Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Chronic malnutrition · Micronutrient deficiency ·

Iron deficiency anemia · Developing world

Key Messages

• Micronutrient insufficiency is associated with an in-
  creasing prevalence of stunting among children in
  developing countries


• Four micronutrients (vitamin A, zinc, iron and io-
  dine) have been directly or indirectly associated
  with about 12% of deaths among <5-year-old chil-
  dren globally


• In resource-poor settings, along with iron deficien-
  cy anemia, low levels of other micronutrients (vita-
  min A, zinc, calcium, riboflavin and vitamin B 12 ) can
  also contribute to anemia


• Vitamin A supplementation reduces all-cause mor-
  tality by 24% and diarrhea-related mortality by 28%
  in children aged 6–59 months


• Zinc supplementation in children aged 1–4 years is
  associated with approximately a 9–18% reduction
  in all-cause mortality


• In resource-poor settings, multiple micronutrient
  supplementation improves growth and motor de-
  velopment, reduces anemia and improves the zinc
  and vitamin A status of infants as well as preschool
  and school children © 2015 S. Karger AG, Basel

Introduction

Global undernutrition estimates suggest that ap-

proximately 178 million children worldwide are

stunted, while 55 million are wasted. The major-

ity lives in developing countries [1, 2]. Multiple

micronutrient (MMN) deficiencies continue to

account for a substantial number of maternal and

child deaths, low birth weight, maternal and child

undernutrition, wasting and stunting as well as

delayed child development globally [3]. It is well

established that about 12% of the global deaths of

children <5 years of age can be attributed to defi-

ciencies in five common micronutrients (vita-

mins A and D, iron, zinc and iodine) singly or in

combination. Maternal micronutrient deficien-

cies are widespread and have major public health

implications in developing countries [4, 5].

There has been considerable progress in glob-

al health. However, factors such as poor breast-

feeding, poverty, food insecurity, inappropriate

feeding practices for infants and young children,

maternal micronutrient deficiencies, poor hy-

giene and sanitation as well as a high burden of

pneumonia and gastroenteritis with tropical en-

teropathy in children continue to contribute to

child undernutrition in developing countries [1,

2]. Despite efforts to combat and reduce the fac-

tor s ment ione d a b ove , t here i s ver y l it t le prog re s s.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 147–151
DOI: 10.1159/000375276

3.2 Micronutrient Deficiencies in Children

Ali Faisal Saleem  Zulfiqar A. Bhutta

3