[Dietary management of severe protein-calorie malnutrition in children]

EXPERIENCE IN DEVELOPING COUNTRIES: Severe child malnutrition is defined by a low weight in relation to height, with major change in body composition, mainly related to a loss of muscle mass. Severe malnutrition may be associated with edema. In absence of appropriate treatment, it is associated with a high risk of death. Protein and energy requirements during recovery are related to the rate of weight gain and the type of synthesized tissues, but the proportion of energy which must come from proteins never exceeds 10% of total energy. The WHO now recommends a protocol in two phases, initiation of cure and rehabilitation, based on the use of two milk diets prepared from skimmed milk, oil and sugar. Recommended diets are the same in presence of edema. They are heavily fortified with minerals and vitamins. It is now recommended to treat children in hospitals. It is likely, however, that the recent development of solid rehabilitation diets resistant to bacterial contamination will make possible a home based rehabilitation phase.