Treatment of protein-energy malnutrition in children

20/04/2023

Malnutrition due to protein and energy deficiency leaves many consequences for the children’s physical and mental health, even leading to death if malnutrition is not treated promptly. The treatment regimen below is recommended for children to get rid of malnutrition.

Protein-energy malnutrition is a common medical condition in children caused by a serious deficiency of energy, protein, and micronutrients which is necessary to the body. Protein-energy malnutrition can be manifested as underweight, stunting, wasting (Marasmus wasting), or edema malnutrition (Kwashiorkor wasting).

Protein-energy malnutrition is a common medical condition in children due to a lack of energy, protein, and micronutrients supplied to the body (Photo: freepik.com)

Malnutrition not only affects children’s physical and mental health, but also pushes them into a pathological spiral of infections, immunodeficiency, and even death if this condition is not treated on time.

Malnutrition affects physics, intelligence, and causes children to suffer from many infectious diseases and immunodeficiency (Photo: freepik.com)

Children with acute energy-protein malnutrition experience severe emaciation as loss of body fat, subcutaneous tissue, and muscle. In terms of protein-energy malnutrition treatment, there are three main stages: Initial treatment (Acute), Nutritional rehabilitation, and Follow-up.

Phase 1: Initial Treatment (Acute)

Phase 1 begins when the child is diagnosed as being malnutrition and begins following the treatment regimen until the child’s health condition gradually stabilizes and the child’s appetite starts to return. During this period, medical staff who take care of the child need to keep an eye on some common problems that would happen in this stage such as hypoglycemia, hypothermia, dehydration, electrolyte imbalance, infection, vitamin and iron deficiency, heart failure, etc.

In particular, it is extremely important in this stage to start feeding children a proper amount of food because acute malnutrition would accompany many medical problems which make children unable to consume the regular amount of protein, fat, and common salt.

Proper food intake for malnutrition children is an important requirement during the acute treatment phase (Photo: freepik.com)

Therefore, at this stage, the World Health Organization (WHO) recommends using milk products which are developed from formula F-75 (75 kcal/100 ml, 0.9 g protein/100 ml) with the following nutritional content:

RECOMMENDATION FROM WHO

Nutritional components Formula F-75
Energy

Protein

Lactose

Potassium

Sodium

Magnesium

Zinc

Copper

% kcal from:

Protein

Lipid

Osmotic concentration

75 kcal (315 kJ)

0.9 g

1.3 g

3.6mmol

0.6mmol

0.43mmol

2.0 mg

0.25 mg

 

5%

32%

333mOsmol/l

Caregivers need to ensure that children consume at least 80 kcal/kg body weight/day but no more than 100 kcal/kg body weight/day. When a child does not eat enough, the epithelial cells will continue to decompose and the child will continue to be emaciated. When children eat more than 100 kcal/kg body weight/day, they will have problems with metabolic imbalance. In case the child refuses to eat, the child needs to be fed through a nasogastric tube. If the child can eat or drink, the caregiver needs to feed the child every 2, 3, or 4 hours, day and night. When the child vomits, the amount of food he eats and the time between meals need to be reduced.

Phase 2: Nutritional rehabilitation with F-100 formula

When the child begins to crave eating, and the health problems in stage 1 have been overcome, the child’s caregiver needs to continue to increase the concentration of energy, protein, and other micronutrients so that the child would catch up with growth momentum according to age and rebuild lost tissue. For the Nutritional Rehabilitation phase, WHO recommends using milk products that follow F-100 formula (100 kcal/100 ml, 2.9 g protein/100 ml. This is a product to treat malnutrition in children recommended for use by the World Health Organization (WHO) and the Ministry of Health. F-100 means that 100ml of the preparation provides up to 100kcal. The F-100 preparation was researched by scientists and is now being used as a general standard treatment regimen for malnutrition children.

For malnutrition, underweight, and stunted children, they can use energy-dense products and nutritional supplements based on the F100 formula recommended by the World Health Organization (WHO). At the same time, a number of other micronutrient supplement products can be used to help improve the child’s growth rate and stature.

The F-100 formula contains the following specific nutritional content:

Nutritional components F-100 formula
Energy

Protein

Lactose

Potassium

Sodium

Magnesium

Zinc

Copper

% kcal from:

Protein

Lipid

Osmotic concentration

100 kcal (420 kJ)

2.9 g

4.2 g

5.9mmol

1.9mmol

0.73mmol

2.3 mg

0.25 mg

 

12%

53%

419mOsmol/l

 

The transition process needs to take place gradually to avoid the risk of heart failure when the child has to consume a large amount of food suddenly. First, the caregiver should switch from the F-75 to F-100 formula with equal food intake and the time between two meals for at least 2 days. After that, the caregiver needs to increase each meal by 10 ml until the child cannot eat anymore. During this period, the child can consume from 150 – 220 kcal/kg body weight. In case of following the regimen correctly, the child can gain 5 – 10 g/kg of initial body weight/day.

