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The WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment include recommendations for the four milestones in the cascade of preventive care, namely identification of risk groups, TB screening and ruling out TB, testing for TBI, and choice and administration of the TPT regimen. The second edition of the TPT guidelines will have the same scope.
The aim of this guideline is to help improve health outcomes for people with tuberculosis (TB), through improved nutritional care and support. The objectives of the guideline are to provide guidance on nutritional assessment, advice and treatment, for integration into clinical care for people with TB. Five guiding principles for nutritional care and support for people with TB are presented. The focus is on nutrition assessment, counselling and management to improve the clinical care of people with TB.
Giving TPT to someone who has TB disease can delay resolution of disease and favour the emergence of drug resistance. Excluding TB disease before initiating preventive treatment is one of the critical steps in the TBI care pathway. This section proposes approaches for ruling out TB disease and diagnosing TBI in people at risk of TB according to HIV status, symptoms, household contact, other risk factors, age, TBI test results and abnormality on CXR (Fig.1).
Nutrition Guidance Advisory Group – nutrition in the life-course
(Note: the areas of expertise of each guideline group member are given in italics)
1. What is the optimal composition of the diet for patients receiving treatment for active TB?
a. Do patients who are newly diagnosed with TB have increased energy requirements?
Nutrition assessment and counselling
Quality of the evidence:
Not available
Values and preferences:
The panel determined that since people with active TB are often underweight and have experienced weight loss by the time of diagnosis, and that low BMI is associated with increased mortality, nutrition screening and assessment is required to determine appropriate nutrition intervention and care.
1. WHO handbook for guideline development. Geneva: World Health Organization; 2012 (http://apps.who.int/iris/bitstream/10665/75146/1/9789241548441_eng.pdf, accessed 3 September 2013).
This guideline will be reviewed in 2020. If new information is available at that time, a guideline review group will be convened to evaluate the new evidence and revise the recommendation if needed. The Department of Nutrition for Health and Development and the Global TB Programme at the WHO headquarters in Geneva, Switzerland, along with their internal partners, will be responsible for coordinating the guideline update, following formal WHO handbook for guideline development (1) procedures.
