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