New WHO Guidelines Tie Tuberculosis Care to Nutrition
In its latest move to advance the End TB Strategy, the World Health Organization (WHO) released consolidated guidelines on tuberculosis (TB) and undernutrition. The update highlights that undernutrition remains a major driver of the TB epidemic, increasing vulnerability, diminishing treatment success, and contributing to avoidable deaths. In 2023, TB claimed about 1.25 million lives globally, underscoring the need for a people-centered approach that addresses basic determinants of health—nutrition being among the most critical.
The new recommendations emphasize integrating nutrition into routine TB care and extending support beyond the patient to household members. This reflects an understanding that successful TB control requires addressing household-level food insecurity and malnutrition, which often accompany poverty and disease burden.
Key Recommendations from the WHO
1) Nutritional assessment and counselling for all TB patients and household contacts
All individuals diagnosed with TB, along with their household contacts, should receive systematic nutritional assessment and counseling. The guidelines acknowledge that many people living in TB-affected households may be malnourished even if they do not yet show overt illness. By normalizing nutrition screening, health systems can identify at-risk individuals early and tailor interventions to improve outcomes.
2) Nutritional interventions for undernourished TB patients
Undernourished TB patients should receive targeted nutritional interventions to enhance clinical outcomes, independent of age, drug resistance, or pregnancy status. Interventions may include dietary support, micronutrient supplementation where appropriate, and ongoing nutrition counseling integrated with TB treatment. The aim is to bolster immune response, improve treatment tolerance, and reduce mortality associated with TB.
3) Food assistance for household contacts in food-insecure settings
In settings where food insecurity is prevalent, the guidelines recommend providing food assistance to TB patients’ household contacts. This preventive measure addresses the risk of transmission and progression by ensuring that those living with TB have access to adequate nutrition, a key determinant of both infection risk and treatment success.
What This Means for Implementation
According to Dr. Tereza Kasaeva, Director of the WHO Department for HIV, Tuberculosis, Hepatitis, and Sexually Transmitted Infections, TB thrives on inequity and undernutrition is a primary contributor. “To end TB, we must address undernutrition and food insecurity as part of a comprehensive, household-centred response. Integrating nutrition into comprehensive TB care is essential to breaking the cycle of disease and poverty,” she said.
The WHO notes that turning these principles into practice will require close collaboration with government agencies and partners involved in nutritional care, food assistance, and social welfare. To aid countries, an operational guidebook will accompany the amended guidelines. The guide will outline practical steps for stakeholder engagement, coordination, and the integration of nutritional care and food aid into TB prevention and treatment programs.
Looking Ahead: A More Holistic TB Response
By embedding nutrition within TB services, health systems can move toward a more holistic, people-centered model of care. This approach recognizes that treating TB successfully involves more than antibiotics; it requires addressing the social and economic conditions that fuel risk. The operational guidebook will support country-level adaptation, helping policymakers align nutritional support with TB services, social protection programs, and primary health care.
As countries adopt these guidelines, they will need to mobilize resources, train healthcare workers in nutritional assessment and counselling, and establish monitoring to measure the impact of food assistance on TB incidence and treatment outcomes. The goal is not only to cure TB but to prevent it by reinforcing the nutrition and resilience of communities most affected by poverty and disease.
Conclusion
The WHO’s updated guidelines mark a pivotal shift toward integrating nutrition with TB care. By prioritizing nutritional assessment, targeted interventions for undernourished patients, and food support for households in need, the organization seeks to reduce TB mortality and transmission while advancing health equity on a global scale.
