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Micronutrient deficiencies associated with malnutrition in children

Sarah M Phillips, MS, RD, LD
Craig Jensen, MD
Section Editor
Kathleen J Motil, MD, PhD
Deputy Editor
Alison G Hoppin, MD


Severely malnourished children typically are brought to medical attention when a health crisis, such as an infection, precipitates the transition between marasmus (a state of nutritional adaptation) and kwashiorkor, in which adaptation is no longer adequate. The World Health Organization (WHO) classifies malnutrition based upon the degree of wasting or stunting and the presence of edema, as described in a separate topic review. (See "Malnutrition in children in resource-limited countries: Clinical assessment".)

Evaluation and management of the malnutrition depends on the clinical setting and cause of malnutrition. Although the principles of assessment and management of malnourished children from resource-rich countries are similar to those from resource-limited countries, the specific details may vary based on local customs and resources. (See "Laboratory and radiologic evaluation of nutritional status in children" and "Failure to thrive (undernutrition) in children younger than two years: Etiology and evaluation".)

The micronutrient deficiencies that are most commonly associated with protein-energy malnutrition (PEM) in children are discussed here. Deficiencies of fat-soluble vitamins, iron, and zinc are particularly common, but deficiencies of other water-soluble vitamins, minerals, and trace elements also may be found, varying with the region and chronicity of the malnutrition [1]. More detailed information about the biochemistry of these micronutrients and their deficiency states is discussed in separate topic reviews. The clinical assessment and treatment of these children, including definitions and anthropometric measurements is discussed separately. (See "Malnutrition in children in resource-limited countries: Clinical assessment".)


In resource-limited settings, micronutrient deficiencies are common in any child with severe acute malnutrition. Deficiencies of fat-soluble vitamins, iron, and zinc are particularly common, but deficiencies of other water-soluble vitamins, minerals, and trace elements also may be found, varying with the region and chronicity of the malnutrition. In most cases, specific testing is not necessary because empiric replacement of vitamins and minerals is routinely included in nutritional rehabilitation. For some deficiencies (eg, Vitamin A), additional replacement doses are given to patients who are symptomatic (table 1). (See "Management of complicated severe acute malnutrition in children in resource-limited countries".)

In resource-rich settings, malnutrition is typically caused by an underlying medical disorder, or a diet that is atypical for the community. In this setting, concerns for specific deficiencies are guided by knowledge about the patient's specific risk factors, such as bowel anatomy or diet, as well as by clinical symptoms. For symptomatic patients, laboratory testing is appropriate to confirm the diagnosis before embarking on replacement, since multiple deficiencies may be present, and signs and symptoms often overlap (table 2).

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Literature review current through: Nov 2017. | This topic last updated: Sep 07, 2017.
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