Pediatric malnutrition is an ongoing burden in developing countries, particularly in Southern Asia, as compared to Latin America and the northern and western regions of Africa. It is globally known to be the most crucial risk factor for morbidity and mortality. Approximately 1.9 billion people in the Asia and Pacific region have limited access to a healthy diet, and the need to improve diet quality, especially in children, is critical. However, when we assess the pathogenesis and pathophysiology of malnutrition, there should be differentiation between non-disease-related malnutrition, also known as non-illness-related malnutrition, and disease-related or illness-related malnutrition. The first type of malnutrition occurs in relation to environmental factors, such as limited food access or decreased dietary intake, which results in an imbalance relative to nutritional needs, which affect growth, developmental, and other health aspects. Disease-related malnutrition may progress to acute or chronic disease and occurs because of an energy imbalance due to increased catabolism, decreased appetite, or increased energy losses, which also have detrimental effects on the outcomes. Studies have clearly observed that disease-related malnutrition is associated with an increase in the length of stay in hospitalized children and additional financial burdens. A study in the Netherlands looked at annual medical costs for the country, estimated at EUR 80 million for disease-related malnutrition, which equals 5.5% of total hospital costs for these hospitalized children. Disease-related malnutrition, especially in pediatric chronic disease, requires long-term nutrition support to prevent long-term growth faltering and impaired development, as well to prevent poor health-related quality of life. The causes of malnutrition in children with chronic disease are multifactorial and are associated with the underlying disease; thus, careful assessment and management are required for chronic disease. This study observed the most common chronic diseases in children, such as congenital heart disease (CHD), chronic kidney disease (CKD), chronic liver disease (CLD), and malignancy, in which their nutritional assessment may be complicated with preceding conditions such as feeding intolerance, water retention, peripheral edema, electrolyte disturbance, tumor masses, and decreases in bone density and fat mass. Indonesia, like other developing countries, is also facing malnutrition in relation to infectious diseases, such as diarrhea, AIDS, tuberculosis, and parasite infections. However, it is also observed that nutritional deficiency is known to be a predisposing factor for poor immune response, which makes children more susceptible to infection. The three factors: undernutrition, infectious diseases, and immune systems, form a simple cycle and make their roles interlinked. Our research focused on chronic malnutrition in children with chronic diseases as mentioned above, which has received less attention in developing countries as compared to malnutrition caused by infectious diseases. The combination of anthropometry assessment, clinical evaluation, observation on feeding tolerance, and biochemistry analysis should be conducted on a regular basis to ensure adequate nutrition. Lack of uniform definitions, heterogenous screening practices and the failure to recognize nutrition as a part of crucial patient care; however, this have contributed to under-recognition of the prevalence of malnutrition in relation to its outcomes. In developing countries, assessment also depends on the availability of resources and regular monitoring to achieve good outcomes. The initial concept of the study was derived from an expert meeting consisted of six child health professionals, who contributed input and presented current challenges in managing malnutrition in chronically-ill children. The purpose of this study was to review articles available for the measurement of malnutrition in pediatric chronic disease, especially in developing countries where there are resource limitations in identifying nutritional status in pediatric chronic disease with complex conditions.

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Regards,
Catherine
Journal Co-Ordinator
Journal of obesity and Eating Disorders