Critical appraisal of the management of severe malnutrition: 2. Dietary management.

Abstract

In the dietary management of severe acute malnutrition in children, there is evidence to support the WHO Manual's protocol of cautious feeding of a low energy and protein formula with small frequent feeds in the initial phase of treatment, particularly in kwashiorkor. However, this initial milk diet (WHO F-75) might benefit from increasing the sulphur amino acid, phosphorus and potassium content and reducing the lactose content, but further studies are needed. Careful tube-feeding results in faster initial recovery and weight gain, but has a significant risk of aspiration in poorly supervised settings. Ready-to-use therapeutic food is an important recent advance in the dietary management of malnutrition in ambulatory settings, allowing more effective prevention programmes and earlier discharge from hospital where community follow-up is available. It should be included in future protocols. There is very good evidence on the use of micronutrients such as zinc, and preliminary evidence suggests that smaller doses of daily vitamin A are preferable to a single large dose on admission for severe malnutrition.

• Authors: David R Brewster
• Journal: Journal of paediatrics and child health (J Paediatr Child Health) Vol. 42 Issue 10 Pg. 575-82 (Oct 2006) ISSN: 1034-4810 [Print] Australia
• PMID: 16972962 (Publication Type: Journal Article, Review)

Chemical References

• Micronutrients

Topics

• Child
• Food, Fortified
• Humans
• Malnutrition (diet therapy)
• Micronutrients (therapeutic use)
• Severity of Illness Index