Sections

Protein-Energy Malnutrition

Guidelines

Guidelines Summary

World Health Organization management guidelines for severe acute malnutrition

Antibiotic Treatment^[62]

Outpatient (uncomplicated malnutrition): Oral (PO) amoxicillin
Inpatient (complicated malnutrition): intravenous (IV) benzyl penicillin or ampicillin, and then PO amoxicillin plus IV/intramuscular (IM) gentamicin

Vitamin A treatment^[51]

Children with severe acute malnutrition should also receive 5000 IU vitamin A daily (not needed if receiving F-75 formula [75 kcal + 0.9 g protein per 100 mL], F-100 formula [100 kcal + 2.9 g protein per 100 mL], or ready-to-use therapeutic food)

Rehydration guidelines^[51]

Those with severe dehydration, but not in shock, should be rehydrated slowly (PO or via nasogastric [NG] tube) at around 5-10 mL/kg/hour for up to 12 hours.
Children with dehydration and signs of shock should receive IV fluids if they are unable to be rehydrated via other means.

Feeding guidelines^[51]

Children with diarrhea should be treated in the same way as those without diarrhea.
Inpatients: Provide F-75 in the stabilization phase and then administer ready-to-use therapeutic food over 2-3 days in the rehabilitation phase once they have an appetite. The recommended energy intake is 100-135 kcal/kg/day

Treating malnourished children with concomitant HIV^[51]

Children infected with human immunodeficiency virus (HIV) should be started on antiretroviral therapy once they are stable.

Use the same feeding approach as children without HIV infection.
Administer zinc in addition to vitamin A.

US Health and Human Services, US Department of Agriculture dietary guidelines

Guidelines and key recommendations from Dietary Guidelines for Americans, 2015-2020, 8th edition, are outlined below.^{[55, 63]}

Guidelines

Follow a health eating pattern across the lifespan.
Focus on variety, nutrient density, and amount.
Limit calories from added sugars and saturated fats, and reduce sodium intake.
Shift to healthier food and beverage choices.
Support healthy eating patterns for all.

Key recommendations

Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level, such as the following:

Vegetables from all subgroups
Fruits
Grains
Fat-free or low-fat dairy
A variety of protein foods
Oils

Limit the intake saturated fats, trans fats, added sugars, and sodium, as follows:

Sugars and saturated fats: Consume less than 10% of calories per day of each.
Sodium: Consume less than 2,300 mg per day.
Alcohol: If consumed, consume in moderation (women: ≤1 drink per day; men: ≤2 drinks per day), and only by adults of legal drinking age.

Americans of all ages should meet the 2018 Physical Activity Guidelines for Americans, which can help in balancing calories and managing body weight.^{[64, 65]}

Medication

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Media Gallery

This photograph shows children and a nurse attendant at a Nigerian orphanage in the late 1960s. Note that four of the children have gray-blond hair, a symptom of the protein-deficiency disease kwashiorkor. Image courtesy of Dr Lyle Conrad and the Centers for Disease Control and Prevention Public Health Image Library.
This late 1960s photograph shows a seated, listless child who was among many individuals found with kwashiorkor in Nigerian relief camps during the Nigerian-Biafran war. Kwashiorkor is a disease that develops due to a severe dietary protein deficiency. This child, whose diet fit such a deficiency profile, presented with symptoms including edema of the legs and feet; light-colored, thinning hair; anemia; a pot-belly; and shiny skin. Image courtesy of Dr Lyle Conrad and the Centers for Disease Control and Prevention Public Health Image Library.

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Author

Hadi Atassi, DO Resident Physician, Department of Internal Medicine, University of Louisville Hospital

Hadi Atassi, DO is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, Greater Louisville Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas L Abell, MD Professor and Arthur M Shoen MD Chair in Gastroenterology, Division of Gastroenterology, Hepatology and Nutrition, Faculty, Uro-Gynecology Fellowship, University of Louisville School of Medicine; Director of GI Motility Clinic at Jewish Hospital/U of Louisville Physicians; Former Director of Nutritional Support, Medical Staff, University of Mississippi Medical Center; Former Medical Staff, Mississippi Methodist Rehabilitation Center

Thomas L Abell, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, International Society for Quality-of-Life Studies

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: ADEPT-GI<br/>Received research grant from: Theravance; Vanda; Allergan<br/>Have a 5% or greater equity interest in: ADEPT-GI<br/>Received income in an amount equal to or greater than $250 from: Theravance<br/>GI Editor for MedStudy for: Reviewer for UpToDate.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Noah S Scheinfeld, JD, MD, FAAD † Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Anusuya Mokashi, MD, MS Resident Physician, Department of Radiology, Staten Island University Hospital

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Dr. Dino Santoro, to the development and writing of this article.

Protein-Energy Malnutrition Guidelines

Guidelines Summary

World Health Organization management guidelines for severe acute malnutrition

US Health and Human Services, US Department of Agriculture dietary guidelines

References

Tables

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