Dietary treatment and nutritional support for children with malnutrition: Methodological approaches (lecture)

The lecture presents definitions of malnutrition from historical to modern concepts. A comparison was made of the diagnoses presented in ICD-10 and ICD-11, as well as generally accepted diagnostic criteria for malnutrition. Definitions are given of kwashiorkor, alimentary marasmus, cachexia and sarcopenia as the main severe manifestations of malnutrition. Treatment of patients with malnutrition is presented depending on the severity stage, using modern formula of enteral nutrition. Methodological approaches to the treatment of patients with kwashiorkor, alimentary marasmus and marasmatic kwashiorkor are presented in detail. The standards of needs for essential nutrients, liquids and energy for children of different age groups are presented, as well as modern and historical formulas for personalized calculation of the energy value of the diet. The coefficients of conversion of the basal metabolic rate in children are presented taking into account physiological and pathological processes. Preferred options for dietary proteins, fats and carbohydrates are described for children with varying degrees of nutritional deficiency depending on their metabolism in the body. A classification of enteral nutrition products is given, as well as options for their use depending on the severity of nutritional deficiency. Indications for tube feeding have been determined: from the use of temporary feeding tubes to gastrostomy. The timing of the transition from an oro- or nasogastric feeding tube to the installation of a gastrostomy, and possible complications of prolonged use of a feeding tube are explained from a pathophysiological standpoint. Treatment of severe nutritional deficiency is presented separately for patients with kwashiorkor, alimentary marasmus and marasmatic kwashiorkor. Modern approaches to the treatment of kwashiorkor have changed in recent years. The transition to parenteral nutrition, causes and options for parenteral nutrition products have been identified

1. Шабалов НП. Детские болезни: 6-е изд., перераб. и доп. СПб.: Питер; 2011. Т. 1. 928 с. Режим доступа: https://gastroscan.ru/literature/pdf/shabalov-np_detskie_bolezni-2011.pdf.

2. Ткачева ОН, Тутельян ВА, Шестопалов АЕ, Котовская ЮВ, Стародубова АВ, Погожева АВ и др. Недостаточность питания (мальнутриция) у пациентов пожилого и старческого возраста: клинические рекомендации. М.; 2020. 74 с. Режим доступа: https://rosagg.ru/wp-content/uploads/2020/12/pitanie.pdf.

3. Rovda YuI, Minyaylova NN, Stroeva VP, Nikitina ED. Protein-energy malteness (PEM) in children (lecture). Mother and Baby in Kuzbass. 2021;2(2):40–51. (In Russ.) Available at: https://mednauki.ru/index.php/MD/article/view/574.

4. Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney LN et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013;37(4):460–481. https://doi.org/10.1177/0148607113479972.

5. Баранов АА, Тутельян ВИ, Чумакова ОВ, Фисенко АП, Никитюк ДБ, Намазова-Баранова ЛС и др. Программа оптимизации вскармливания детей первого года жизни в Российской Федерации. М.; 2024. Режим доступа: https://praesens.ru/rubricator/klinicheskie-rekomendatsii/7e8c59d0-1cb8-4cc7-9cfe-1fcefb0216f5/.

6. Zvonkova NG, Borovik TE, Skvortsova VA, Fisenko AP, Bushueva TV, Lukoyanova OL et al. Malnutrition in infants (To the new edition of «Program for optimizing the feeding of children of the first year of life in the Russian Federation»). Pediatriya – Zhurnal im G.N. Speranskogo. 2020;99(2):190–198. (In Russ.) https://doi.org/10.24110/0031-403X-2020-99-2-190-198.

7. Bouma S. Diagnosing Pediatric Malnutrition: Paradigm Shifts of Etiology – Related Definitions and Appraisal of the Indicators. Nutr Clin Pract. 2017;32(1):52–67. https://doi.org/10.1177/0884533616671861.

