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Nat Rev Dis Primers. 2017 Sep 21;3:17067. doi: 10.1038/nrdp.2017.67.

Severe childhood malnutrition.

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Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research &Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.
Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Clinical Research Department, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
The Childhood Acute Illness &Nutrition (CHAIN) Network, Nairobi, Kenya.
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi.
Department of Population Health, London School of Hygiene &Tropical Medicine, London, UK.
Lao Friends Hospital for Children, Luang Prabang, Laos.
Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA.
Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi.
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.


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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