MODERATE ACUTE MALNUTRITION

AS stated earlier, moderate acute malnutrition is defined as: (a) weight for height between - 2 to - 3 z-score, (b) MUAC between 11.5-12.4 cm, and (c) absence of edema or visible wasting.

Children with MAM are best managed at home, unless have some other co-morbidity or medical complications. Some cases can be managed in nutritional rehabilitation centers (NRCs) in early stages. Important considerations in the management of MAM include:

• Initial assessment for complications and appropriate management, including de-worming.

• Ensure minimum daily caloric intake of 150 calories/ kg and 2-3 grams proteins/kg from all sources including regular and supplementary feeds.

• Supplementary foods must be energy-dense providing 1.5-2 cal/gm (instead of usual 0.8 cal/gm) along with- 35-45% calories from fats with minimum 5% from n-6 PUFA, 0.5% from n-3 PUFA, linolenic acid:alpha- linoleic acid ratio of 5-15% and protein digestibility corrected amino acid score (PDCAAS) of gt;70% (WHO 2014 recommendations). A cereal/legume mix diet with milk and animal protein sources may be used in appropriate quantity and frequency. Supplementary foods through various sources, e.g. RUTF or home­made items may be used for this purpose.

• Micronutrient supplementation or fortification of foods.

• Nutritional counseling for appropriate volume, frequency and diversity of home diet, cooking practices, food hygiene, etc.

6.1.8