8. Peterkova VA, Bezlepkina OB, Bolotova NV, Bogova EA, Vasyukova OV, Girsh YaV et al. Clinical guidelines "Obesity in children". Problemy Endokrinologii. 2021;67(5):67–83. (In Russ.) https://doi.org/10.14341/probl12802.

9. Петеркова ВА, Нагаева ЕВ, Ширяева ТЮ. Оценка физического развития детей и подростков: методические рекомендации. М.; 2017. 55 с. Режим доступа: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/037/250/original/МР_Оценка_Физ_развития_детей.pdf?1518106827.

10. Сорокина ЛД, Марченко ЕА, Завьялова АН, Новикова ВП, Хавкин АИ. Квашиоркор: патофизиологические аспекты и пути решения проблемы. Вопросы детской диетологии. 2022;20(6):71–80. https://doi.org/10.20953/1727-5784-2022-6-71-80. Sorokina LD, Marchenko EA, Zavyalova AN, Novikova VP, Khavkin AI. Kwashiorkor: pathophysiological aspects and solutions. Pediatric Nutrition. 2022;20(6):71–80. (In Russ.) https://doi.org/10.20953/1727-5784-2022-6-71-80.

11. Titi-Lartey OA, Gupta V. Severe Acute Malnutrition: Recognition and Management of Marasmus and Kwashiorkor. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559224.

12. Иванов ДО, Новикова ВП, Завьялова АН, Лисица ИА (ред.). Недостаточность питания у детей. М.: ГЭОТАР-Медиа; 2025. 480 с. Режим доступа: https://www.elibrary.ru/tjteyz.

13. Тутельян ВА, Никитюк ДБ, Аксенов ИВ, Батурин АК, Бессонов ВВ, Воробьева ВМ и др. Нормы физиологических потребностей в энергии и пищевых веществах для различных групп населения Российской Федерации. М.; 2021. 72 с. Режим доступа: https://www.rospotrebnadzor.ru/documents/details.php?ELEMENT_ID=18979.

14. Ferrer M, Anthony TG, Ayres JS, Biffi G, Brown JC, Caan BJ et al. Cachexia: A systemic consequence of progressive, unresolved disease. Cell. 2023;186(9):1824–1845. https://doi.org/10.1016/j.cell.2023.03.028.

15. Zavyalova AN, Novikova VP, Yakovleva MN. Sarcopenia in children: lecture. Meditsinskiy Sovet. 2024;18(1):245–253. (In Russ.) https://doi.org/10.21518/ms2023-470.

16. Zavyalova AN, Novikova VP, Klikunova KA. Nutritional status and feeding problems in children with dysphagia and cerebral palsy in different social settings. Experimental and Clinical Gastroenterology. 2022;198(2):21–29. (In Russ.) Available at: https://www.nogr.org/jour/article/view/1865.

17. Завьялова АН, Новикова ВП, Кликунова КА, Гавщук МВ, Лисовский ОВ. Способ диагностики саркопении. Патент RU 044862 B1, 06.10.2023. Режим доступа: https://elibrary.ru/jsdorq.

18. Zavyalova AN, Novikova VP, Yakovleva MN. Pediatric sarcopenia: risk factors and diagnostic criteria (pilot study). Preventive and Clinical Medicine. 2024;(1):14–24. (In Russ.) Available at: https://profclinmed.szgmu.ru/PIK_1-2024.pdf.

19. Завьялова АН, Новикова ВП, Яковлева МН, Фирсова ЛА. Реестр пациентов с capкопенией детского возраста. Регистрация базы данных RU 2023620963, 22.03.2023. Режим доступа: https://www.elibrary.ru/sjnsli.

20. Боровик ТЭ, Ладодо КС (ред.). Клиническая диетология детского возраста: руководство для врачей. 2-е изд. М.: МИА; 2015. 720 с. Режим доступа: https://thelib.net/3310707-klinicheskaja-dietologijadetskogo-vozrasta-rukovodstvo-dlja-vrachej.html.

