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PERSPECTIVE article

Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
Volume 13 - 2025 | doi: 10.3389/fped.2025.1523613

Gastrointestinal changes in paediatric malnutrition that may impact on nutrition choice

Provisionally accepted
Rosan Meyer Rosan Meyer 1,2*Lauren Arpe Lauren Arpe 3Aydan Kansu Aydan Kansu 4Veronica Kelly Veronica Kelly 5Keith Lindley Keith Lindley 3Mairéad O'Meara Mairéad O'Meara 5Maria Del Carmen Rivero Maria Del Carmen Rivero 6Suzanne Van Zundert Suzanne Van Zundert 7,8Saioa Vicente Santamaría Saioa Vicente Santamaría 9Orjena Žaja Orjena Žaja 10Elena Oliveros Elena Oliveros 11,12Leanne Olivier Leanne Olivier 13Koen Joosten Koen Joosten 14
  • 1 KU Leuven, Leuven, Belgium
  • 2 University of Winchester, Winchester, United Kingdom
  • 3 Great Ormond Street Hospital, London, United Kingdom
  • 4 Department of Pediatric Gastroenterology, Hepatology & Ntrition, Ankara University School of Medicine, Ankara, Türkiye
  • 5 Children´s Health Ireland, Dublin, Ireland
  • 6 Hospital Virgen de la Macarena, Seville, Spain
  • 7 Department of Nutrition and Dietetics, Amsterdam University Medical Center, Amsterdam, Netherlands
  • 8 Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
  • 9 Hospital Universitario Ramón y Cajal, Madrid, Spain
  • 10 Sestre Milosrdnice University Hospital Center, university of Zagreb, Zagreb, Croatia
  • 11 Abbott (Spain), Granada, Spain
  • 12 Abbott Nutrition, Granada, Spain
  • 13 Nutrition International, Abbott, Maidenhead, United Kingdom
  • 14 Erasmus MC-Sophia Children´s Hospital, Department of Intensive Care Neonatology & Pediatrics, Rotterdam, Netherlands

The final, formatted version of the article will be published soon.

    Undernutrition is defined as 'a condition resulting from imbalanced nutrition or abnormal utilization of nutrients.' In this paper, the term malnutrition is used to refer to undernutrition. Malnutrition may be driven by poor socioeconomic conditions or by disease, and it is estimated that diseaserelated malnutrition (DRM) impacts up to 28% of hospitalized children in Europe. Malnutrition results in alterations in gastrointestinal function that lead to malabsorption of macro-and micronutrients. It can lead to altered gut motility and a deficiency of stomach acid, which can result in intestinal colonization by pathogens, causing diarrhoea and high burdens of intestinal infection. The presence of compromised gastrointestinal function in children with DRM is critical as it negatively impacts the efficacy of nutritional support and recovery. When choosing novel strategies and nutritional therapies for malnourished children, consideration should be given to gut-protective interventions that promote better treatment tolerance. When breastmilk is unavailable, whole protein feeds are currently considered as first-line treatment for malnutrition in children with a normal functioning gastrointestinal tract. However, peptide-based feeds have been associated with improved gastrointestinal tolerance and absorption, reduced diarrhoea, reduced inflammation, improved growth and have restored gut integrity compared with free amino acid and whole-protein feeds. At a recent meeting, experts in this area have identified significant research gaps in the literature on peptide-based feeds in children and possible gaps in clinical practice. Whilst the group acknowledges that further work is needed, this paper provides an overview on this topic to further drive research in this area.

    Keywords: Disease-related malnutrition, gastrointestinal function, Children, Nutritional Support, Malabsorption, diarrhoea, peptide-based enteral therapy (limit: 8)

    Received: 06 Nov 2024; Accepted: 05 Feb 2025.

    Copyright: © 2025 Meyer, Arpe, Kansu, Kelly, Lindley, O'Meara, Rivero, Van Zundert, Vicente Santamaría, Žaja, Oliveros, Olivier and Joosten. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Rosan Meyer, KU Leuven, Leuven, Belgium

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.