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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 assessment (eg resistance to TB drugs, poor adherence, comorbid conditions) and nutrition assessment of the causes of under-nutrition, 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 under-nutrition 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.

Recommendations

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. – World Health Organisation