Menu ENN Search

WHO Guideline: Nutritional care and support for patients with TB

Undernutrition increases the risk of tuberculosis (TB) and in turn TB can lead to malnutrition. Undernutrition is therefore highly prevalent among people with TB. It has been demonstrated that undernutrition is a risk factor for progression from TB infection to active TB disease and that undernutrition at the time of diagnosis of active TB is a predictor of increased risk of death and TB relapse. However, the evidence concerning the effect of nutritional supplementation on TB prevention and health outcomes among people with TB had not previously been systematically reviewed.

WHO has recently produced a guideline on the principles and recommendations for nutritional care and support of patients with TB as part of their regular TB care. Of note, it does not consider the provision of food as part of a package of enablers to improve TB treatment adherence or as means to mitigate the negative financial consequences of TB.

The primary audience for the guideline is health workers providing care to people with TB. However, the guideline is also intended for a wider audience, including policy-makers, their expert advisers, and technical and programme staff at organisations involved in the design, implementation and scaling-up of nutrition actions for public health.

Three systematic reviews were updated to inform this guideline. The overall evidence base on effects of nutritional supplements for TB prevention and care is limited and the overall quality is low or very low for most outcomes. There is no evidence on improvement of TB treatment outcomes, or prevention of progression from TB infection to active disease, when using nutritional supplementation as an addition to standard care. There is no evidence that nutritional management of acute malnutrition of patients with active TB should be different than for those without active TB.


Five guiding principles are identified as key for providing nutritional care and support as an integral part of TB care and prevention:

  1. All people with active TB should receive TB diagnosis, treatment and care according to WHO guidelines and international standards of care. When malnutrition is identified at the time of TB diagnosis, TB is considered a key causal factor that needs to be addressed. It is essential that nutrition assessment and assistance do not divert resources from optimal TB diagnosis and care. Concerns about weight loss or failure to gain weight during TB treatment should trigger further clinical assess ment (e.g. resistance to TB drugs, poor adherence, comorbid conditions) and nutrition assessment of the causes of undernutrition, in order to determine the most appropriate interventions.
  2. An adequate diet, containing all essential macro- and micronutrients, is necessary for the well-being and health of all people, including those with TB infection or TB disease.
  3. Because of the clear bidirectional causal link between undernutrition and active TB, nutrition screening, assessment and management are integral components of TB treatment and care.
  4. Poverty and food insecurity are both causes and consequences of TB, and those involved in TB care therefore play an important role in recognising and addressing these wider socioeconomic issues.
  5. TB is commonly accompanied by comorbidities such as HIV, diabetes mellitus, smoking and alcohol or substance abuse, which have their own nutritional implications, and these should be fully considered during nutrition screening, assessment and counselling.


Patients with TB should be nutritionally assessed and receive the same nutritional care and support as other individuals or populations of similar nutritional status, in agreement with all relevant WHO recommendations.

The WHO guideline recommendations are grouped on four areas related to nutritional care and support – nutrition assessment and counselling, management of SAM, management of MAM, and micronutrient supplementation – to cover especially vulnerable populations, with an additional area for contact investigation.

Closer nutritional monitoring and earlier initiation of nutrition support (before the first two months of TB treatment are completed) should be considered if the nutritional indicator is approaching the cut-off value for a diagnosis of severe undernutrition.

Research priorities

Guideline group members and stakeholders identified several research priorities to improve the body of evid- ence at the basic, clinical, epidemiological and operational levels, on the nutrit- ional care and support for patients with TB.

WHO. Guideline: Nutritional care and support for patients with tuberculosis. Geneva: World Health Organisation; 2013.

More like this

FEX: The link between tuberculosis and undernutrition

Research snapshot1 Undernutrition increases the frequency, severity and fatality of many infections, including tuberculosis (TB), while infections, in turn, worsen...

FEX: Nutritional Support Through HBC in Malawi

By Mieke Moens, MSF Mieke Moens is a paediatric nurse, and is responsible for the PMTCT and nutrition programme for MSF Thyolo, Malawi The author would like to acknowledge...

FEX: Cotrimoxazole as a Prophylaxis for HIV Positive Malnourished Children

Summary of review1 By Susan Thurstans, AAH Susan Thurstans is the HIV adviser with Action Against Hunger (AAH), based in Malawi Thanks to Amador Gomez, Technical Advisor,...

