New concepts on nutritional management of severe malnutrition: the role of protein.
Current guidelines for the management of severe malnutrition are mainly based on new concepts regarding the causes of malnutrition and on advances in our knowledge of the physiological roles of micronutrients. In contrast to the early 'protein dogma', there is a growing body of evidence that severely malnourished children are unable to tolerate large amounts of dietary protein during the initial phase of treatment. Similarly, great caution must be exercised to avoid excessive supply of iron and sodium in the diet, while keeping energy intake at maintenance levels during early treatment. Because severely malnourished children require special micronutrients, a mineral-vitamin mix is added to the milk-based formula diets, which are specially designed for the initial treatment and the rehabilitation phase. To further improve nutritional rehabilitation and reduce cases of relapse, 'ready-to-use therapeutic food' and 'ready-to-eat nutritious supplements' with relatively low protein (10% protein calories) and high fat content (54-59% lipidic calories) have been developed. Although current dietary recommendations do not differentiate between oedematous and nonoedematous forms of malnutrition or between adults and children, there are indications that further clarification is still needed for applying dietary measures for specific target groups.
Scherbaum
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Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany. scherbau@uni-hohenheim.de
Fürst
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D002648:Child; D002675:Child, Preschool; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D006801:Humans; D007223:Infant; D007501:Iron / Q000008:administration & dosage; D009748:Nutrition Disorders / Q000401:mortality / Q000628:therapy*; D018529:Nutritional Support; D012964:Sodium / Q000008:administration & dosage
D004041:Dietary Fats; D004044:Dietary Proteins; D012964:Sodium; D007501:Iron