to complement their maternal micronutrient needs.

In settings where calcium intake is low, calcium supplementation as part of antenatal care is recommended in pregnant women with active TB for the prevention of pre-eclampsia, particularly among those pregnant women at higher risk of developing hypertension.

* providing the equivalent micronutrient profile recommended in the Technical note (see WHO documents below)


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

WHO documents

GRC-approved guidelines
Other guidance documents


Systematic reviews used to develop the guidelines
Related Cochrane reviews
Clinical trials