Expert consensus on nutritional therapy for tuberculosis and diabetes mellitus comorbidity

doi:10.19982/j.issn.1000-6621.20260187

Abstract

Abstract:

Tuberculosis (TB) and diabetes mellitus (DM) are two major global diseases, and the comorbid nutritional problems seriously compromise treatment outcomes. To standardize the clinical practice of nutritional therapy for patients with TB-DM comorbidity in China, the Chinese Antituberculosis Association jointly collaborated with multiple institutions and assembled a multidisciplinary expert panel. Based on available domestic and international research evidence and clinical practice experience, the panel comprehensively evaluated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) System to formulate this consensus. This consensus systematically addresses 10 key components of nutritional therapy: principles and objectives, nutritional risk screening and assessment, dietary nutritional intervention, enteral and parenteral nutrition support, nutrition therapy monitoring, impacts of medications on nutritional management, nutritional intervention for comorbidities, nutritional care for special populations and health education. A total of 20 core recommendations have been established in this consensus. It aims to provide scientific, standardized and operational guidance for clinical nutritional diagnosis and management. By optimizing nutritional therapy, it can effectively improve glycemic abnormalities in patients and facilitate better anti-tuberculosis treatment outcomes.

Key words: Tuberculosis, Diabetes mellitus, Comorbidity, Nutritional support, Guidebooks

CLC Number:

R52
R587.1

Chinese Antituberculosis Association, Nutrition Branch of the Chinese Antituberculosis Association, Hunan Antituberculosis Association, Hunan Institute for Tuberculosis Control (Hunan Chest Hospital), Shanghai Pulmonary Hospital, Xiangya School of Public Health, Central South University. Expert consensus on nutritional therapy for tuberculosis and diabetes mellitus comorbidity[J]. Chinese Journal of Antituberculosis, 2026, 48(7): 913-924. doi: 10.19982/j.issn.1000-6621.20260187