21. Самаль ТН, Украинцев СЕ. Гипотрофия у детей раннего возраста: клиника, диагностика, современные подходы к лечению. Минск: БГМУ; 2004. 20 с. Режим доступа: https://medby.narod.ru/student/BSMU/2004/338388.doc.

22. Пугаев АВ, Ачкасов ЕЕ. Оценка состояния питания и определение потребности в нутритивной поддержке. М.: Профиль; 2007. 85 с. Режим доступа: https://elibrary.ru/qkpxhd.

23. Khlebovets NI. Hypotrophy in young children. Journal of the Grodno State Medical University. 2005;(3):205–208. (In Russ). Available at: http://elib.grsmu.by/handle/files/24835.

24. Zavyalova AN, Gostimskii AV, Lisovskii OV, Gavshchuk MV, Karpatskii IV, Pogorelchuk VV, Mironova AV. Enteral nutrition in palliative medicine in children. Pediatrician (St. Petersburg). 2017;8(6):105–113. (In Russ.) https://doi.org/10.17816/PED86105-113.

25. Новикова ВП, Гурова ММ, Завьялова АН, Маталыгина ОА, Богданова НМ, Яковлева МН и др. Навигатор по продуктам питания детей раннего возраста. В: Навигатор по специализированным продуктам для кормящих женщин и детским формулам для вскармливания детей от рождения до 3 лет. СПб.: СПбГПМУ; 2022. Т. 1. 672 с. Режим доступа: https://elibrary.ru/gfezjv.

26. Афончиков ВС, Беликов ВЛ, Дмитриев АВ, Ерпулева ЮВ, Кучер АГ, Лапицкий АВ и др. Руководство по клиническому питанию. 4-е изд., обновл. и перераб. СПб.: Арт-Экспресс; 2023. 556 с. Режим доступа: https://elibrary.ru/ebqwlh.

27. Khoroshilov IE. Enteral nutrition as a method of prevention and treatment of malnutrition. Consilium Medicum. Gastroenterology (Suppl.). 2008;(2):49–53. (In Russ.) Available at: https://omnidoctor.ru/library/izdaniya-dlya-vrachey/consilium-medicum/cm2008/gastro2008_pril/gastro2008_2_pril/enteralnoe-pitanie-kak-metod-profilaktikii-lecheniya-nedostatochnosti-pitaniya/.

28. Хорошилов ИЕ, Панов ПБ. Клиническая нутрициология. СПб.: ЭЛБИ-СПб; 2009. 279 c. Режим доступа: https://www.elibrary.ru/qlwauf.

29. Luft VM, Lapitsky AV, Sergeeva AM. Enteral nutritional mixtures in palliative medicine: differentiated choice possibilities. Palliative Medicine and Rehabilitation. 2021;(2):9–14. (In Russ.) Available at: https://www.elibrary.ru/xeuwpo.

30. Ерпулева ЮВ. Клиническое питание у детей. М.; 2023.144 с. https://doi.org/10.33029/9704-7972-8-KLIN-2023-1-144.

31. Erpuleva YuV, Lekmanov AU, Gribakin SG, Ryzhov EA, Tabackina TE. Modern technologies of enteral nutrition in critically ill children. Russian Bulletin of Pediatric Surgery, Anesthesiology and Resuscitation. 2014;4(1):80–87. Available at: https://elibrary.ru/sfzcxl.

32. Петриков СС, Хубутия МШ, Попова ТС (ред.). Парентеральное и энтеральное питание: национальное руководство. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа; 2023. 1168 с. Режим доступа: https://www.rosmedlib.ru/book/ISBN9785970472774.html.

33. Schofiеld W.N. Prеdicting basal metabolic ratе, nеw standards and rеviеw of prеvious work. Hum Nutr Clin Nutr. 1985;39(1):5–41.

34. Marino L, Meyer R, Kruizenga H, Wierdsma N. Diet Pocket Guide. Paediatrics. Amsterdam: VU Universaty Press; 2019. 349 p.

