Protein-Energy Malnutrition Guidelines

Updated: Mar 11, 2019
  • Author: Hadi Atassi, DO; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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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]


  1. Follow a health eating pattern across the lifespan.
  2. Focus on variety, nutrient density, and amount.
  3. Limit calories from added sugars and saturated fats, and reduce sodium intake.
  4. Shift to healthier food and beverage choices.
  5. 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]