Consolidated Guidelines

Dissemination

Nutrition assessment and counselling

• All individuals with active TB should receive (i) an assessment of their nutritional status and (ii) appropriate counselling based on their nutritional status at diagnosis and throughout treatment (strong recommendation, no evidence).

Management of severe acute malnutrition

Systematic reviews were conducted to address the following questions (see Annex 3 for questions in PICO format)

1. What is the optimal composition of the diet for patients receiving treatment for active TB?

2. Should macronutrient supplements be recommended to improve TB treatment and health outcomes for well-nourished or undernourished patients (children, adolescents, adults and pregnant and lactating women) being treated for active TB?

TB is a contagious disease related to poverty, undernutrition and poor immune function. TB morbidity and mortality are highest in developing countries. In 2012, there were an estimated 8.6 million new cases of TB (13% coinfected with HIV). There were 950 000 deaths due to TB among people who were HIV negative and another 320 000 among people who were HIV positive (7). While TB is more common among men than women, it is one of the top killers of women worldwide; including HIV-positive women, half a million women died from TB in 2012.

WHO thanks the Government of Luxembourg, the National Institutes of Health (NIH), the United States Agency for International Development (USAID) and the Bill & Melinda Gates Foundation for financial support for this work. Donors do not fund specific guidelines and do not participate in any decision related to the guideline development process, including the composition of research questions, membership of the guideline groups, conduct and interpretation of systematic reviews, or formulation of recommendations.

This guideline was coordinated by Dr Maria del Carmen Casanovas and Dr Knut Lönnroth, with technical input from Dr Luz Maria De-Regil, Dr Ernesto Jaramillo, Dr Juan Pablo Peña-Rosas, Mrs Randa Saadeh and Mrs Diana Weil. This work was initiated as part of the general programme of work of the Department of Nutrition for Health and Development, and the Global TB Programme (GTB) in the World Health Organization (WHO) Geneva.

Guideline Development Group

1. Professor SCHÜNEMANN, Holger (Chair) Departments of Clinical Epidemiology & Biostatistics and of Medicine McMaster University Ontario, Canada

2. Dr BAVEJA, Sujata Head of Department, Microbiology Lokmanya Tilak Municipal Medical College and General Hospital Mumbai, India

3. Dr CīRULE, Andra Head Doctor Centre of Tuberculosis and Lung Diseases Riga East University Hospital Riga, Latvia

4. Dr ESCOMBE, Rod Infection prevention and control consultant Sao Paulo, Brazil