Caregivers should feed the child with F-100 until the child’s weight and height reach SD -1 (90%) according to the WHO average reference value table.

Phase 3: Follow-up

At this time, the child’s nutritional situation has basically been controlled, but caregivers still need to continue to care for, maintain, and prevent malnutrition with a balanced diet.

Formula F-100 – nutritional solution for underweight and stunted children in Vietnam according to WHO recommendations

In Vietnam, the problem of malnutrition in children is still a big challenge. According to the results of the National Nutrition Survey (2018-2020) announced by the Ministry of Health in April 2021, the rate of stunting malnutrition (height/age) in children under 5 years old nationwide is 19.6%, and underweight is 19.9%. This means that for every 5 children under 5 years old, 1 child is stunted or underweight. This number has been a big progress, but the rate of stunted and underweight children in Vietnam is still ranked quite high compared to the world. One of the main causes of child malnutrition is poor diet and lack of nutrients.

Malnutrition and stunting put children at high risk of serious infectious diseases with a burden which is 9-20 times heavier than that of normal children. In the long term, it will affect their physical, intellectual, and mental health and children’s learning ability. Furthermore, longer days of illness also cause significant downward shifts in costs for families, society, and nation.

To explain the malnutrition situation in Vietnam, according to experts, the main cause of stunting in Vietnamese children is that the diet is not balanced and diverse, as well as failure to meet the recommended nutritional needs for important nutrients (such as Protein, Energy, Zinc, Calcium, Vitamin A, Vitamin D, Fe,…).

Imbalanced, nutritionally inadequate diets are part of the cause of malnutrition and stunting in children. (Photo: Freepik.com)

For further information, experts also point out that for underweight and stunted children, parents can supplement nutritional products that have High energy formula 100 Kcal as recommended by many health organizations around the world, especially by the World Health Organization (WHO) to be used as a standard treatment regimen for children with malnutrition, underweight, and stunting, in order to help children catch up with normal growth in height and weight in age. In detail, in the document “Training course on the management of severe malnutrition” issued by WHO in 2002, formula F-100 was recommended for use in the appropriate period to treat severe malnutrition in children.

In particular, the High Energy formula 100Kcal has been clinically proven in malnutrition children, confirming its effectiveness in helping children grow in height and weight appropriately in the early stages of life. Clinically proven results “Efficacy of F-100, diluted F-100, and infant formula as rehabilitation diet for infants aged < 6 months with severe acute malnutrition: a randomized clinical trial” shows: F100 formula can be used safely for children with severe acute malnutrition (Severe Acute Malnourished – SAM in the recovery period). In particular, children who are fed with F-100 formula have higher energy absorption, faster weight gain, and faster recovery than children fed conventional formula.

Nutritional products with High Energy formula 100Kcal combined with Vitamins, Minerals, and a healthy diet and lifestyle will help improve the growth rate and stature of malnourished and stunted children effectively.

Understanding the nutritional challenges of malnutrition, underweight, and stunted children in Vietnam, Nutricare Nutrition Joint Stock Company has diligently researched and launched a new product –  Nutricare Colos24h Grow Plus – a nutritional solution for malnutrition children, underweight and stunting according to WHO recommendations. Nutricare’s nutrition experts have researched and applied the High Energy formula 100 Kcal to the new product Nutricare Colos24h Grow Plus, specially designed for malnutrition and stunted children, supporting them to gain healthy weight.

Noticeably, the new Nutricare Colos24h Grow Plus also adds 24h – Colostrum imported directly from the USA to help increase resistance, reduce sickness series and help reduce infections for children. A combination of Calcium, Vitamin D3, and 52 essential nutrients are also added to support weight gain, height increment, and brain development for every stage of child development.

Malnutrition in children is an urgent problem for every country in general and Vietnam in particular. Promoting the application of formulas recognized by the International Organization in nutritional products, while still adjusting for the unique physical characteristics of Vietnamese children, will be a solid nutritional springboard for children to have the opportunity to easily supplement adequate nutrients in any region or locality across the country.

REFERENCES

  1. Ahmed, Tahmeed, M. Iqbal Hossain, Munirul Islam, A.M. Shamsir Ahmed, Farzana Afroze, and M. Jobayer Chisti. “Protein-Energy Malnutrition in Children.” Hunter’s Tropical Medicine and Emerging Infectious Diseases, January 1, 2020, 1034–41. https://doi.org/10.1016/B978-0-323-55512-8.00143-5.
  2. WHO. “Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers,” 1999.
  3. Trạm Y tế Phường 8. “Tình trạng suy dinh dưỡng ở trẻ em Việt Nam hiện nay” April 9, 2019.
  4. Sở Y tế Thành phố Hà Nội. “Tỷ lệ suy dinh dưỡng cấp tính ở Việt Nam khoảng 6-7%” June 10, 2020.
  5. Sở Y tế Thành phố Hà Nội. “Giảm tỷ lệ suy dinh dưỡng thấp còi ở trẻ em dưới 5 tuổi” April 16, 2021
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