Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Primary malnutrition · Secondary malnutrition ·

Management · Prevention

Key Messages

• Malnutrition is responsible for almost one third of
  all deaths in children <5 years of age and causes
  impaired intellectual capabilities among those
  who survive


• Primary malnutrition, commonly seen in develop-
  ing countries, is due to the combined effect of mul-
  tiple factors including low birth weight, lack of ad-
  equate food, frequent infections and environmen-
  tal enteropathy


• Secondary malnutrition results from an underlying
  disease that compromises growth directly or
  through its deleterious effect on appetite or the
  absorption of nutrients


• Most children with primary malnutrition can be
  managed at home with interventions such as coun-
  seling of parents on the proper diet to be given to
  the child, with emphasis on continued breastfeed-
  ing and appropriate complementary feeding, mi-
  cronutrient supplementation, periodic deworming,
  ensuring household food security, etc.


• Children with severe acute malnutrition and com-
  plications require treatment in a hospital; those
  without complications can be treated at home with
  ready-to-use therapeutic food


• Without treating the underlying cause (malabsorp-
  tion, infections, etc.), it is impossible to manage sec-
  ondary malnutrition © 2015 S. Karger AG, Basel

Introduction

To ensure proper physical growth and cognitive

development, appropriate and adequate nutrition

is essential. Malnutrition is defined as a deviation

from the normal state of nutrition; it can logically

be either undernutrition or overnutrition (over-

weight and obesity). A deficiency in proper nutri-

tional elements due to any cause leads to under-

nutrition. Undernutrition is a broad term ranging

from restricted intrauterine growth, low birth

weight, stunting, wasting and underweight to mi-

cronutrient deficiencies. It is the outcome of sub-

optimal dietary intake, metabolic stress, malab-

sorption and increased nutrient demands. It in-

cludes having low weight for age (underweight),

being too short for one’s age (stunted) or too thin

for one’s height (wasted) and/or being deficient

in vitamins and minerals (micronutrient malnu-

trition). Undernutrition may develop either be-

cause people cannot access proper food or have

an underlying disorder that limits eating or ab-

sorbing consumed food. In the context of low-

and middle-income countries, where overnutri-

tion is relatively less prevalent, malnutrition

commonly implies stunting, wasting and/or un-

derweight. There is no universally accepted defi-

nition of malnutrition; however, the WHO states

that malnutrition is the cellular imbalance be-

tween the supply of nutrients and energy and the

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 139–146
DOI: 10.1159/000367880

3.1 Primary and Secondary Malnutrition

Lubaba Shahrin  Mohammod Jobayer Chisti  Tahmeed Ahmed

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