Guideline

Guideline: nutritional care and support for patients with tuberculosis

Year of Publication

2013

Issuing Institution

World Health Organization

Links

WHO IRIS,WHO IRIS

Recommendations

12 included recommendations

All individuals with active TB should receive (i) an assessment of their nutritional status and (ii) appropriate counselling based on their nutritional status at diagnosis and throughout treatment.

Status

Retired

Recommended in favor

Strong

School-age children and adolescents (5 to 19 years), and adults, including pregnant and lactating women, with active TB and severe acute malnutrition should be treated in accordance with the WHO recommendations for management of severe acute malnutrition

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Children who are less than 5 years of age with active TB and severe acute malnutrition should be treated in accordance with the WHO recommendations for the management of severe acute malnutrition in children who are less than 5 years of age

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

School-age children and adolescents (5 to 19 years), and adults, including lactating women, with active TB and moderate undernutrition, who fail to regain normal body mass index after 2 months’ TB treatment, as well as those who are losing weight during TB treatment, should be evaluated for adherence and comorbid conditions. They should also receive nutrition assessment and counselling and, if indicated, be provided with locally available nutrient-rich or fortified supplementary foods, as necessary to restore normal nutritional status

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

Children who are less than 5 years of age with active TB and moderate undernutrition should be managed as any other children with moderate undernutrition. This includes provision of locally available nutrientrich or fortified supplementary foods, in order to restore appropriate weight-for-height

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Pregnant women with active TB and moderate undernutrition, or with inadequate weight gain, should be provided with locally available nutrientrich or fortified supplementary foods, as necessary to achieve an average weekly minimum weight gain of approximately 300 g in the second and third trimesters.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Patients with active multidrug-resistant TB and moderate undernutrition should be provided with locally available nutrient-rich or fortified supplementary foods, as necessary to restore normal nutritional status

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

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 (2, 4), 1 but are unavailable

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

All pregnant 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 (5), to complement their maternal micronutrient needs.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

For pregnant women with active TB in settings where calcium intake is low, calcium supplementation as part of antenatal care is recommended for the prevention of pre-eclampsia, particularly among those pregnant women at higher risk of developing hypertension, in accordance with WHO recommendations (6)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

All lactating women with active TB should be provided with iron and folic acid and other vitamins and minerals, according to the United Nations Multiple Micronutrient Preparation (5), to complement their maternal micronutrient needs.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

In settings where contact tracing is implemented, household contacts of people with active TB should have a nutrition screening and assessment as part of contact investigation. If malnutrition is identified, it should be managed according to WHO recommendations (2–4).

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low