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Severe childhood malnutrition


The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting and kwashiorkor, of which severe wasting and kwashiorkor are commonly referred to as severe acute malnutrition. Here, we use the term ‘severe malnutrition’ to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.

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Figure 1: Organ system involvement in severe malnutrition.
Figure 2: Prevalence of wasting.
Figure 3: Metabolic changes in severe malnutrition.
Figure 4: Assessment of oedema.
Figure 5: Overview of management of severe and moderate malnutrition.
Figure 6: Detailed management of complicated severe malnutrition.


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The authors are grateful to Grace Belayneh for her thoughtful assistance in the coordination of this work and facilitation of communication among the writing group.

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Introduction (Z.A.B.); Epidemiology (M.K. and Z.A.B.); Mechanisms/pathophysiology (R.H.B. and J.A.B.); Diagnosis, screening and prevention (A.B., I.T. and M.K.); Management (J.A.B. and I.T.); Quality of life (J.A.B.); Outlook (Z.A.B., M.K. and A.B.); Overview of Primer (Z.A.B.).

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Correspondence to Zulfiqar A. Bhutta.

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Bhutta, Z., Berkley, J., Bandsma, R. et al. Severe childhood malnutrition. Nat Rev Dis Primers 3, 17067 (2017).

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