Although there is encouraging evidence of progress in reducing the prevalence of acute protein-energy malnutrition (PEM), this condition still affects millions of children around the world Acute edematous protein-energy malnutrition is a potentially life-threatening condition, which in the most severe form is frequently associated with multiple organ failure.
Consequently, the first goal of the management of acute malnutrition is the stabilization of vital functions, particularly cardiovascular function and blood pressure and acid-base and electrolyte imbalances.
Once stabilization is achieved, nutritional rehabilitation can proceed. There are well established protocols for the sequential and progressive increase in nutrient delivery during this early recovery phase. A carefully controlled sequence of nutrient delivery is essential, to avoid metabolic disturbances. The metabolic status of children with PEM result from the adaptation of enzymatic pathways and organ functions to low substrate levels. A rapid increase in substrate supply may rapidly disrupt that equilibrium, resulting in metabolic disturbances.
Recent emphasis on the nutritional rehabilitation of the malnourished child has focused on organ-specific nutrients and on the longer-term nutrient requirements of children recovering from malnutrition but who continue to be exposed to mild, subclinical diseases. For example, one area of interest is the role of the gut as a nitrogen-processing organ, and its potential contribution to achieve the positive N balance needed to sustain recovery. Similarly, the role of certain nutrients like arginine and the polyunsaturated fatty acidic of the n-6 series on the recovery of immune function have been explored. Children continuously exposed to mild infections must mount protracted acute-phase response, and the nutritional and metabolic cost of this response has also been the focus of attention. The specific requirements of indispensable amino acids to sustain that response may either promote skeletal muscle protein catabolism, or increase the demand for certain dietary amino acids. The ultimate goal is that, based on our understanding on these issues, recovery diets can be developed that not only contribute the necessary amounts of essential nutrients, but that also enhance recovery by specific effects on different functions and organ systems.