Severe childhood malnutrition

Journal article

Severe childhood malnutrition predominantly occurs among children under 5 years of age living in impoverished conditions and among at-risk populations in low- and middle-income countries. Risk factors include poverty, poor living conditions with pervasive deficits in sanitation and hygiene, frequent infectious and environmental insults, food insecurity with poor prenatal maternal and foetal nutritional status, and suboptimal nutritional intake in infancy and early childhood. Major forms of malnutrition include stunting, wasting, and kwashiorkor; this review focuses on severe wasting and kwashiorkor, sometimes referred to as severe acute malnutrition. Children with any form of severe malnutrition, and especially those with multiple forms, are at markedly elevated risk of serious illness and death, primarily from acute infectious diseases. International growth standards form the basis of diagnosis and provide therapeutic endpoints based on anthropometry. Early detection and outpatient therapy of wasting and kwashiorkor with ready-to-use therapeutic food forms the cornerstone of modern therapy; only the small percentage of children with complicated severe malnutrition require inpatient care to address life-threatening infections and metabolic abnormalities, and for re-feeding with milk-based formulas. However, normalization of all physiological and metabolic functions is challenging, and children remain at high risk for relapse and mortality after discharge. Further research to better understand the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment are urgently needed to reduce global child mortality associated with severe malnutrition.

Authors: Bhutta, Z; Berkley, J; Bandsma, R; Kerac, M; Trehan, I

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer Nature
• Journal: Nature Reviews Disease Primers
• Volume: 3
• Article number: 17067
• Publication date: 2017-09-21
• Acceptance date: 2017-07-21
• DOI: 10.1038/nrdp.2017.67
• ISSN: 2056-676X
• Keywords: Article; Review