Figures/Tables 2

References 96

[1]	国家感染性疾病临床医学研究中心, 深圳市第三人民医院, 国家代谢性疾病临床医学研究中心, 等. 结核病与糖尿病共病的治疗管理专家共识[J]. 中国防痨杂志, 2021, 43(1): 12-22. doi:10.3969/j.issn.1000-6621.2021.01.004.
[2]	杨敏, 付亮, 邓国防. 结核病并发糖尿病治疗管理相关进展[J]. 中国防痨杂志, 2021, 43(1): 87-90. doi:10.3969/j.issn.1000-6621.2021.01.016.
[3]	屈燕, 李涛, 马文斌, 等. 世界卫生组织《2025年全球结核病报告》解读[J]. 结核与肺部疾病杂志, 2025, 6 (6): 613-623. doi:10.19983/j.issn.2096-8493.20250178.
[4]	Noubiap J J, Nansseu J R, Nyaga U F, et al. Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2·3 million patients with tuberculosis[J]. Lancet Glob Health, 2019, 7(4): e448-e460. doi:10.1016/S2214-109X(18)30487-X.
[5]	Kong D, Xia Y, Wang X, et al. Prevalence trends, population characteristics and treatment outcomes of tuberculosis combined with diabetes in Southwest China: a register-based retrospective study[J]. Front Public Health, 2024, 12: 1445857. doi:10.3389/fpubh.2024.1445857.
[6]	牛亚燕, 时翠林, 曾令武, 等. 结核病合并糖尿病的研究进展[J]. 国际流行病学传染病学杂志, 2021, 48(6): 479-483. doi:10.3760/cma.j.cn331340-20211016-00202.
[7]	田瑶, 刘辉敏, 傅满姣, 等. 结核病与糖尿病共病诊疗现状[J]. 结核与肺部疾病杂志, 2022, 3(2): 91-95. doi:10.19983/j.issn.2096-8493.20210111.
[8]	董航, 杜映荣. 糖尿病与肺结核共病的临床研究进展[J]. 结核与肺部疾病杂志, 2022, 3(1): 65-69. doi:10.19983/j.issn.2096-8493.20210121.
[9]	Girishbhai Patel D, Baral T, Jacob Kurian S, et al. Nutritional status in patients with tuberculosis and diabetes mellitus: A comparative observational study[J]. J Clin Tuberc Other Mycobact Dis, 2024, 35: 100428. doi:10.1016/j.jctube.2024.100428.
[10]	Zeng M, Ran J, Luo Y, et al. The potential role and value of vitamin D in the treatment of tuberculosis[J]. Front Cell Infect Microbiol, 2026, 15: 1654860. doi:10.3389/fcimb.2025.1654860.
[11]	Yang Y, Cai J, Wang X, et al. Nutritional supplementation during tuberculosis treatment to improve clinical symptoms: a double-blinded placebo-controlled randomized trial[J]. Food Funct, 2025, 16(1): 102-111. doi:10.1039/d4fo05172f. pmid: 39620654
[12]	Schünemann H, Brożek J, Guyatt G, et al. GRADE Handbook[M/OL]. [2020-07-16]. https://gdt.gradepro.org/app/handbook/handbook.html.
[13]	GRADE pro GDT. GRADE your evidence and improve your guideline development in health care[EB/OL]. [2020-07-10]. https://www.gradepro.org/.
[14]	Balshem H, Helfanda M J, Schunemann H, et al. GRADE指南: Ⅲ.证据质量分级[J]. 中国循证医学杂志, 2011, 11(4): 451-455. doi:10.3969/j.issn.1672-2531.2011.04.017.
[15]	Ngo M D, Bartlett S, Ronacher K. Diabetes-Associated Susceptibility to Tuberculosis: Contribution of Hyperglycemia vs. Dyslipidemia[J]. Microorganisms, 2021, 9(11): 2282. doi:10.3390/microorganisms9112282.
[16]	Zhang P, Shi H, Xie Y, et al. Optimized anti-tuberculosis duration for drug-susceptible pulmonary tuberculosis-diabetes mellitus comorbidities: study protocol for a multicenter randomized controlled trial[J]. BMC Pulm Med, 2024, 24(1): 469. doi:10.1186/s12890-024-03271-8. pmid: 39334186
[17]	Kendall E A, Azman A S, Cobelens F G, et al. MDR-TB treatment as prevention: The projected population-level impact of expanded treatment for multidrug-resistant tuberculosis[J]. PLoS One, 2017, 12(3): e0172748. doi:10.1371/journal.pone.0172748.
