Pediatric Nutrition in Practice

146 Shahrin  Chisti  Ahmed

achieve the optimal in utero growth. National im-
munization programs, vitamin A supplementation
campaigns, zinc as part of the treatment of diar-
rhea and periodic deworming programs have im-
mense roles in preventing malnutrition.

Conclusions

• Primary malnutrition is mainly a concern in
  developing countries, and the contributing
  factors are found to be food insecurity, pov-

erty, maternal malnutrition, malfeeding prac-

tice and environmental enteropathy

• Community-based screening and manage-
  ment should be emphasized in preventing and
  managing primary malnutrition


• Secondary malnutrition is more prevalent in
  developed countries and is difficult to treat
  without alleviation of the underlying causes


• Secondary malnutrition should be managed in
  a facility as an adjunct to the management of
  the underlying cause

10 WHO: Guideline: updates on the man-

agement of severe acute malnutrition in

infants and children. Geneva, WHO,

2013.

11 Fuchs GJ: Secondary malnutrition in

children; in Suskind RM, Lewinter-Sus-

kind L (eds): The Malnourished Child.

New York, Vevey/Raven, 1990.

12 Bhutta ZA, Das JK, Rizvi A, Gaffey MF,

et al.; Lancet Nutrition Interventions

Review Group; Maternal and Child Nu-

trition Study Group: Evidence-based

interventions for improvement of ma-

ternal and child nutrition: what can be

done and at what cost? Lancet 2013; 382:

452–477.

References

1 WHO: Malnutrition: the global picture.
Geneva, WHO, 2000.
2 Ahmed T, Michaelsen KF, Frem JC,
Tumvine J: Malnutrition: report of the
FISPGHAN Working Group. J Pediatr
Gastroenterol Nutr 2012; 55: 626–631.
3 Prendergast AJ, Rukobo S, Chasekwa B,
Mutasa K, Ntozini R, et al: Stunting is
characterized by chronic inflammation
in Zimbabwean infants. PLoS One 2014;
9:e86928.
4 Black RE, Victora CG, Walker SP, Bhut-
ta ZA, Christian P, et al: Maternal and
child undernutrition and overweight in
low-income and middle-income coun-
tries. Lancet 2013; 382: 427–451.
5 Fischer Walker CL, Lamberti L, Adair L,
et al: Does childhood diarrhea influence
cognition beyond the diarrhea-stunting
pathway? PLoS One 2012; 7:e47908.

6 UNICEF: Improving child nutrition. The

achievable imperative for global prog-

ress. New York, UNICEF, 2013.

7 Jamison DT, Feachem RG, Makgoba

MW, et al (eds): Disease and Mortality

in Sub-Saharan Africa, ed 2. Washing-

ton, World Bank, 2006. http://www.

ncbi.nlm.nih.gov/books/NBK2279/.

8 Liu L, Johnson HL, Cousens S, Perin J,

Scott S, et al: Global, regional, and na-

tional causes of child mortality: an up-

dated systematic analysis for 2010 with

time trends since 2000. Lancet 2012; 379:

2151–2161.

9 WHO: Report of Second Nutrition Guid-

ance Expert Advisory Group (NUGAG)

meeting of the Subgroup of Nutrition in

the Life Course and Undernutrition –

Area Acute Malnutrition. WHO, Gene-

va, 2011.

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