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Cerebrovascular Accident (Stroke)
In primary moderate acute malnutrition, management at home is recommended, including counseling of parents, with emphasis on continuing breastfeeding and appropriate complementary feeding nutrition-specific interventions. Children with severe acute malnutrition without any complications can be managed in the community with ready-to-use therapeutic food peanut paste, milk powder, vegetable oil and a mineral and vitamin mix as per WHO recommendations [ 33 ].
Children who have been treated for complications and have appetite can also be treated in the hospital with ready-to-use therapeutic food. Severe acute malnutrition complications i. If the child fails to improve clinically by 48 h or deteriorates after 24 h, a third-generation cephalosporin i. The feeding frequency is gradually decreased Table 2. Feeding of children with severe acute malnutrition adapted from Koletzko et al. The refeeding syndrome is due to the sudden availability of glucose, leading to inhibition of gluconeogenesis and an insulin surge. This causes rapid intracellular influx of potassium, magnesium, and phosphate and therefore low serum levels and poor myocardial contractility [ 4 , 34 ]. In settings where a program for the community-based management of severe acute malnutrition with ready-to-use therapeutic food is not available, F is used.
The WHO recommends the milk-based diet for nutritional rehabilitation F, which contains kcal and 2. Chronic malnutrition needs nutrition-sensitive interventions scaled up at the national or regional level, including ensuring household food security, safe water, proper hygiene, female education, creating proper livelihoods, social protection schemes, etc. Growth monitoring should be implemented at the community level, where the nutritional status of infants and young children should be assessed every one—three months and their growth empowered through counseling of parents, even before malnutrition occurs.
For the management of secondary acute malnutrition, it is crucial to identify the underlying disease by history taking, examination and laboratory investigations [ 5 ]. Exclusive breastfeeding for the first six months along with iron supplementation is adequate for preterm and low-birth-weight infants. They are at risk of necrotizing enterocolitis if aggressive enteral feeding is delivered. In mild inflammatory bowel disease or disease in remission, the intake of a normal diet can be suggested. Commercial, specially prepared liquid formulas are helpful for some patients with inflammatory bowel disease [ 36 ]. In advanced chronic liver disease, the diet may need to be protein sparing for the prevention of hyperammonemia.
A combination of lipids and carbohydrates with a minimal amount of protein should be used. Another important feature in chronic liver disease is decreased bile salt excretion into the small intestine, which can cause malabsorption of fats and fat-soluble vitamins. This can be faced by using medium-chain triglycerides as the source of dietary fat, since they do not depend upon bile salts for absorption. Water-soluble forms of the usually fat-soluble vitamins A, D, E and K should be used. Children with chronic renal disease may benefit from high-energy as well as high-quality protein in quantities that will not induce or worsen uremia [ 5 ]. Children with congenital heart disease need to be provided with sufficient energy and protein without increasing the fluid volume too much.
They have reduced food intake due to fatigue, dyspnea and frequent lung infections. The heart failure and increased breathing efforts induce a hypermetabolic state that further increases the demand for more nutrients [ 5 ]. The diet has to be modified to cater to the increased caloric needs. Parenteral nutrition can be used to improve nutrition in case of poor tolerance to large volumes of enteral feeds. The principles of management of severe malnutrition resulting from the underlying diseases mentioned above are similar to those for primary severe acute malnutrition.
In humanitarian crises, supplementary feeding is considered the main strategy for preventing and treating moderate acute malnutrition. According to the Sphere guidelines [ 37 ], two types of supplementary feeding programs can be implemented: i blanket supplementary feeding programs for preventing, and ii targeted supplementary feeding programs for treating moderate acute malnutrition and preventing severe acute malnutrition. The use of each depends on the severity of acute malnutrition, vulnerable population groups and the risk of an increase in acute malnutrition. Blanket supplementary feeding programs are recommended where food safety is low and there is a need to expand interventions beyond only moderate acute malnutrition cases.
They should be accompanied by general food distribution targeting affected households. Defined impact indicators for blanket supplementary feeding programs do not exist, but it is important to check coverage, adherence, acceptability and rations provided. The indicators for managing moderate acute malnutrition mainly refer to targeted supplementary feeding. The main aim of a targeted supplementary feeding program is to prevent the moderately malnourished becoming severely malnourished and to rehabilitate them. These types of program usually provide a food supplement to the general ration for moderately malnourished individuals, for pregnant and nursing mothers, and other at-risk individuals.