[18]	Fox G J, Dobler C C, Marais B J, et al. Preventive therapy for latent tuberculosis infection-the promise and the challenges[J]. Int J Infect Dis, 2017, 56: 68-76. doi:10.1016/j.ijid.2016.11.006. pmid: 27872018
[19]	Meng J, Li X, Xiong Y, et al. The role of vitamin D in the prevention and treatment of tuberculosis: a meta-analysis of randomized controlled trials[J]. Infection, 2025, 53(3): 1129-1140. doi:10.1007/s15010-024-02446-z.
[20]	中华医学会结核病学分会重症专业委员会. 结核病营养治疗专家共识[J]. 中华结核和呼吸杂志, 2020, 43(1): 17-26. doi:10.3760/cma.j.issn.1001-0939.2020.01.006.
[21]	中华医学会糖尿病学分会. 中国糖尿病防治指南(2024版)[J]. 中华糖尿病杂志, 2025, 17(1): 16-139. doi:10.3760/cma.j.cn115791-20241203-00705.
[22]	中国医疗保健国际交流促进会营养与代谢管理分会, 中国营养学会临床营养分会, 中华医学会糖尿病学分会, 等. 中国糖尿病医学营养治疗指南(2022版)[J]. 中华糖尿病杂志, 2022, 14(9): 881-933. doi:10.3760/cma.j.cn115791-20220704-00324.
[23]	World Health Organization. Guideline: Nutritional Care and Support for Patients with Tuberculosis[R]. Geneva: World Health Organization, 2013.
[24]	He L, Zhang G, Wei M, et al. Effect of Individualized Dietary Intervention on Oxidative Stress in Patients with Type 2 Diabetes Complicated by Tuberculosis in Xinjiang, China[J]. Diabetes Ther, 2019, 10(6): 2095-2105. doi:10.1007/s13300-019-00691-2. pmid: 31538317
[25]	中国营养学会膳食营养素参考摄入量2023专家委员会. 《中国居民膳食营养素参考摄入量》2023修订版简介[J]. 营养学报, 2023, 45(6): 521-524. doi:10.3969/j.issn.0512-7955.2023.06.001.
[26]	王乐乐, 杨松, 唐神结. 活动性肺结核患者微量营养素变化及其相关营养治疗的研究进展[J]. 结核与肺部疾病杂志, 2020, 1(4): 281-284. doi:10.3969/j.issn.2096-8493.2020.03.015.
[27]	Said E, Mousa S, Fawzi M, et al. Combined effect of high-dose vitamin A, vitamin E supplementation, and zinc on adult patients with diabetes: A randomized trial[J]. J Adv Res, 2020, 28: 27-33. doi:10.1016/j.jare.2020.06.013.
[28]	Krul-Poel Y H, Ter Wee M M, Lips P, et al. MANAGEMENT OF ENDOCRINE DISEASE: The effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis[J]. Eur J Endocrinol, 2017, 176(1): R1-R14. doi:10.1530/EJE-16-0391.
[29]	唐先珍, 黄涛, 马瑶, 等. 补充维生素D辅助治疗肺结核效果和安全性的荟萃分析[J]. 中华医学杂志, 2020, 100(32): 2525-2531. doi:10.3760/cma.j.cn112137-20200121-00146.
[30]	Cioboata R, Balteanu M A, Zlatian O M, et al. Impact of vitamin C deficiency on imaging patterns and ventilatory function in pulmonary tuberculosis[J]. Front Med (Lausanne), 2025, 12: 1554723. doi:10.3389/fmed.2025.1554723.
[31]	姜丽, 张晓强, 刘伶俐, 等. 结核病患者营养素缺乏临床特征研究进展[J]. 中国防痨杂志, 2020, 42(7): 741-746. doi:10.3969/j.issn.1000-6621.2020.07.018.
[32]	Elbarbary N S, Ismail E A R, Zaki M A, et al. Vitamin B complex supplementation as a homocysteine-lowering therapy for early stage diabetic nephropathy in pediatric patients with type 1 diabetes: A randomized controlled trial[J]. Randomized Controlled Trial Clin Nutr, 2020, 39(1): 49-56. doi:10.1016/j.clnu.2019.01.006.
[33]	石汉平, 许红霞, 李苏宜, 等. 营养不良的五阶梯治疗[J]. 肿瘤代谢与营养电子杂志, 2015, 2(1): 29-33.
[34]	高纯, 胡俊波. 临床营养筛查与评估方法的现状与进展[J]. 临床外科杂志, 2016, 24(12): 896-898. doi:10.3969/j.issn.1005-6483.2016.12.003.
[35]	罗小青, 段思雨, 林铭钰, 等. 结核病并发糖尿病住院患者的营养风险及其影响因素[J]. 中国防痨杂志, 2021, 43(1): 42-46. doi:10.3969/j.issn.1000-6621.2021.01.009.
