Program in International and Community Nutrition and Department of Nutrition, University of California, Davis, CA 95616, USA.
Nat Rev Endocrinol. 2009 Nov;5(11):597-603. doi: 10.1038/nrendo.2009.194. Epub 2009 Sep 29.
Approximately 11% of children worldwide suffer from moderate or severe acute malnutrition, which is defined as low weight for height or mid-upper arm circumference with respect to international standards, or the presence of bipedal edema. These children have a considerably increased risk of dying. Experience from the past two decades indicates that children with uncomplicated moderate or severe acute malnutrition can be managed successfully as outpatients, by use of appropriate treatment of infections and either lipid-based, ready-to-use therapeutic foods or appropriately formulated home diets, along with psychosocial care. Children's caregivers prefer community-based treatment, which is also less costly than inpatient care. Children with severe acute malnutrition and life-threatening complications require short-term inpatient care for treatment of infections, fluid and electrolyte imbalances, and metabolic abnormalities. Initial dietary management relies on low-lactose, milk-based, liquid formulas but semi-solid or solid foods can be started as soon as appetite permits, after which children can be referred for ambulatory treatment. National programs for the community-based management of acute malnutrition (CMAM) provide periodic anthropometric and clinical screening of young children, and referral of those who meet established criteria. This Review describes the main components of the treatment of young children with acute malnutrition in resource poor settings and some recent advances in CMAM programs.
全世界约有 11%的儿童患有中重度急性营养不良，其定义为身高体重比或上臂中部周长低于国际标准，或存在双下肢水肿。这些儿童的死亡风险显著增加。过去二十年的经验表明，患有不复杂的中重度急性营养不良的儿童可以作为门诊患者成功治疗，通过适当治疗感染以及使用基于脂质的、即用型治疗食品或适当配方的家庭饮食，并辅以心理社会关怀。儿童护理人员更喜欢社区为基础的治疗，这种治疗也比住院治疗成本更低。患有严重急性营养不良和危及生命并发症的儿童需要短期住院治疗以治疗感染、液体和电解质失衡以及代谢异常。初始饮食管理依赖于低乳糖、牛奶基、液体配方，但一旦食欲允许，就可以开始使用半固体或固体食物，然后可以将这些儿童转介进行门诊治疗。以社区为基础的急性营养不良管理（CMAM）国家方案定期对幼儿进行人体测量和临床筛查，并对符合既定标准的儿童进行转介。本综述描述了资源匮乏环境中治疗幼儿急性营养不良的主要方法以及 CMAM 方案的一些最新进展。
