世界卫生组织最近更新了预防和管理婴儿和5岁以下儿童的消瘦和营养水肿(急性营养不良)的指南。除了关于营养框架的差异,该框架定义了用于门诊治疗严重消瘦和/或营养性水肿的即用治疗食品(RUTF)所需的能量数量,实践指导也存在重要差距。而不是建议的能量摄入量150-185千卡/千克/天,我们的替代计算表明,要求仅为105-120千卡/千克/天。如果为true,这种热量过量喂养的实施可能会产生不利后果。还需要解决实际指导方面的差距,包括过渡到家庭饮食的时机,治疗性进食的最大持续时间,特别是在非响应者中(南亚为50%),以及增强家庭食品作为主要治疗性食品选择的作用。
The World Health Organization has recently updated the
guideline on the prevention and management of
wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years. Apart from differences with regard to the nutritional framework that defines the quantity of energy required as Ready-to-Use Therapeutic Food (RUTF) for the outpatient treatment of severe
wasting and/or nutritional oedema, there are also important gaps in the practical guidance. Instead of the recommended energy intake of 150-185 kcal/kg/day, our alternative calculations indicate the requirement to be only 105-120 kcal/kg/day. If true, the implementation of such caloric overfeeding can have adverse consequences. Gaps in practical guidance also need to be addressed, including the timing of transition to home-based diets, maximal duration of therapeutic feeding, especially in non-responders (∼50% in South Asia), and the role of augmented home foods as the primary therapeutic food option.