Recent issues in energy-protein malnutrition in children

Thirty years ago, protein deficiency was perceived to be the major nutritional problem of children in developing countries. Later on increasing the energy intake of young children during the complementary feeding period became a priority. Early studies on the pathophysiology of malnutrition are now turned into strategic and practical consequences for the prevention and treatment of severe malnutrition, four of which are presented. (1) Almost half of the deaths worldwide are due to being underweight. Nowadays, well-defined preventive and curative interventions have been identified. (2) An efficient and rigorous technique based on linear programming is now available to design a diet suitable for the complementary feeding period using locally available foods with a minimum budget to cover the nutritional requirements of at least 97% of the children. (3) Managing acute malnutrition in emergencies has greatly improved by the use of a spread that a child can eat directly without the addition of water (often called Ready-to-Use Therapeutic Food) and Community Therapeutic Care that treats the majority of severely malnourished children at home. (4) Recent data strongly suggest that it is possible to avoid death due to careful and rapid rehydration despite the high purging rate even if many of the risk factors for mortality are present in these severely malnourished children. Recovery from malnutrition was achieved in 7 days.