[36]	方雪娥, 毛燕君, 汤玲玲, 等. 肺结核住院患者营养风险筛查和评估的最佳证据总结[J]. 中华护理杂志, 2019, 54(9): 1406-1410. doi:10.3761/j.issn.0254-1769.2019.09.025.
[37]	陈卫星, 陆川, 杨培双. 肺结核合并糖尿病患者营养风险评估及影响因素的研究[J]. 糖尿病新世界, 2019, 22(20): 137-138. doi:10.16658/j.cnki.1672-4062.2019.20.137.
[38]	刘晓童, 王安素, 蒋中艳, 等. 结核病患者营养筛查和评估工具研究进展[J]. 中国防痨杂志, 2022, 44(8): 855-859. doi:10.19982/j.issn.1000-6621.20220140.
[39]	Xu Y C, Vincent J I. Clinical measurement properties of malnutrition assessment tools for use with patients in hospitals: a systematic review[J]. Nutr J, 2020, 19(1): 106. doi:10.1186/s12937-020-00613-0. pmid: 32957989
[40]	Lin H S, Lin M S, Chi C C, et al. Nutrition Assessment and Adverse Outcomes in Hospitalized Patients with Tuberculosis[J]. J Clin Med, 2021, 10(12): 2702. doi:10.3390/jcm10122702.
[41]	中国营养学会糖尿病营养工作组. 《中国2型糖尿病膳食指南》及解读[J]. 营养学报, 2017, 39(6): 521-529. doi:10.3969/j.issn.0512-7955.2017.06.002.
[42]	李华, 吴庆峰, 薛晴晴, 等. 低血糖指数食品的研究进展[J]. 河南工业大学学报(自然科学版), 2023, 44(2): 119-126. doi:10.16433/j.1673-2383.2023.02.016.
[43]	张晴, 周建超, 赵妍娟, 等. 低血糖指数糖尿病膳食对2型糖尿病患者代谢及营养状况的影响研究[J]. 中国全科医学, 2012, 15(12): 1319-1321. doi:10.3969/j.issn.1007-9572.2012.12.005.
[44]	陈玮, 王希, 潘思旭, 等. 糖尿病专用配方和标准肠内营养制剂对重症病人高血糖影响的Meta分析[J]. 肠外与肠内营养, 2021, 28(6): 368-375. doi:10.16151/j.1007-810x.2021.06.010.
[45]	柳梅, 范学朋. 含缓释淀粉的肠内营养制剂对危重症病人血糖及预后的影响[J]. 肠外与肠内营养, 2015, 22(3): 140-142. doi:10.16151/j.1007-810x.2015.03.004.
[46]	孟丽娜, 张广宇, 张玉想. ICU重症结核性脑膜炎患者的营养评估与支持[J]. 中华临床医师杂志(电子版), 2013, 7(6): 2657-2659. doi:10.3877/cma.j.issn.1674-0785.2013.06.088.
[47]	黄雪芝, 罗建冬, 吴登助, 等. 重症肠结核并发肠瘘患者的营养支持治疗[J]. 中国防痨杂志, 2021, 43(2): 194-196. doi:10.3969/j.issn.1000-6621.2021.02.017.
[48]	中国人民解放军总医院第八医学中心结核病医学部/全军结核病研究所/全军结核病防治重点实验室/结核病诊疗新技术北京市重点实验室, 《中国防痨杂志》编辑委员会. 结核病重症患者营养评估及营养支持治疗专家共识[J]. 中国防痨杂志, 2022, 44(5): 421-432. doi:10.19982/j.issn.1000-6621.20220041.
[49]	Compher C, Bingham A L, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition[J]. JPEN J Parenter Enteral Nutr, 2022, 46(1): 12-41. doi:10.1002/jpen.2267.
[50]	Bidstrup T B, Stilling N, Damkier P, et al. Rifampicin seems to act as both an inducer and an inhibitor of the metabolism of repaglinide[J]. Eur J Clin Pharmacol, 2004, 60(2): 109-114. doi:10.1007/s00228-004-0746-z. pmid: 15034704
[51]	Singer P, Blaser A R, Berger M M, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit[J]. Clin Nutr, 2023, 42(9): 1671-1689. doi:10.1016/j.clnu.2023.07.011. pmid: 37517372
[52]	浙江省医学会重症医学分会. 中国重症患者肠外营养治疗临床实践专家共识(2024)[J]. 中华危重病急救医学, 2024, 36(7): 673-680. doi:10.3760/cma.j.cn121430-20240123-00080.
[53]	张颖, 叶云, 左秀英, 等. 肺结核合并糖尿病患者营养管理的最佳证据总结[J]. 结核与肺部疾病杂志, 2025, 6(5): 538-543. doi:10.19983/j.issn.2096-8493.20250098.
[54]	Wang J, Xiong K, Wang Q, et al. Adjunctive vitamin A and D during pulmonary tuberculosis treatment: a randomized controlled trial with a 2×2 factorial design[J]. Food Funct, 2020, 11(5): 4672-4681. doi:10.1039/c9fo02751c.
[55]	Lin Y, Bai Y, Zhang T, et al. Unfavourable treatment outcomes in tuberculosis patients with different vitamin D status and blood glucose levels in a programme setting in China[J]. Trop Med Int Health, 2020, 25(3): 373-379. doi:10.1111/tmi.13355. pmid: 31802572
