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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".)


Children with protein-energy malnutrition (PEM) may have deficiencies of the two primary essential fatty acids (EFA), linoleic and linolenic acid. EFA levels may be altered by diet, disease, or prematurity. The biochemical effects of deficiency are an increased triene/tetraene ratio and will be evident prior to any physical changes. Physical signs include scaly dermatitis, alopecia, and thrombocytopenia. Deficiency of EFA can affect growth, and cognitive and visual function in infants [2].


Children with protein-energy malnutrition (PEM) also may have deficiencies of the fat-soluble vitamins: A, D, E, and K (table 1). (See "Laboratory and radiologic evaluation of nutritional status in children".)


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Literature review current through: Sep 2016. | This topic last updated: Jul 1, 2016.
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