35. Kleinman RE, Greer FR (eds.). Pediatric Nutrition. 8th ed. Itasca, IL: American Academy of Pediatrics; 2020. 1731 p. Available at: https://psv4.userapi.com/s/v1/d/0EZsSCOQ0XIKfwihp-hImQ85rRn1HNAh93NLIhdqXbqRgAQsDQJvE1hMNp8613WpCperGqYZOKrZ6KuboRCMA4LACGbn44BoZUrI_KUxyS-qk-P/Pediatric_Nutrition_Kleinman_8_ed_2019.pdf.

36. Николаев ДВ, Щелыкалина СП. Биоимпедансный анализ состава тела человека. В: Берестень НФ, Сандриков ВА, Федорова СИ (ред.). Функциональная диагностика: национальное руководство. М.: ГЭОТАРМедиа; 2023. С. 409–411. Режим доступа: https://www.elibrary.ru/sbadsh.

37. Burrin DG, Davis TA. Proteins and amino acids in enteral nutrition. Curr Opin Clin Nutr Metab Care. 2004;7(1):79–87. https://doi.org/10.1097/00075197-200401000-00013.

38. Kulkarni B, Mamidi RS. Nutrition rehabilitation of children with severe acute malnutrition: Revisiting studies undertaken by the National Institute of Nutrition. Indian J Med Res. 2019;150(2):139–152. https://doi.org/10.4103/ijmr.IJMR_1905_18.

39. Cardino VN, Goeden T, Yakah W, Ezeamama AE, Fenton JI. New Perspectives on the Associations between Blood Fatty Acids, Growth Parameters, and Cognitive Development in Global Child Populations. Nutrients. 2023;15(8):1933. https://doi.org/10.3390/nu15081933.

40. Iddrisu I, Monteagudo-Mera A, Poveda C, Pyle S, Shahzad M, Andrews S, Walton GE. Malnutrition and Gut Microbiota in Children. Nutrients. 2021;13(8):2727. https://doi.org/10.3390/nu13082727.

41. Chen RY, Mostafa I, Hibberd MC, Das S, Mahfuz M, Naila NN et al. A Microbiota-Directed Food Intervention for Undernourished Children. N Engl J Med. 2021;384(16):1517–1528. https://doi.org/10.1056/NEJMoa2023294.

42. Garrett WS. Microbial Nourishment for Undernutrition. N Engl J Med. 2021;384(16):1566–1567. https://doi.org/10.1056/NEJMe2104212.

43. Briend A, Friis H, Michaelsen K. A Microbiota-Directed Food Intervention for Undernourished Children. N Engl J Med. 2022;386(15):1483. https://doi.org/10.1056/NEJMc2110544.

44. Mostafa I, Ferdous J, Parvin I, Rahman HH, Saqeeb KN, Chisti MJ et al. A multicountry, randomized trial of three nutritional supplements on short-term and sustained anthropometric recovery in children 6–24 months of age with moderate wasting and acute illnesses: the NUTRIMAM study protocol. Trials. 2024;25(1):738. https://doi.org/10.1186/s13063-024-08390-5.

45. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, JonkersSchuitema C et al. ESPEN practical guideline: Home enteral nutrition. Clin Nutr. 2022;41(2):468–488. https://doi.org/10.1016/j.clnu.2021.10.018.

46. Иванов ДО, Строкова ТВ, Камалова АА, Александрович ЮС, Таран НН, Завьялова АН и др. Диагностика и коррекция нутритивного статуса у детей с детским церебральным параличом. СПб.: СПбГПМУ; 2020. 100 с. Режим доступа: https://www.elibrary.ru/nfrlbt.

47. ТTitova ON, Strokova TV, Taran NN, Pavlovskaya EV, Matinyan IA. Experience of nutritional condition correction in children with infantile cerebral palsy: clinical review. RMJ. 2019;27(7):16–21. (In Russ.) Available at: https://www.rmj.ru/articles/pediatriya/Opyt_korrekcii_pischevogo_statusa_u_detey_s_detskim_cerebralynym_paralichom_klinicheskoe_nablyudenie/.