[56]	Fletcher B R, Damery S, Aiyegbusi O L, et al. Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis[J]. PLoS Med, 2022, 19(4): e1003954. doi:10.1371/journal.pmed.1003954.
[57]	Devineni D, Vaccaro N, Murphy J, et al. Effects of rifampin, cyclosporine A, and probenecid on the pharmacokinetic profile of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in healthy participants[J]. Int J Clin Pharmacol Ther, 2015, 53(2): 115-128. doi:10.5414/CP202158.
[58]	Cho S K, Yoon J S, Lee M G, et al. Rifampin enhances the glucose-lowering effect of metformin and increases OCT1 mRNA levels in healthy participants[J]. Clin Pharmacol Ther, 2011, 89(3): 416-421. doi:10.1038/clpt.2010.266. pmid: 21270793
[59]	Jaakkola T, Backman J T, Neuvonen M, et al. Effect of rifampicin on the pharmacokinetics of pioglitazone[J]. Br J Clin Pharmacol, 2006, 61(1): 70-78. doi:10.1111/j.1365-2125.2005.02515.x.
[60]	Chou H W, Wang J L, Chang C H, et al. Risk of severe dysglycemia among diabetic patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Chinese Taiwan[J]. Clin Infect Dis, 2013, 57(7): 971-980. doi:10.1093/cid/cit439.
[61]	Backman J T, Luurila H, Neuvonen M, et al. Rifampin markedly decreases and gemfibrozil increases the plasma concentrations of atorvastatin and its metabolites[J]. Clin Pharmacol Ther, 2005, 78(2): 154-167. doi:10.1016/j.clpt.2005.04.007. pmid: 16084850
[62]	Zhang W, Deng S, Chen X P, et al. Pharmacokinetics of rosuvastatin when coadministered with rifampicin in healthy males: a randomized, single-blind, placebo-controlled, crossover study[J]. Clin Ther, 2008, 30(7): 1283-1289. doi:10.1016/s0149-2918(08)80052-5. pmid: 18691987
[63]	Kyrklund C, Backman J T, Kivistö K T, et al. Rifampin greatly reduces plasma simvastatin and simvastatin acid concentrations[J]. Clin Pharmacol Ther, 2000, 68(6): 592-597. doi:10.1067/mcp.2000.111414. pmid: 11180018
[64]	Khosroshahi R A, Zare M, Zeraattalab-Motlagh S, et al. Effects of a Low-Protein Diet on Kidney Function in Patients With Chronic Kidney Disease: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Controlled Trials[J]. Nutr Rev, 2025, 83(7): e2127-e2138. doi:10.1093/nutrit/nuae178.
[65]	Rhee C M, Ahmadi S F, Kovesdy C P, et al. Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials[J]. J Cachexia Sarcopenia Muscle, 2018, 9(2): 235-245. doi:10.1002/jcsm.12264. pmid: 29094800
[66]	Zheng C M, Hsu Y H, Lu C L, et al. The modulating effect of dietary protein intake on mortality in long-term hemodialysis patients: A nationwide population-based study[J]. Int J Clin Pract, 2021, 75(3): e13747. doi:10.1111/ijcp.13747.
[67]	Mafra D, Brum I, Borges N A, et al. Low-protein diet for chronic kidney disease: Evidence, controversies, and practical guidelines[J]. J Intern Med, 2025, 298(4): 319-335. doi:10.1111/joim.20117.
[68]	Martino F K, Zattarin A, Cinquini C, et al. Low-Protein Diet in Elderly Patients with Chronic Kidney Disease Stage 4 and 5 in Conservative Management: Focus on Sarcopenia Development[J]. Nutrients, 2024, 16(10): 1498. doi:10.3390/nu16101498.
