Malnutrition results in the reduction of cell-mediated immunity, thereby increasing the risk of diseases such as TB. The catabolic effect of TB disease results in weight loss and wasting, which in turn worsens the malnutrition, creating a vicious cycle (104). Children and adolescents with TB disease frequently present with failure to thrive or weight loss (see Chapter 3 on diagnostic approaches). Severe malnutrition is associated with increased mortality in children, adolescents and adults with TB (105). Management of TB in children with malnutrition, including nutritional support, is covered in Section 7.6.