FEX: Mortality and causes of mortality in children 6-59 months of age admitted to inpatient therapeutic feeding centres in Niger

By Florence Tapié de Céleyran, Kerstin Hanson, Cecilia Ferreyra, Nuria Salse, Didier Tshialala, Cristian Casademont, Rebecca Grais and Helena Huerga View this...

FEX: Emmanuel International

By Andrew Mellen, Emmanuel International Andrew Mellen has been the relief programme manager with EI Malawi since 2003. With a background in agriculture, he previously worked...

FEX: NOMA: a neglected disease!

News By GESNOMA, Winds of Hope, Sentinelles, and Médecins sans Frontières NOMA (cancrum oris and fusospirochetal gangrene or Necrotising Ulcerative Stomatitis),...

en-net: HIV/Nutrition Consultant Vacancy

The Asia Pacific Collaborating Centre in HIV Nutrition (APCHIN) is a partnership with UN World Food Programme (WFP), Rome/Bangkok; The Albion Centre (Albion), Sydney and The...

FEX: Better Practice in Targeted Food Assistance

Summary of published report1 C-Safe, a consortium of non-governmental organisations (NGOs) for the southern Africa food security emergency, has recently completed its second...

FEX: Revised MSF nutrition guidelines III

By Saskia van der Kam and Sophie Baquet, MSF The summary below is based upon a near final draft of the new MSF guidelines.1 The guidelines may therefore undergo some revision...

Resource: WHO/UNICEF/WFP Interim guideline: Nutritional Care of Children and Adults with Ebola Virus Disease in Treatment Centres

This interim guideline provides recommendations on nutritional support to adults and paediatric patients in Ebola treatment unit (ETUs). It highlights the key clinical problems...

FEX: WHO consultation on management of moderate malnutrition in U5s

The WHO, in collaboration with UNICEF, WFP and UNHCR, hosted a second consultation to discuss the programmatic aspects of the management of moderate malnutrition in children...

en-net: What should be the nutritional support to adult patients with Ebola Virus Disease (EVD) in treatment centres in West Africa?

Dear experts, I would appreciate your help in this. I drafted the following text but you might have ideas and other suggestions. Please help me on this one... This question...

en-net: Therapeutic food for MDR-TB and HIV patients

Through my experience meeting with different people in forums and workshops, I found that there are organizations and/or government agencies providing RUSF/Plumpy'Nut for...

FEX: HIV/AIDS Home Based Care in Zimbabwe

By Hisham Khogali Hisham Khogali is currently the Senior Food Security Officer of the International Federation of the Red Cross and Red Crescent. Prior to this, Hisham worked...

FEX: Review of evidence of role of nutrition in HIV infection

Summary of published research1 A HIV infected mother and HIV infected child receive a voucher that entitles her to a month's supply of CSB and household food items In 2007...

FEX: Operational research in low-income countries: what, why, and how?

Summary of research1 A Lancet published article puts forward a definition of operational research, articulates its relevance to infectious-disease-control programmes, and...

en-net: WFP Swaziland Nutrition & HIV Consultant

Job title: Nutrition & HIV Consultant Functional Area: Programme, Nutrition & HIV Level: Consultant (8 - 10 years experience) CO/Division-Unit: WFP Swaziland Country...

en-net: FANTA-2 Bridge Update: November 2011

FANTA-2 BRIDGE UPDATE | November 2011 In this issue of the FANTA-2 Bridge Update, we highlight some of the latest publications, events, and news from the FANTA-2 Bridge...

FEX: Community management of acute malnutrition in Mozambique

By Edna Germack Possolo, Yara LĂ­via Novele Ngovene and Maaike Arts Edna Germack Possolo is Chief of the Nutrition Department of the Ministry of Health, Republic of Mozambique...

FEX: Anthropometric predictors of mortality in undernourished adults in southern Sudan

Summary of published research1 Location: South Sudan What we know: Acute adult undernutrition tends to occur in prolonged severe famines. There is a lack of evidence on which...


Reference this page

WHO Guideline: Nutritional care and support for patients with TB. Field Exchange 47, April 2014. p59.



Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.