Author's Accepted Manuscript
Letter to the Editor Aftab Ahmad, Shoji Komai, Agustin Legido MD, PhD, MBA
www.elsevier.com/locate/enganabound
PII: DOI: Reference:
S1071-9091(15)00015-7 10.1016/j.spen.2015.03.001 YSPEN530
To appear in: Semin Pediatr Neurol
Cite this article as: Aftab Ahmad, Shoji Komai, Agustin Legido MD, PhD, MBA, Letter to the Editor, Semin Pediatr Neurol , 10.1016/j.spen.2015.03.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter to the Editor
Dr. Jo M. Wilmshurst, was the Guest Editor of the Seminars in Pediatric Neurology issue about Child Neurology in Africa (2014;21:1-58). In it, Kerac et al. (pages 42-49) reviewed the topic “The Interaction of Malnutrition and Neurologic Disability in Africa.” They emphasized the high frequency of malnutrition and associated neurological disability. Specifically, they reviewed the consequences of global malnutrition, and deficits of macronutrients and micronutrients. Mechanisms include decreased food intake, increased nutrient losses and increased nutrient requirements. The authors concluded highlighting the high frequency and severity of the problem, and the need to implement multidisciplinary programs at a regional and international level to solve the problem.
Drs. Aftab Ahmad and Shoji Komai submitted the Letter to the Editor published below, which follows up on the worldwide importance of the issue addressed by Kerac et al.’s paper (2014).
Agustin Legido, MD, PhD, MBA Editor
Malnutrition and Neurological Problems Among Children in the Developing World Malnutrition is a big challenge to most of developing and low income countries. It not only results in death of people, and especially children, but those who survive face severe mental and other physical health problems. In addition, malnutrition not only brings sufferings to families but also great loss to the economy of the country as malnourished people develop brain and other 1
health disorders, and therefore, they cannot be productive individuals of society.1 The worldwide prevalence of severe malnutrition in children is very high and results in around 1 million deaths each year. Some Asian countries including India, Pakistan, Afghanistan, Bangladesh, Indonesia and Yemen have around 12 million children suffering from severe malnutrition (Table). Across Africa approximately 3% children under the age of five are suffering this disease, which causes death in several hundred thousand children each year. 2 At a global level, the number of children suffering from severe malnutrition is around 20 million, 3 and they are 10 times more likely to die compared to well-nourished children 4. The effects of global severe malnutrition on the nervous system are diverse, most frequently causing neurodevelopment delay. 5, 6 Furthermore, specific disabilities include blindness due to deficiency of vitamin A, intractable epilepsy due to deficiency of vitamin B6 and cognitive impairment due to iodine and iron deficiency 7. The neurological impairment due to severe malnutiriton in children range from 19-61 per 1000. 8 Maternal malnutrition also results in a number of neurological problems like neural tube defects, impaired cognitive functions, birth asphyxia, cerebral palsy, etc, which cause life-long neurological disabilities. 7 Furthermore, the latter further lead to malnutrition as they are associated with difficulties in swallowing and impairment of consciousness, which impairs effective nutrition.9 Besides neurological disorders, severe malnutrition makes the population more prone to suffer infectious diseases. 10 In order to decrease the frequency and severity of malnutrition in developing countries, there is a need for government and non-government organizations to focus on effective strategies. This should include vitamin A supplementation, salt iodization, water fluoride supplementation, and provision of enough food in hunger struck areas, among others. The use of
2
nutrient dense, lipid-based ready to use therapeutic food in patients with severe malnutrition has proved very useful in reducing mortality.2 The severe malnourished population around the world needs immediate attention and corrective actions. This is catastrophic for health and a frequent cause of death. However, severe malnutrition is one of the most avoidable conditions if attention and priority is given to the problem.
3
References 1.
Drake RE, Binagwaho A, Martell HC, et al.: Mental healthcare in low and middle income countries. BMJ 349:g7086, 2014
2.
