title: Severe acute malnutrition.
abstract: OBJECTIVE
  The mortality and morbidity associated with severe acute malnutrition (SAM) remain high. A summary of recent studies that are of interest to clinicians treating children with SAM is provided.
  
  
  RESULTS
  Three important themes emerged in 2015: the use of anthropometry in the diagnosis of SAM and its correlation with body composition; the composition of ready-to-use therapeutic feeds (RUTF); and an improved understanding of the pathophysiology of SAM.
  
  
  CONCLUSIONS
  Standard anthropometry does not accurately predict body composition and mid-upper arm circumference more accurately reflects fat mass in children. As single measure, mid-upper arm circumference identifies those children who are most likely to die from SAM and is not influenced by dehydration. However, a significant proportion of SAM children requiring treatment will not be detected. Present RUTF formulations are deficient in long chain polyunsaturated fatty acids. Current evidence suggests that preformed docosahexaenoic acid should be added and/or the content of linoleic acid reduced in RUTF. In contrast to an animal model, stabile children with SAM have the same cardiac index as children without SAM. The situation in haemodynamically unstable children is unknown, continued conservative use of intravenous fluids seems advisable. A reduction in variability of the faecal DNA virome may account for increased susceptibility to malnutrition in vulnerable children.
authors.affiliation: Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
authors.forename: E D
authors.initials: ED
authors.lastname: Nel
mesh_terms: D000818:Animals; D001132:Arm; D001823:Body Composition; D001837:Body Weights and Measures; D002648:Child; D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D002149:Energy Intake; D019317:Evidence-Based Medicine; D057140:Fast Foods / Q000032:analysis / Q000592:standards; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000627:therapeutic use; D005527:Food, Fortified / Q000032:analysis / Q000592:standards; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000379:methods* / Q000592:standards / Q000639:trends; D017410:Practice Guidelines as Topic; D000067011:Severe Acute Malnutrition / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy
chemical_list: D015525:Fatty Acids, Omega-3