UNICEF/World Food Programme/United Nations High Commissioner for Refugees Consultation on the Management of Moderate Malnutrition in Children under 5 Years of Age

Moderate malnutrition includes all children with moderate wasting, defined as a weight-for-height between –3 and –2 z-scores of the World Health Organization (WHO) child growth standards, and all those with moderate stunting, defined as a height-for-age between –3 and –2 z-scores of the WHO child growth standards [1]. Most of these children will be moderately underweight (weight-for-age between –3 and –2 z-scores). Moderate malnutrition affects large numbers of children in poor countries, placing them at increased risk of mortality. A recent analysis of data from 388 national surveys from 139 countries from 2005 has provided an estimate that about 36 million children aged 6 to 59 months are suffering from moderate wasting. Approximately 178 million are estimated to be stunted [2]. Moderate malnutrition increases the risk of death from common diseases and, if not adequately treated, may worsen, resulting in severe acute malnutrition (severe wasting and/or edema) and/or severe stunting (heightfor-age < –3 z-scores), which are both life-threatening conditions. Therefore, the management of moderate malnutrition is a public health priority. In contrast to severe malnutrition, programs for the management of moderate malnutrition in children have remained virtually unchanged for the past 30 years, although it seems likely that this form of malnutrition is associated with a larger proportion of nutrition-related deaths than severe malnutrition. WHO convened a meeting in Geneva from 30 September to 3 October 2008 to address this problem. The overall aim of the meeting was to answer the question “What diets should be recommended to feed moderately malnourished children?”* The general objectives of the meeting were to identify areas of consensus on the nutrient needs and dietary management of moderate malnutrition in children that can be translated into evidence-based global guidelines, and to identify knowledge gaps that should be addressed by research, both in the area of dietary management and in the modalities for providing that diet. The specific objectives of the meeting were: » To provide an estimate of the nutritional requirements of children with moderate malnutrition, examining wasted and stunted children separately; » To examine current approaches for the management of moderate malnutrition, based either on dietary counseling or on the provision of food supplements; » To formulate recommendations to improve the dietary management of moderate malnutrition. The expected outcomes of the meeting were: » Preliminary recommendations for the management of moderate malnutrition, with a detailed research agenda to generate evidence needed to strengthen these preliminary guidelines; » Recommendations for feeding children with moderate malnutrition for the Codex Alimentarius working group developing standards of food products for underweight children. In the absence of specific recommendations, it was also assumed during this meeting that children with severe stunting would benefit from a diet adapted for moderately stunted children and that children suffering from growth faltering would benefit from a diet adapted for wasted or stunted children, depending on the nature of their growth deficit. In absence of a strong evidence base to make