Management of severe acute malnutrition 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.
Severe acute malnutrition is identified differently in different age groups:
- Children under 5 years of age: very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or very low mid-upper arm circumference (children 6-59 months of age only)
- School-age children and adolescents 5-19 years of age: very low BMI*-for-age
- Adults: very low BMI
- Pregnant women: very low mid-upper arm circumference
Those suffering from severe acute malnutrition are particularly susceptible to the negative health effects of tuberculosis.
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 (IAMI manual, Technical note; see 'WHO documents' below).
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 (updated guideline on management of SAM; see 'WHO documents' below).
* BMI = body mass index, kg/m2
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.
Nutritional care and support for patients with tuberculosis
Updates on the management of severe acute malnutrition in infants and children
Guidance for national tuberculosis programmes on the management of tuberculosis in children: second edition
Other guidance documents
IMAI district clinician manual: hospital care for adolescents and adults. Guidelines for the management of common illnesses with limited resources, volumes 1 and 2
Systematic reviews used to develop the guidelines
Nutritional supplements for people being treated for active tuberculosis
The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review