48. Pak LA, Makarova SG, Fisenko AP, Kuzenkova LM, Chumbadze TR. Experience in catering for patients with cerebral palsy during comprehensive rehabilitation at the Federal center. L.O. Badalyan Neurological Journal. 2020;1(2):100–111. (In Russ.) Available at: https://www.neuro-journal.ru/jour/article/view/22/22.

49. Maslova NA, Zvonkova NG, Borovik TE, Fisenko AP, Kuzenkova LM, Chernikov VV et al. The nutritional support in children with spastic forms of cerebral palsy. Russian Pediatric Journal. 2022;25(1):4–11. (In Russ.) https://doi.org/10.46563/1560-9561-2022-25-1-4-11.

50. Titova ON, Taran NN, Strokova TV, Matinyan IA, Keleinikova AV, Pavlovskaya EV. Evaluation of the efficacy of using a mixture based on whey protein hydrolysate for nutritional supplementation of children with cerebral palsy. RMJ. Medical Review. 2020;4(5):282–289. (In Russ.) https://doi.org/10.32364/2587-6821-2020-4-5-282-289.

51. Kamalova AA, Rakhmaeva RF, Ahmadullina EM, Basanova LI. Effectiveness of nutritional status correction in children with cerebral palsy. Russian Bulletin of Perinatology and Pediatrics. 2021;66(4):135–140. (In Russ.) https://doi.org/10.21508/1027-4065-2021-66-4-135-140.

52. Romano C, van Wynckel M, Hulst J, Broekaert I, Bronsky J, Dall’Oglio L et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment. J Pediatr Gastroenterol Nutr. 2017;65(2):242–264. https://doi.org/10.1097/MPG.0000000000001646.

53. Gramlich L, Hurt RT, Jin J, Mundi MS. Home Enteral Nutrition: Towards a Standard of Care. Nutrients. 2018;10(8):1020. https://doi.org/10.3390/nu10081020.

54. Scarpato E, Staiano A, Molteni M, Terrone G, Mazzocchi A, Agostoni C. Nutritional assessment and intervention in children with cerebral palsy: a practical approach. Int J Food Sci Nutr. 2017;68(6):763–770. https://doi.org/10.1080/09637486.2017.1289502.

55. Leyderman IN, Gritsan AI, Zabolotskikh IB, Lomidze SV, Mazurok VA, Nekhaev IV et al. Perioperative nutritional support. Russian Federation of anesthesiologists and reanimatologists guidelines. Annals of Critical Care. 2018;(3):5–21. (In Russ.) https://doi.org/10.21320/1818-474X-2018-3-5-21.

56. Luft VM, Tyavokina EIu, Sergeeva AM, Lapitsky AV. Refeeding syndrome and its prevention in patients with anorexia nervosa. Consilium Medicum. 2021;23(2):144–147 (In Russ.) Available at: https://omnidoctor.ru/library/izdaniya-dlya-vrachey/consilium-medicum/cm2021/cm2021_2_nevro/refiding-sindrom-i-ego-profilaktika-u-bolnykh-nervnoy-anoreksiey/.

57. Lisitsa IA, Aleksandrovich YuS, Zavyalova AN, Lisovskii OV, Novikova VP, Pogorelchuk VV. Features of refeeding syndrome in pediatric intensive care unit patients (literature review). Messenger of Anesthesiology and Resuscitation. 2024;21(5):97–107. (In Russ.) https://doi.org/10.24884/2078-5658-2024-21-5-97-107.

58. Dipasquale V, Cucinotta U, Romano C. Acute Malnutrition in Children: Pathophysiology, Clinical Effects and Treatment. Nutrients. 2020;12(8):2413. https://doi.org/10.3390/nu12082413.

