e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Management of moderate undernutrition in individuals with active tuberculosis

Intervention | Last updated: 9 August 2023

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



Guidelines and guidance documents Learn More Alternate Text

GRC-approved guidelines

Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2nd ed

Nutritional care and support for patients with tuberculosis

Other guidance documents

Technical note: supplementary foods for the management of moderate acute malnutrition in infants and children 6–59 months of age

Integrated management of adolescent and adult illness (IMAI) district clinician manual: Hospital care for adolescents and adults

Evidence

Systematic reviews used to develop the guidelines

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

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 Alternate Text

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.

Summary of this review Alternate Text

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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