[69]	Ko G J, Kalantar-Zadeh K, Goldstein-Fuchs J, et al. Dietary Approaches in the Management of Diabetic Patients with Kidney Disease[J]. Nutrients, 2017, 9(8): 824. doi:10.3390/nu9080824.
[70]	Chen Y, Wang X, Jia Y, et al. Effect of a sodium restriction diet on albuminuria and blood pressure in diabetic kidney disease patients: a meta-analysis[J]. Int Urol Nephrol, 2022, 54(6): 1249-1260. doi:10.1007/s11255-021-03035-x.
[71]	Collins A J, Pitt B, Reaven N, et al. Association of Serum Potassium with All-Cause Mortality in Patients with and without Heart Failure, Chronic Kidney Disease, and/or Diabetes[J]. Am J Nephrol, 2017, 46(3): 213-221. doi:10.1159/000479802. pmid: 28866674
[72]	Kalantar-Zadeh K, Fouque D. Nutritional Management of Chronic Kidney Disease[J]. N Engl J Med, 2017, 377(18): 1765-1776. doi:10.1056/NEJMra1700312.
[73]	中华医学会结核病学分会. 抗结核药所致药物性肝损伤诊治指南(2024年版)[J]. 中华结核和呼吸杂志, 2024, 47(11): 1069-1090. doi:10.3760/cma.j.cn112147-20240614-00338.
[74]	Zeng L, Jin X, Xiao Q A, et al. Ferroptosis: action and mechanism of chemical/drug-induced liver injury[J]. Drug Chem Toxicol, 2024, 47(6): 1300-1311. doi:10.1080/01480545.2023.2295230.
[75]	Singal A K, Wong R J, Dasarathy S, et al. ACG Clinical Guideline: Malnutrition and Nutritional Recommendations in Liver Disease[J]. Am J Gastroenterol, 2025, 120(5): 950-972. doi:10.14309/ajg.0000000000003379. pmid: 40314389
[76]	Lee H, Yoo J J, Ahn S H, et al. New Evidence of Oral Branched-Chain Amino Acid Supplementation on the Prognosis of Patients With Advanced Liver Disease[J]. Clin Transl Gastroenterol, 2022, 13(12): e00542. doi:10.14309/ctg.0000000000000542.
[77]	Giezenaar C, Chapman I, Luscombe-Marsh N, et al. Ageing Is Associated with Decreases in Appetite and Energy Intake-A Meta-Analysis in Healthy Adults[J]. Nutrients, 2016, 8(1): 28. doi:10.3390/nu8010028.
[78]	Kawano R, Takahashi F, Hashimoto Y, et al. Short energy intake is associated with muscle mass loss in older patients with type 2 diabetes: A prospective study of the KAMOGAWA-DM cohort[J]. Clin Nutr, 2021, 40(4): 1613-1620. doi:10.1016/j.clnu.2021.02.049. pmid: 33752149
[79]	Ji T, Zhang L, Han R, et al. Management of Malnutrition Based on Multidisciplinary Team Decision-Making in Chinese Older Adults (3M Study): A Prospective, Multicenter, Randomized, Controlled Study Protocol[J]. Front Nutr, 2022, 9: 851590. doi:10.3389/fnut.2022.851590.
[80]	Matia Martin P, Robles Agudo F, Lopez Medina J A, et al. Effectiveness of an oral diabetes-specific supplement on nutritional status, metabolic control, quality or life, and functional status in elderly patients. A multicentre study[J]. Clin Nutr, 2019, 38(3): 1253-1261. doi:10.1016/j.clnu.2018.05.007.
[81]	Gielen E, Beckwée D, Delaere A, et al. Nutritional interventions to improve muscle mass, muscle strength, and physical performance in older people: an umbrella review of systematic reviews and meta-analyses[J]. Nutr Rev, 2021, 79(2): 121-147. doi:10.1093/nutrit/nuaa011. pmid: 32483625