59. Aliyu I, Ibrahim HU, Idris U, Michael GC, Ibrahim UA , Mohammed A et al. The clinical profile and outcome of children with acute malnutrition in a tertiary health center in North-West Nigeria: A 1-year retrospective review. J Clin Sci. 2020;17(4):120–126. https://doi.org/10.4103/jcls.jcls_55_19.

60. Lisitsa IA, Zavyalova AN, Ignatova PD, Makarova TYu. Microbiome of patients in the intensive care unit. Literature review. University Therapeutic Journal. 2024;6(3):5–18. (In Russ.) https://doi.org/10.56871/UTJ.2024.67.59.001.

61. Nel E, Lombard M. Ready-to-use therapeutic foods for the treatment of malnourished children and infants. Curr Opin Clin Nutr Metab Care. 2021;24(3):276–280. https://doi.org/10.1097/MCO.0000000000000747.

62. Imdad A, Rogner JL, François M, Ahmed S, Smith A, Tsistinas OJ et al. Increased vs. Standard Dose of Iron in Ready-to-Use Therapeutic Foods for the Treatment of Severe Acute Malnutrition in a Community Setting: A Systematic Review and Meta-Analysis. Nutrients. 2022;14(15):3116. https://doi.org/10.3390/nu14153116.

63. Pham TP, Alou MT, Golden MH, Million M, Raoult D. Difference between kwashiorkor and marasmus: Comparative meta-analysis of pathogenic characteristics and implications for treatment. Microb Pathog. 2021;150:104702. https://doi.org/10.1016/j.micpath.2020.104702.

64. Verrest L, Wilthagen EA, Beijnen JH, Huitema ADR, Dorlo TPC. Influence of Malnutrition on the Pharmacokinetics of Drugs Used in the Treatment of Poverty-Related Diseases: A Systematic Review. Clin Pharmacokinet. 2021;60(9):1149–1169. https://doi.org/10.1007/s40262-021-01031-z.

65. Wyart E, Bindels LB, Mina E, Menga A, Stanga S, Porporato PE. Cachexia, a Systemic Disease beyond Muscle Atrophy. Int J Mol Sci. 2020;21(22):8592. https://doi.org/10.3390/ijms21228592.

66. Bizuneh FK, Tolossa T, Bekonjo NE, Wakuma B. Time to recovery from severe acute malnutrition and its predictors among children aged 6–59 months at Asosa general hospital, Northwest Ethiopia. A retrospective follow up study. PLoS ONE. 2022;17(8):e0272930. https://doi.org/10.1371/journal.pone.0272930.

67. Otiti MI, Allen SJ. Severe acute malnutrition in low-and middle-income countries. Paediatr Child Health. 2021;31(8):301–307. https://doi.org/10.1016/j.paed.2021.05.001.

68. Zavyalova AN. Nutrition in neurologically impaired children. Medicine: Theory and Practice. 2019;4(1):42–51. (In Russ.) Available at: https://ojs3.gpmu.org/index.php/med-theory-and-practice/article/view/446.

69. Lisitsa IA, Alexandrovich YuS, Zavyalova AN, Lisovskii OV, Razumov SA. Dysphagia in pediatric intensive care unit patients (review). Messenger of Anesthesiology and Resuscitation. 2023;20(6):97–105. https://doi.org/10.24884/2078-5658-2023-20-6-97-105.

70. Maru Y, Tamiru D, Baye K, Chitekwe S, Kifle YG, Lailou A, Belachew T. Comparing time to recovery in wasting treatment: simplified approach vs. standard protocol among children aged 6–59 months in Ethiopia-a cluster-randomized, controlled, non-inferiority trial. Front Pediatr. 2024;12:1337370. https://doi.org/10.3389/fped.2024.1337370.

71. Nel E. Severe acute malnutrition. Curr Opin Clin Nutr Metab Care. 2018;21(3):195–199. https://doi.org/10.1097/MCO.0000000000000465