University of Aberdeen, Scotland.
Indian Pediatr. 2010 Aug;47(8):667-78. doi: 10.1007/s13312-010-0103-5.
Wasting, kwashiorkor and stunting are not usually due to either protein or energy deficiency. Treatment based upon this concept results in high mortality rates, and failure of treated children to return physiologically to normal. They become relatively obese with insufficient lean tissue. Preventive strategies have also failed. Wasting and stunting are primarily due to deficiency of type II nutrients and kwashiorkor probably due to deficiency of several type I nutrients that confer resistance to oxidative stress. Modern dietary treatments are based upon the F75 formula whilst the child is sick without an appetite, followed by F100 for rapid gain of weight. Derivative, ready-to-use therapeutic foods (RUTF) allow treatment of large numbers of children at home, are preferred by mothers and dramatically improve coverage. Children are indentified by screening in the community and treated before complications arise, using simple protocols. Successful treatment of the sick children with severe malnutrition not only depends upon these products, but appropriate management of complications. The physiology of the malnourished child is completely different from the normal child and many drugs and treatments that are safe in children with normal physiology are fatal for the malnourished child. In particular, the diagnosis and management of diarrhea and dehydration is different in the malnourished child. Giving standard treatment frequently leads to circulatory overload and death from heart failure. The challenge now is to find successful local ways to prevent malnutrition and achieve nutritional security. Until prevention works, we have to rely on fortified foods for treatment and convalescence from illness.
消瘦、恶性营养不良病和发育迟缓通常不是由于蛋白质或能量缺乏引起的。基于这一概念的治疗方法会导致高死亡率，而且接受治疗的儿童在生理上无法恢复正常。他们会变得相对肥胖，但肌肉组织不足。预防策略也已失败。消瘦和发育迟缓主要是由于第二类营养素缺乏，而恶性营养不良病可能是由于几种具有抗氧化应激能力的第一类营养素缺乏所致。目前的饮食治疗方法基于 F75 配方，适用于患病且食欲不振的儿童，随后使用 F100 配方以快速增加体重。衍生的、即用型治疗食品（RUTF）允许在家庭中治疗大量儿童，受到母亲们的青睐，并显著提高了覆盖率。通过社区筛查发现患有严重营养不良的儿童，在出现并发症之前，使用简单的方案进行治疗。成功治疗患有严重营养不良的患病儿童不仅取决于这些产品，还取决于对并发症的适当管理。营养不良儿童的生理学与正常儿童完全不同，许多在正常生理儿童中安全的药物和治疗方法对营养不良儿童是致命的。特别是，腹泻和脱水的诊断和治疗在营养不良儿童中有所不同。给予标准治疗常常导致循环超负荷和心力衰竭导致死亡。目前的挑战是找到成功的地方方法来预防营养不良并实现营养安全。在预防措施生效之前，我们必须依靠强化食品来治疗和从疾病中康复。
