Proposed Recommended Nutrient Densities for Moderately Malnourished Children

Abstract

Recommended Nutrient Intakes (RNIs) Key words: Ascorbate, biotin, calcium, catch-up growth, cobalamin, convalescence, copper, DRV, essential fatty acid, folic acid, growth, iodine, iron, magnesium, malnutrition, manganese, niacin, nutrient density, nutrition, nutritional deficiency, nutritional requirements, pantothenic acid, phosphorus, potassium, protein, protein-energy malnutrition, pyridoxine, RDA, recommendations, riboflavin, RNI, selenium, sodium, stunting, sulfur, thiamine, vitamin A, vitamin D, vitamin E, vitamin K, wasting, zinc SummaryThe objective is to derive nutrient requirements for moderately malnourished children that will allow them to have catch-up growth in weight and height, prevent their death from nutritional disease, strengthen their resistance to infection, allow for convalescence from prior illness, and promote normal mental, physical, and metabolic development.The malnourished population will have been exposed to nutritional stress and seasonal shortages and will have been living in unhygienic conditions; a proportion will have been severely malnourished. Typically, from 5% to 15% of children aged 6 to 59 months are moderately wasted, and 20% to 50% are stunted in height.There has been little published on the requirements for the moderately wasted or stunted child per se. However, with the change in definition of severe malnutrition from the Wellcome classification [1] based upon weight-for-age to one based upon weight-forheight, reanalysis of the data shows that many of the studies of children with less than 60% weight-for-age included children who were moderately wasted by modern criteria, albeit stunted. The physiological and other data from the older literature therefore are likely to apply to those with moderate as well as those with severe wasting.In order to derive the requirements of each nutrient for moderately malnourished children, the lower and upper boundaries were assumed to lie between the requirement for a normal, healthy child living in a clean environment and the requirement for treatment of a severely malnourished child living in a contaminated environment. The therapeutic diets used for treatment of the severely malnourished in the developing world have been remarkably successful and are capable of sustaining rates of weight gain of more than 10 g/kg/day and returning the children to physiological normality.The requirements for normal Western individuals (Recommended Nutrient Intake, RNI) were used as the minimum requirements. They were converted into nutrient:energy densities with the use of the energy

Proximate Composition, Amino and Fatty Acid Profiles and Element Compositions of Four Different Moringa Species

“…The necessary amount of dry matter intake to cover 15% of the respective nutrient demand of a child (Golden, 2009) is calculated for leaves of M. oleifera, M. hildebrandtii and M. drouhardii and presented in Table 9. As a source for protein and essential amino acids (EAA), M. oleifera leaves are superior to the leaves of M. hildebrandtii and M. drouhardii.…”

Evolution of nutritional management of acute malnutrition

“…These children share many of the changes seen in severe malnutrition, albeit often in a milder form (36). The success of treatment of the severely malnourished led us to attempt to improve the food given in supplementary feeding programs as well, largely because there have been such poor results with fortified corn-soy-blends (CSB).…”

“…It does not take much of a reduction in appetite to cause a loss of weight. Thus, if body tissue requires 5 kcal to synthesize one gram of tissue (36), and a similar shortfall in intake will cause a loss of one gram of tissue, then a child whose energy requirement for maintenance is 100 kcal/kg/ d, but takes only 90 kcal/kg/d, to give a shortfall of 10 kcal/kg/d, will lose 2 g/kg/d. In 10 days the child will lose 2% of body weight and in 3 months 20% of body weight to be classified as malnourished (assuming no metabolic adaptation).…”

“…The use of relatively small amounts of fortified foods that contain all the essential nutrients in a balance that promotes growth and development (36) to populations at very high risk of famine has led to prevention of severe and moderate malnutrition and prevention of stunting (81,82) and a very high acceptability among the beneficiary population. Of critical importance, during these studies there was no education campaign and no change in public health services, sanitation or water supply.…”

Developing and Testing the Acceptability of Therapeutic Food for the Management of Severely Malnourished Children

“…Generally, it indicates that the ingredients that were used in the formulation of P-519 were rich in these macro and micro minerals. In a normal population there is difference in nutrient requirements because of the variation in body weight, body composition and physiological state [23]. Even though the nutrient content of P-519 did not meet all the nutrients recommendations for RUTF, it is possible [3]; F-75, F-100 and F-135 figures adapted from WHO (2003) [9]; Plumpy nut figures adapted from Action Contre Le Faim (2011) [22].…”