[82]	Talar K, Hernández-Belmonte A, Vetrovsky T, et al. Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies[J]. J Clin Med, 2021, 10(8): 1630. doi:10.3390/jcm10081630.
[83]	Diao H, Yan F, He Q, et al. Association between Dietary Inflammatory Index and Sarcopenia: A Meta-Analysis[J]. Nutrients, 2023, 15(1): 219. doi:10.3390/nu15010219.
[84]	Jalili C, Talebi S, Bagheri R, et al. The Association between Dietary Inflammatory Index and Aging Biomarkers/Conditions: A Systematic Review and Dose-response Meta-analysis[J]. J Nutr Health Aging, 2023, 27(5): 378-390. doi:10.1007/s12603-023-1919-8. pmid: 37248762
[85]	Li Y, Huang Y, Yan J, et al. Anti-inflammatory diet and low muscle mass among older adults: a cohort study based on clhls[J]. Geriatr Nurs, 2025, 64: 103378. doi:10.1016/j.gerinurse.2025.05.017.
[86]	张锋, 张小佛, 周海依, 等. 儿童结核病患者营养风险评估及营养支持的应用研究[J]. 临床肺科杂志, 2024, 29(5): 734-738. doi:10.3969/j.issn.1009-6663.2024.05.016.
[87]	裴舟, 罗飞宏. 中国儿童糖尿病诊治进展[J]. 诊断学理论与实践, 2024, 23(5): 461-466. doi:10.16150/j.1671-2870.2024.05.001.
[88]	Annan S F, Higgins L A, Jelleryd E, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes[J]. Pediatr Diabetes, 2022, 23(8): 1297-1321. doi:10.1111/pedi.13429. pmid: 36468223
[89]	中华预防医学会儿童保健分会. 中国儿童维生素A、维生素D临床应用专家共识(2024)[J]. 中国儿童保健杂志, 2024, 32(4): 349-358, 361. doi:10.11852/zgetbjzz2024-0279.
[90]	Wang Q, Ma A, Schouten E G, et al. A double burden of tuberculosis and diabetes mellitus and the possible role of vitamin D deficiency[J]. Clin Nutr, 2021, 40(2): 350-357. doi:10.1016/j.clnu.2020.08.040. pmid: 32948348
[91]	Herrera M T, Gonzalez Y, Hernández-Sánchez F, et al. Low serum vitamin D levels in type 2 diabetes patients are associated with decreased mycobacterial activity[J]. BMC Infect Dis, 2017, 17(1): 610. doi:10.1186/s12879-017-2705-1. pmid: 28882103
[92]	de Bock M, Codner E, Craig M E, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes[J]. Pediatr Diabetes, 2022, 23(8): 1270-1276. doi:10.1111/pedi.13455. pmid: 36537523
[93]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022)[第一部分][J]. 中华妇产科杂志, 2022, 57(1): 3-12. doi:10.3760/cma.j.cn112141-20210917-00528.
[94]	American Diabetes Association Professional Practice Committee. 15. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2022[J]. Diabetes Care, 2022, 45(Suppl 1): S232-S243. doi:10.2337/dc22-S015.
[95]	韩婷婷, 刘桂珍, 陈秋奇, 等. 世界卫生组织《应对结核病及其共病合作行动框架》解读[J]. 中国防痨杂志, 2023, 45(1): 25-30. doi:10.19982/j.issn.1000-6621.20220464.
[96]	Patra J, Jha P, Rehm J, et al. Tobacco smoking, alcohol drinking, diabetes, low body mass index and the risk of self-reported symptoms of active tuberculosis: individual participant data (IPD) meta-analyses of 72,684 individuals in 14 high tuberculosis burden countries[J]. PLoS One, 2014, 9(5): e96433. doi:10.1371/journal.pone.0096433.

推荐强度	具体描述
强推荐(1级)	明确显示干预措施利大于弊
弱推荐(2级)	利弊不确定或无论质量高低的证据均显示利弊相当

证据级别	定义
高质量(A)	非常确信估计的效应值接近真实的效应值;进一步研究也不可能改变该估计效应值的可信度
中等质量(B)	对估计的效应值确信程度中等:估计值有可能接近真实值,但仍存在二者不相同的可能性;进一步研究有可能改变该估计效应值的可信度
低质量(C)	对估计的效应值的确信度有限:估计值与真实值可能大不相同;进一步研究极有可能改变该估计效应值的可信度
极低质量(D)	对估计的效应值几乎没有信心:估计值与真实值很可能完全不同;对效应值任何估计都很不确定