Define Diet for Treatment for Protein Energy Malnutrition?
Treatment of cases of kwashiorkor or marasmus involves mainly providing appropriate nutrition support. The child should receive a diet that provides adequate amounts of energy and protein. Both of these are required in larger quantities than normal requirements for rapid recovery. The child should be given the following concentrations:
Energy: 170 - 200 kcal per kg of body weight
Protein: 3 - 4 g/kg of body weight
Initially, milk based liquid diet, using either fresh milk or dry skimmed milk powder, is recommended. A milk formula could be prepared in one litre of clean water by adding dried skimmed milk powder: 90 g, sugar: 70 g and vegetable oil: 50 g. About 100 ml of reconstituted preparation would provide 100 kcal and 3 g of protein. The formula should be given to the children at the rate of 100-150 ml per kg of body weight. As dried skimmed milk powder does not contain any vitamin A, it should be enriched with vitamin A. Sugar or vegetable oil can be added to increase the energy content. In the beginning, the child may refuse to accept any feeds due to loss of appetite. Under such situations, the diet could be given with a spoon. In extreme cases, gastric intubation (feeding through tube) may be resorted to. With improvement in appetite, the child would start eating the diet readily, at which time gradually solid foods can be introduced. In older children special diet based on cereal, pulse, dried skim milk powder aid sugar/jaggery can be given. Addition of vegetable oil would increase the energy density of the recipe.