In conclusion, acute malnutrition is a nutritional deficiency resulting from either inadequate energy or protein intake, with variable clinical presentation. Clinical examination and careful measurement of growth status and reference to standard growth charts is essential in order to identify children with acute malnutrition. Most children with primary acute malnutrition can be managed at home, while those with severe acute malnutrition and complications require treatment in a hospital; those without complications can be treated at home with ready-to-use therapeutic food.
The management of secondary malnutrition is mainly based on treating the underlying cause malabsorption, infections, etc. All authors have read and agreed to the published version of the manuscript. National Center for Biotechnology Information , U. Journal List Nutrients v. Published online Aug Author information Article notes Copyright and License information Disclaimer. Received Jul 4; Accepted Aug This article has been cited by other articles in PMC. Abstract Acute malnutrition is a nutritional deficiency resulting from either inadequate energy or protein intake. Keywords: acute malnutrition, marasmus, kwashiorkor, primary malnutrition, secondary malnutrition, management.
Introduction Acute malnutrition is a nutritional deficiency resulting from either inadequate protein or energy intake. Table 1 New terms used for childhood malnutrition adapted from Koletzko, B. Open in a separate window. Pathophysiology Inadequate energy intake leads to various physiologic adaptations, including growth restriction, loss of fat, muscle, and visceral mass, reduced basal metabolic rate, and reduced total energy expenditure [ 4 , 5 , 6 ]. Clinical Syndromes Acute malnutrition pertains to a group of linked disorders that includes kwashiorkor, marasmus, and intermediate states of marasmic kwashiorkor. Marasmic Kwashiorkor Marasmic kwashiorkor is represented by mixed features of both marasmus and kwashiorkor.
Assessment An adequate nutritional assessment includes detailed dietary history, physical examination, anthropometric measurements including weight, length, and head circumference in younger children using appropriate reference standards, such as the WHO standard growth charts [ 22 ], and basic laboratory indices if possible. Treatment Management strategies for acute malnutrition depend on the type of malnutrition, identification of its cause, and its severity [ 5 ]. Primary Acute Malnutrition In primary moderate acute malnutrition, management at home is recommended, including counseling of parents, with emphasis on continuing breastfeeding and appropriate complementary feeding nutrition-specific interventions.
Table 2 Feeding of children with severe acute malnutrition adapted from Koletzko et al. Secondary Acute Malnutrition For the management of secondary acute malnutrition, it is crucial to identify the underlying disease by history taking, examination and laboratory investigations [ 5 ]. Acute Malnutrition Management in Humanitarian Crises In humanitarian crises, supplementary feeding is considered the main strategy for preventing and treating moderate acute malnutrition. Author Contributions V. Funding This research received no external funding.
Conflicts of Interest The authors declare no conflict of interest. References 1. Olsen E. Failure to thrive: The prevalence and concurrence of anthropometric criteria in a general infant population. Joosten K. Prevalence of malnutrition in pediatric hospital patients. Mehta N. Defining pediatric malnutrition: A paradigm shift toward etiology-related definitions. JPEN J. Grover Z. Protein energy malnutrition. Koletzko B. Pediatric Nutrition in Practice.
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The multidimensional background of malnutrition among rural older individuals in Bangladesh—a challenge for the Millennium Development Goal. Public Health Nutr. Batool R. Protein—energy malnutrition: A risk factor for various ailments. Food Sci. Fischer Walker C. Oshikoya K. A systematic review of pharmacokinetics studies in children with protein-energy malnutrition.
Mamoun N. Prevalence, types and risk factors for malnutrition in displaced sudanese children. Georgieff M. Nutrition and the developing brain: Nutrient priorities and measurement. Edhborg M. Fussy child difficult parenthood? Dicko M. Sorghum grain as human food in Africa: Relevance of content of starch and amylase activities. Wright C. The use and interpretation of growth charts.
Brook C. Determination of body composition of children from skinfold measurements. British Nutrition Foundation Nutrient Requirements. Cross J. Clinical examination compared with anthropometry in evaluating nutritional status. Ivanovic D. Long-term effects of severe undernutrition during the first year of life on brain development and learning in Chilean high-school graduates. Head size and intelligence, learning, nutritional status and brain development. Myatt M. A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs.
Samson-Fang L. Identification of malnutrition in children with cerebral palsy: Poor performance of weight-for-height centiles. Kong C. Weight-for-height values and limb anthropometric composition of tube-fed children with quadriplegic cerebral palsy. When the paper is ready, we check it for plagiarism and send it to you. If you want to change something, you can request a free revision. Custom writing help is not prohibited by any university or college.
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