La malnutrition aiguë sévère : de la physiopathologie à la prise en charge

Undernutrition is a major global health issue. In 2022, acute malnutrition affected 45 million children under the age of five, including at least 13.6 million in severe acute malnutrition (SAM). Acutely malnourished children have a high risk of mortality, of staturo-ponderal growth retardation and of co-morbidities such as diarrhea. They can also present cognitive and metabolic disorders in adulthood. SAM includes nutritional edema (kwashiorkor) and severe wasting. Management of SAM is based on the guidelines of the World Health Organization (WHO), updated in 2023. Diagnostic is performed through clinical exam and anthropometric criteria, as middle-upper arm circumference or weight-for-age z-score. Ready-to-use therapeutic food (RUTF) are used to treat children aged 6–59 months up to recovery. Nowadays, a particular focus on improving recovery and coverage is performed, notably through integrated/simplified protocols, formulation of alternative RUTFs or anticipation of risks of relapse for SAM children. Finally, the prevention of SAM, which is now included in WHO's guidelines, deserves greater attention by, for example, targeting nutrition of children of 6–59 months and/or nutritional quality of pregnant and lactating women.