Micronutrient supplementation in individuals with active tuberculosis

Intervention | Last updated: 13 June 2023

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.

Low circulating concentrations of micronutrients, such as vitamins A, E and D, and iron, zinc and selenium have been reported in some patients, though levels usually return to normal after 2 months of appropriate TB treatment.

WHO Recommendations

A daily multiple micronutrient supplement at 1× recommended nutrient intake* should be provided in situations where fortified or supplementary foods should have been provided in accordance with standard management of moderate undernutrition (IAMI manual, Technical note; see 'WHO documents' below), but are unavailable.

All pregnant and lactating women with active TB should receive multiple micronutrient supplements that contain iron and folic acid and other vitamins and minerals, according to the United Nations Multiple Micronutrient Preparation (UNICEF, WHO, UNU joint report; see 'WHO documents' below) to complement their maternal micronutrient needs.

In settings where calcium intake is low, calcium supplementation as part of antenatal care is recommended in pregnant women with active TB for the prevention of pre-eclampsia, particularly among those pregnant women at higher risk of developing hypertension.

* providing the equivalent micronutrient profile recommended in the Technical note (see WHO documents below)

Guidelines and guidance documents Learn More

GRC-approved guidelines

Nutritional care and support for patients with tuberculosis

Guideline: calcium supplementation in pregnant women

WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia

Technical note: supplementary foods for the management of moderate acute malnutrition in infants and children 6–59 months of age

IMAI district clinician manual: hospital care adolescents and adults

Composition of a multi-micronutrient supplement to be used in pilot programmes among pregnant women in developing countries: report of a United Nations Children's Fund (‎UNICEF)‎, World Health Organization (‎WHO)‎ and United Nations University workshop

Evidence

Systematic reviews used to develop the guidelines

Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems

Hofmeyr GJ, Lawrie TA, Atallah ÁN, Duley L, Torloni MR. Cochrane Database of Systematic Reviews. 2014; Issue 6. Art. No.: CD001059.

Nutritional supplements for people being treated for active tuberculosis

Sinclair D, Abba K, Grobler L, Sudarsanam TD. Cochrane Database of Systematic Reviews. 2011; Issue 11. Art. No.: CD006086.

Podcast (Cochrane)

Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes"

Buppasiri P, Lumbiganon P, Thinkhamrop J, Ngamjarus C, Laopaiboon M, Medley N. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD007079.

Summary of this review

Related Cochrane reviews

Nutritional supplements for people being treated for active tuberculosis.

Grobler L, Nagpal S, Sudarsanam TD, Sinclair D.Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD006086.

Summary of this review

Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems

Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Cochrane Database of Systematic Reviews. 2018; Issue 10. Art. No.: CD001059.

Cost-effectiveness Learn More

Cost-effectiveness analyses

Optimizing treatment for the prevention of pre-eclampsia/eclampsia in Nepal: is calcium supplementation during pregnancy cost-effective?

Feldhaus I, LeFevre AE, Rai C, Bhattarai J, Russo D, Rawlins B, et al.<br>\r\nCost Eff Resour Alloc. 2016; 14:13.\r\n

Should women be advised to use calcium supplements during pregnancy? A decision analysis

Meertens LJE, Scheepers HCJ, Willemse JPMM, Spaanderman MEA, Smits LJM.<br>\r\nMatern Child Nutr. 2018; 14(1).\r\n

e-Library of Evidence for Nutrition Actions (eLENA)