Briend A, Collins S: Therapeutic nutrition for children with severe acute malnutrition: Summary of African experience. Indian Pediatr 47:655–659, 2010
3.
Ahmed T, Hossain M, Mahfuz M, et al.: Severe acute malnutrition in Asia. Food Nutr Bull 35:S14–26, 2014
4.
Uauy R, Desjeux J-F, Ahmed T, et al.: Global efforts to address severe acute malnutrition. J Pediatr Gastroenterol Nutr 55:476–81, 2012
5.
Grantham-McGregor S, Cheung YB, Cueto S, et al.: Developmental potential in the first 5 years for children in developing countries. Lancet 369:60–70, 2007
6.
Gladstone M, Mallewa M, Alusine Jalloh A, et al.: Assessment of neurodisability and malnutrition in children in Africa. Semin Pediatr Neurol 21:50–7, 2014
7.
Kerac M, Postels DG, Mallewa M, et al.: The interaction of malnutrition and neurologic disability in Africa. Semin Pediatr Neurol 21:42–9, 2014
8.
Gladstone M: A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings. Ann Trop Paediatr 30:181–96, 2010
9.
Li F, Liu Y, Wang X, et al.: Evaluation of malnutrition in patients with nervous system disease. Expert Rev Neurother 14:1229–37, 2014
10.
Schaible UE, Kaufmann SHE: Malnutrition and infection: complex mechanisms and global impacts. PLoS Med 4:e115, 2007
4
Aftab Ahmad, Shoji Komai Nara Institute of Science and Technology (NAIST) Ikoma, Nara, Japan. E.mail: [email protected] Tel. No: +81-743-72-5418
5
Table. Prevalence of Severe Malnutirion in Representative Asian countries SAM cases
No. Country
(millions) 1
India
8
2
Pakistan
1.4
3
Indonesia
1.2
4
Bangladesh
0.6
5
Afghanistan
0.6
6
Yemen
0.6
Total
12.4
6
Letter to the Editor Aftab Ahmad, Shoji Komai, Agustin Legido MD, PhD, MBA
www.elsevier.com/locate/enganabound
PII: DOI: Reference:
S1071-9091(15)00015-7 10.1016/j.spen.2015.03.001 YSPEN530
To appear in: Semin Pediatr Neurol
Cite this article as: Aftab Ahmad, Shoji Komai, Agustin Legido MD, PhD, MBA, Letter to the Editor, Semin Pediatr Neurol , 10.1016/j.spen.2015.03.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter to the Editor
Dr. Jo M. Wilmshurst, was the Guest Editor of the Seminars in Pediatric Neurology issue about Child Neurology in Africa (2014;21:1-58). In it, Kerac et al. (pages 42-49) reviewed the topic “The Interaction of Malnutrition and Neurologic Disability in Africa.” They emphasized the high frequency of malnutrition and associated neurological disability. Specifically, they reviewed the consequences of global malnutrition, and deficits of macronutrients and micronutrients. Mechanisms include decreased food intake, increased nutrient losses and increased nutrient requirements. The authors concluded highlighting the high frequency and severity of the problem, and the need to implement multidisciplinary programs at a regional and international level to solve the problem.
Drs. Aftab Ahmad and Shoji Komai submitted the Letter to the Editor published below, which follows up on the worldwide importance of the issue addressed by Kerac et al.’s paper (2014).
