PROTEIN-ENERGY MALNUTRITION - THE NATURE AND EXTENT OF THE PROBLEM

The paper begins by describing how the names 'protein malnutrition' an d 'protein-energy malnutrition' (PEM) developed from the local name 'K washiorkor'. The central feature of severe PEM is oedema; the classica l theory suggests that the cause is a deficiency of protein, but other factors are also involved. In the community mild-moderate PEM is defi ned by deficits in growth. A distinction has to be made between low we ight for height (wasting) and low height for age (stunting), Stunting in particular affects some 50% of children worldwide. Its causes and c onsequences are briefly discussed. In adults, severe PEM has essential ly the same features as in children and includes the condition 'famine oedema' or 'hunger oedema'; there are again controversies about its c ause. In the community, chronic malnutrition is assessed by the body m ass index (BMI) (Wt/Ht(2)). Grades of deficiency have been defined and examples are given of functional consequences of a low BMI. Secondary malnutrition differs from primary PEM because of the role played by c ytokines and other concomitants of illness or injury. The importance i s emphasized of chronicity or duration in determining the clinical pic ture.