The clinical challenge of preventing and treating malnutrition.

Malnutrition remains a major problem in children in large parts of the developing world. About 150 million young children in the developing world are either wasted or stunted, and it has been estimated that over half of childhood deaths are attributable to the potentiating effects of malnutrition. Thus, tackling both mild-moderate and severe malnutrition effectively is essential if the millennium development goals are to be achieved. Intervention strategies to promote exclusive breastfeeding for about 6 months in the absence of maternal HIV infection will result in significant improvements in nutrition, and are key to prevention strategies for malnutrition. Careful evaluation and effective counseling of HIV-positive mothers regarding feeding choices is essential. Evidence from a number of randomized controlled trials shows that ready to use foods have an important role to play in the prevention and treatment of both outpatient and inpatient malnutrition. Such foods were initially produced commercially, but it has been shown, particularly in Malawi, that such foods can be locally produced at low cost. In some parts of the world, HIV is a major underlying cause of malnutrition in children and is associated with high mortality rates in those with severe malnutrition. Strategies for the prevention and treatment of children with HIV need to be escalated.