Dietary counseling in the management of moderate malnourishment in children.
BACKGROUND
Dietary counseling is an integral part of treating malnutrition. A first step toward improving the management of moderate malnutrition is to evaluate dietary messages in current programs and assess their adequacy and effectiveness.


OBJECTIVE
To ascertain current recommendations regarding family foods for the treatment of moderate malnutrition and assess whether these are likely to meet nutritional requirements for rehabilitation; to review the effectiveness of dietary counseling in the management of moderate malnutrition.


METHODS
Information was requested from 10 United Nations agencies or donors, 20 international nongovernmental organizations, 3 pediatric associations, and 6 national programs about the dietary advice they give to caregivers of moderately malnourished children. Adequacy was assessed by comparing dietary recommendations with nutritional requirements. Linear programming was used to identify problem nutrients. A literature search was conducted of studies using family foods for rehabilitating malnourished children.


RESULTS
There was a greater emphasis on providing food supplements for rehabilitation than on utilizing family foods. Dietary recommendations were mostly vague and unlikely to be effective. Those developed by the World Health Organization and the Food and Agriculture Organization for well-nourished children may meet nutritional requirements in moderate malnutrition if the recommendations are made more prescriptive. Zinc and vitamin E emerged as possible problem nutrients. Intervention studies in wasted children suggest that counseling caregivers about family foods can achieve good rates of weight gain.


CONCLUSIONS
Dietary counseling can be effective in managing malnutrition, but it is often weak or absent and should be strengthened. More attention will need to be given to formulating the messages and improving counseling skills.
Ashworth
Ann
A
Nutrition and Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. ann.hill@lshtm.ac.uk
Ferguson
Elaine
E
D015362:Child Nutrition Disorders / Q000178:diet therapy* / Q000534:rehabilitation; D002675:Child, Preschool; D004035:Diet Therapy / Q000379:methods*; D019587:Dietary Supplements; D005192:Family Health; D019648:Foods, Specialized; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D018673:Nutrition Policy; D015397:Program Evaluation; D012016:Reference Values; D016896:Treatment Outcome; D014811:Vitamin E Deficiency / Q000517:prevention & control; D015032:Zinc / Q000172:deficiency
D015032:Zinc