Critical appraisal of the management of severe malnutrition: 2. Dietary management.
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.
Brewster
David R
DR
Fiji School of Medicine, Suva, Fiji. d.brewster@fsm.ac.fj
D002648:Child; D005527:Food, Fortified; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy*; D018977:Micronutrients / Q000627:therapeutic use; D012720:Severity of Illness Index
D018977:Micronutrients