Agustin Legido, MD, PhD, MBA Editor
Malnutrition and Neurological Problems Among Children in the Developing World Malnutrition is a big challenge to most of developing and low income countries. It not only results in death of people, and especially children, but those who survive face severe mental and other physical health problems. In addition, malnutrition not only brings sufferings to families but also great loss to the economy of the country as malnourished people develop brain and other 1
health disorders, and therefore, they cannot be productive individuals of society.1 The worldwide prevalence of severe malnutrition in children is very high and results in around 1 million deaths each year. Some Asian countries including India, Pakistan, Afghanistan, Bangladesh, Indonesia and Yemen have around 12 million children suffering from severe malnutrition (Table). Across Africa approximately 3% children under the age of five are suffering this disease, which causes death in several hundred thousand children each year. 2 At a global level, the number of children suffering from severe malnutrition is around 20 million, 3 and they are 10 times more likely to die compared to well-nourished children 4. The effects of global severe malnutrition on the nervous system are diverse, most frequently causing neurodevelopment delay. 5, 6 Furthermore, specific disabilities include blindness due to deficiency of vitamin A, intractable epilepsy due to deficiency of vitamin B6 and cognitive impairment due to iodine and iron deficiency 7. The neurological impairment due to severe malnutiriton in children range from 19-61 per 1000. 8 Maternal malnutrition also results in a number of neurological problems like neural tube defects, impaired cognitive functions, birth asphyxia, cerebral palsy, etc, which cause life-long neurological disabilities. 7 Furthermore, the latter further lead to malnutrition as they are associated with difficulties in swallowing and impairment of consciousness, which impairs effective nutrition.9 Besides neurological disorders, severe malnutrition makes the population more prone to suffer infectious diseases. 10 In order to decrease the frequency and severity of malnutrition in developing countries, there is a need for government and non-government organizations to focus on effective strategies. This should include vitamin A supplementation, salt iodization, water fluoride supplementation, and provision of enough food in hunger struck areas, among others. The use of
2
nutrient dense, lipid-based ready to use therapeutic food in patients with severe malnutrition has proved very useful in reducing mortality.2 The severe malnourished population around the world needs immediate attention and corrective actions. This is catastrophic for health and a frequent cause of death. However, severe malnutrition is one of the most avoidable conditions if attention and priority is given to the problem.
3
References 1.
Drake RE, Binagwaho A, Martell HC, et al.: Mental healthcare in low and middle income countries. BMJ 349:g7086, 2014
2.
Briend A, Collins S: Therapeutic nutrition for children with severe acute malnutrition: Summary of African experience. Indian Pediatr 47:655–659, 2010
3.
Ahmed T, Hossain M, Mahfuz M, et al.: Severe acute malnutrition in Asia. Food Nutr Bull 35:S14–26, 2014
4.
Uauy R, Desjeux J-F, Ahmed T, et al.: Global efforts to address severe acute malnutrition. J Pediatr Gastroenterol Nutr 55:476–81, 2012
5.
Grantham-McGregor S, Cheung YB, Cueto S, et al.: Developmental potential in the first 5 years for children in developing countries. Lancet 369:60–70, 2007
6.
Gladstone M, Mallewa M, Alusine Jalloh A, et al.: Assessment of neurodisability and malnutrition in children in Africa. Semin Pediatr Neurol 21:50–7, 2014
7.
Kerac M, Postels DG, Mallewa M, et al.: The interaction of malnutrition and neurologic disability in Africa. Semin Pediatr Neurol 21:42–9, 2014
8.
Gladstone M: A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings. Ann Trop Paediatr 30:181–96, 2010
9.
Li F, Liu Y, Wang X, et al.: Evaluation of malnutrition in patients with nervous system disease. Expert Rev Neurother 14:1229–37, 2014
10.
Schaible UE, Kaufmann SHE: Malnutrition and infection: complex mechanisms and global impacts. PLoS Med 4:e115, 2007
4
Aftab Ahmad, Shoji Komai Nara Institute of Science and Technology (NAIST) Ikoma, Nara, Japan. E.mail: [email protected] Tel. No: +81-743-72-5418
5
Table. Prevalence of Severe Malnutirion in Representative Asian countries SAM cases
No. Country
(millions) 1
India
8
2
Pakistan
1.4
3
Indonesia
1.2
4
Bangladesh
0.6
5
Afghanistan
0.6
6
Yemen
0.6
Total
12.4
6
