Management of the severely malnourished child: perspective from developing countries

Bhan, M. K.; Bhandari, Nita; Bahl, Rajiv

doi:10.1136/bmj.326.7381.146

Cited by 87 publications

(69 citation statements)

References 24 publications

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“…Marasmus is diagnosed when subcutaneous fat and muscle are lost because of endogenous mobilization of all available energy and nutrients. Clinical aspects include a triangular face, primary or secondary amenorrhea, extended abdomen and anal or rectal prolapse (16).…”

Section: Introductionmentioning

confidence: 99%

Impact of malnutrition on immunity and infection

França¹,

Ishikawa²,

Zorzella-Pezavento³

et al. 2009

J. Venom. Anim. Toxins incl. Trop. Dis

105

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Malnutrition may be a consequence of energy deficit or micronutrient deficiency. It is considered the most relevant risk factor for illness and death, particularly in developing countries. In this review we described the magnitude of this problem, as well as its direct effect on the immune system and how it results in higher susceptibility to infections. A special emphasis was given to experimental models used to investigate the relationship between undernutrition and immunity.Malnutrition is obviously a challenge that must be addressed to health authorities and the scientific community.

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Section: Introductionmentioning

confidence: 99%

Impact of malnutrition on immunity and infection

França¹,

Ishikawa²,

Zorzella-Pezavento³

et al. 2009

J. Venom. Anim. Toxins incl. Trop. Dis

105

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show abstract

“…For children suffering from SAM; zinc, potassium and magnesium along with vitamin A and folic acid are the most important while iron and sodium should be limited (Bhan, Bhandari, & Bahl, 2003).…”

Section: Micronutrient Profilementioning

confidence: 99%

“…Deficiency impairs the working of immune system and has a direct consequence on the structure and function of mucosa (Bhan et al, 2003). Mucosa effect relates to mal-digestion.…”

Section: Micronutrient Profilementioning

confidence: 99%

Nutrient and Anti-nutrient Profile of a Local Formula from Sorghum, Peanut, Honey and Ghee (Metu2) for Treatment of Severe Acute Malnutrition

Andrew¹,

Yiga²,

Kuorwel³

et al. 2018

JFR

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World over, we are still struggling with persistent acute malnutrition levels; an estimated 17 million preschool children suffer from SAM, roughly the same figures as reported in 2013, a trend depicting insufficient progress towards the 2025 World Health Assembly. One such affected area is Karamoja Region in North Eastern Uganda. Partly, the trend could be attributed to unsustainable interventions like RUTF. Formulas from locally available foods could provide not only an affordable but also a culturally acceptable and effective home based solution. Locally available sorghum, peanut, honey and ghee in North Eastern Uganda, is such a potential local formula. The nutritional and anti-nutritional profile of this local formula(metu2) was compared to plumpy-nut. Standard official analytical methods were used. Proximate composition was comparable and within the WHO recommendations for therapeutic formulas. Local formula(metu2) had a comparatively high energy content, 528kcal/100g to 509kcal in plumpynut. Vitamin A and K contents were below the WHO recommendations in local formula while Na, Mg and essential fatty acids were comparable and within the contents needed for SAM recovery. Zn was comparatively higher in plumpy-nut but levels in both formulas were below the recommendations. Trypsin inhibitors, phytates and condensed tannins were higher in local formula while aflatoxins were within the limits but not for plumpynut. Though lacking in critical K, Zn and Vitamin A, local formula(metu2) was comparable to plumpy-nut and its efficacy to sustain recovery from SAM needs to be studied.

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“…Os exames bioquímicos e a investigação do processo infeccioso devem ser solicitados segundo a avaliação clínica durante a hospitalização e ambulatorialmente (6,7) . De acordo com a OMS, os exames complementares solicitados para crianças com desnutrição grave podem ser reunidos em grupos básicos.…”

Section: Triagem Da Criança Com Depunclassified

“…Os principais sinais e sintomas encontrados são: sede moderada, olhos encovados, pulso fraco ou ausente, extremidades frias, hipoglicemia, saliva espessa, mucosas secas e letargia. Quanto à terapia de hidratação, deve-se priorizar a via oral, limitando a endovenosa a casos graves e choque (2,7) .…”

Section: • Oralunclassified

Desnutrição energético-proteica grave durante a hospitalização: aspectos fisiopatológicos e terapêuticos

Lima

Gamallo

Oliveira

2010

Rev. paul. pediatr.

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RESUMOObjetivos: Apresentar a conduta para o tratamento da desnutrição energético-proteica grave e os principais aspectos fisiopatológicos da doença.Fontes de dados: Tomando como base o Manual da Organização Mundial da Saúde (OMS, 1999), realizou-se uma busca por trabalhos publicados em inglês, espanhol e português sobre o tratamento hospitalar de crianças com desnutrição grave, nas bases de dados Lilacs, Medline e SciELO, publicados nos últimos dez anos, utilizando-se as palavras-chave: desnutrição, criança, hospitalização, terapia nutricional, diretrizes, OMS.Síntese dos dados: Foram abordadas as principais características fisiopatológicas da desnutrição grave e a conduta recomendada para o tratamento. Identificaram-se as principais complicações clínico-metabólicas, como a hipotermia, a hipoglicemia, a desidratação e as infecções recorrentes, além da má absorção e a fase de estabilização ou de recuperação do desnutrido grave. A compreensão de todos esses conceitos relacionados à fisiopatologia da desnutrição energético-proteica, associada ao adequado planejamento e execução da terapia nutricional, pode reduzir o risco de morbimortalidade em crianças com idade inferior a cinco anos.Conclusões: As diretrizes da OMS devem ser implantadas levando-se em consideração a realidade de cada região e a capacitação do profissional da saúde quanto ao conhecimento da complexidade e fisiopatologia da desnutrição energético-proteica grave, para adequado diagnóstico e tratamento. O sucesso do tratamento está associado ao cuidado e à atenção ao paciente.Palavras-chave: desnutrição; criança; hospitalização; terapia nutricional; Organização Mundial da Saúde. ABSTRACTObjective: To identify the main physiopathological aspects of severe protein-energy malnutrition and its treatment.Data sources: Based on the World Health Organization guidelines (WHO, 1999), an electronic search for papers on hospital treatment of children with severe malnutrition was performed on Lilacs, Medline and SciELO databases. Studies in English, Spanish and Portuguese published in the last ten years were searched by the following key-words: malnutrition, child, hospitalization, nutrition therapy, practice guidelines, WHO.Data synthesis: The main pathological aspects of severe malnutrition and its specific treatment were reviewed. The main clinical and metabolic complications of severe malnutrition were identified such as hypothermia, hypoglycemia, dehydration, usual infections, intestinal malabsorption, as well as stabilization and recovery phases, were defined. Understanding the main concepts of the physiopathology of this condition, associated with appropriate nutrition support planning, can decrease morbidity and mortality risks of children younger than five years old.Conclusions: The implementation of the 1999 WHO guidelines should take into consideration local economic and cultural aspects, as well as the professional health care training. Due to the complexity of severe malnutrition, adequate knowledge about basic aspects of this condition helps provid...

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Management of the severely malnourished child: perspective from developing countries

Cited by 87 publications

References 24 publications

Impact of malnutrition on immunity and infection

Impact of malnutrition on immunity and infection

Nutrient and Anti-nutrient Profile of a Local Formula from Sorghum, Peanut, Honey and Ghee (Metu2) for Treatment of Severe Acute Malnutrition

Desnutrição energético-proteica grave durante a hospitalização: aspectos fisiopatológicos e terapêuticos

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