On October 8, 2025, the World Health Organization (WHO) released updated guidelines within its consolidated framework on tuberculosis (TB), specifically Module 6: Tuberculosis and Comorbidities, focusing on the critical intersection of TB and undernutrition. Published as part of the WHO’s End TB Strategy, these guidelines address undernutrition as a major global driver of TB, increasing disease susceptibility, worsening treatment outcomes, and contributing to preventable mortality. The recommendations advocate for a people-centered, comprehensive approach to TB care by integrating nutritional interventions to break the cycle of disease and poverty.
Key recommendations include routine nutritional assessment and counseling for all individuals with TB and their household contacts, recognizing the high prevalence of undernutrition in TB-affected households. Nutritional interventions are advised for all TB patients with undernutrition, regardless of age, drug resistance, pregnancy status, or severity, to optimize clinical outcomes. Additionally, food assistance is recommended for household contacts in food-insecure settings to prevent TB incidence, informed by evidence from the RATIONS trial (Bhargava et al., The Lancet, 2023), which demonstrated reduced TB activation through nutritional supplementation. These measures aim to improve treatment success, reduce relapse rates, and lower TB-related mortality.
Implementation requires collaboration across government sectors, nutritional care providers, and social welfare services. An accompanying operational handbook will provide practical guidance for stakeholder coordination and integration of nutritional support into TB programs. The guidelines expand on prior WHO recommendations, which primarily addressed HIV-associated TB, and update earlier nutritional care protocols for TB patients.
The WHO acknowledges contributions from evidence reviewers, guideline development groups, technical experts, and community representatives. Available via the WHO TB Knowledge Sharing Platform, these guidelines underscore the need for equitable, multidisciplinary TB care to address social determinants like food insecurity. By prioritizing nutritional support, the WHO aims to advance global TB elimination efforts, particularly in high-burden, resource-limited settings, fostering improved health outcomes and health equity.
