Pediatric Nutrition in Practice

Primary and Secondary Malnutrition 141

3

velopment is common. Length for age at 2 years is
associated with better cognitive scores in later
childhood (0.17–0.19 cognitive Z scores per unit
change in length-for-age Z score) [5].
The high prevalence of stunting among chil-
dren <5 years of age in Africa (36% in 2011) and
Asia (27% in 2011) remains a pervasive public
health problem. The prevalence of stunting is
slowly decreasing globally, but the absolute num-
ber of children affected has increased in Africa.
More than 80% of the world’s stunted children
live in only 14 countries in Asia and Africa, the
top 6 countries being India, Nigeria, Pakistan,
China, Indonesia and Bangladesh [6].

C a u s e s o f M a l n u t r i t i o n

The UNICEF formulated a conceptual frame-
work to identify the determinants or causes of
malnutrition ( fig. 1 ) [6]. In addition to these de-
terminants, other factors such as unplanned ur-

banization, environmental degradation, time

constraints of caregivers and the consumption of

food contaminated with toxins (e.g. aflatoxin in

food) should also be taken into consideration [7].

Poverty and food insecurity constrain the acces-

sibility of nutritious diets that have a high protein

quality, adequate micronutrient content and bio-

availability, essential fatty acids, low antinutrient

content and high nutrient density [8].

Classification of Malnutrition

Based on anthropometric measurements, malnu-

trition can be classified as stunting, wasting and

underweight. Height or length for age is useful for

assessing stunting, which is the result of chronic

malnutrition. Weight for height or length is used

for assessing wasting, which is the result of acute

malnutrition. Weight for age measures under-

weight, indicating the combined effect of acute

and chronic malnutrition ( table 2 ).

Ta b l e 1. Diseases or conditions that can cause secondary malnutrition in children

Infectious causes Noninfectious causes

Diarrhea, dysentery, persistent diarrhea
(continuing for ≥14 days)

Low birth weight

Repeated episodes of acute respiratory infection Burns

Tuberculosis Chromosomal disorders (e.g. trisomy 21); cleft lip/palate

Helminthiasis Food allergy (e.g. cow’s milk protein allergy)

Measles Alimentary and hepatic diseases: inflammatory bowel disease (ulcerative
colitis, Crohn’s disease), celiac disease, chronic liver disease

Malaria Respiratory disease: cystic fibrosis, bronchiectasis, bronchial asthma

Kala azar (leishmaniasis) Cardiac diseases: congenital heart disease, rheumatic heart disease,
endocarditis, heart failure due to any cause

Human immunodeficiency virus infection Renal diseases: chronic kidney disease, renal tubular acidosis,
glomerulonephritis, nephrotic syndrome
Endocrine diseases: diabetes mellitus, congenital hypothyroidism,
congenital adrenal hyperplasia
Nervous system diseases: cerebral palsy, neuroendocrine disorder
Malignancies: leukemias, lymphomas, other malignancies
Metabolic diseases: inborn errors of metabolism, Wilson’s disease, etc.

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