Malnutrition is a global public health problem that is associated with high health care cost, and increased morbidity and mortality. Childhood malnutrition of every form, including undernutrition (wasting, stunting and underweight), micronutrient deficiencies, as well as overweight and obesity, consists a triple burden of disease and is one of the leading causes of poor health in children.¹

Global Burden and Associated Factors

Globally in 2019, 149 million children under the age of 5 years were stunted, almost 50 million wasted, 340 million suffered from micronutrient deficiencies and 38.2 million were overweight and obese. Approximately 45% of deaths among children under 5 years of age can be attributed to undernutrition.¹

The sources of malnutrition are complex, multidimensional, and interrelated. They are further divided into three different levels; basic, underlying and immediate. These involve factors such as economy, family history, lack of awareness, and poor lifestyle.² 

Impact on Host Defenses and Infections

The increased predisposition of the nutrient-deficient host to infection is presumed to be largely due to impaired immune function. The integrity of the gastrointestinal mucosa is commonly impaired in malnutrition and, together with reduced gastric acid secretion, leads to an increased susceptibility to some pathogens.³

Medium and Long-term Consequences of Malnutrition

Children under 5 years who are undernourished may suffer from long-term effects that are irreversible, including impaired physical growth and cognitive development. Furthermore, under-nutrition may reduce sensory-motor abilities, reproductive function and increase children’s vulnerability to infections and hereditary diseases, such as diabetes.¹

Management of Mild to Moderate Malnutrition

Management of mild to moderate malnourished children involves appropriate complementary feeding with enhanced calorie and protein uptake. During common illness, such as diarrhea, they are in need of proper care along with adequate nutrients, provided either through food or by supplementation.

Pediatric oral nutrition supplements (ONS) are designed to be consumed orally by children who do not get adequate nutrition by food intake alone. They contain at least one non-protein source of calories (carbohydrate and/or fat) and nitrogen (as intact protein, digested protein, and/or amino acids) in balanced amounts, as well as a wide range of micronutrients to supplement or use as the sole source to provide complete nutritional requirements for children.⁴

Certain nutrients like vitamin A, Zn or protein may be specifically important in children with ponderal and linear growth. This helps in nourishing the child adequately leading to good growth.⁵

Addition of probiotics, which the bacteria can be ingested to benefit intestinal health, together with prebiotic (fructooligosaccharides, FOS) helps to support gut health.

Addition of carnitine in the supplements helps in incremental growth in children due to its role in muscle growth factor.⁶

Nutritional supplementation and food fortification are therefore recommended for achieving the desired nutrient density and nutrient adequacy to promote growth in children who are at risk of, with undernutrition and picky eaters.⁴