Protein-calorie deficits in developing countries.

Abstract

Twenty years ago, we were invited to present a paper on severe protein-malnutrition in children in a meeting organized by this same Academy. In reviewing that paper for this presentation, it was very frustrating to find that the basic principles we stated there in regard to the nature of the probelm and its epidemiology are as valid today as they were 20 years ago. As most other workers in the field, we were then particularly concerned with the severe forms of protein-calorie malnutrition (PCM): kwashiorkor and marasmus. These individual cases occupied a large proportion of pediatric beds in hospitals of most developing countries, and we were interested in finding better ways to treat them. But also we were studying these cases as a basis for understanding the responsible factors better and for designing possible preventive measures. The interrelations of kwashiorkor and marasmus were recognized then, as well the fact that both protein and calories should be considered together in the epidemiology of the problem. We were also beginning to understand that the severe clinical cases that we were seeing in the hospitals were only the visible part of a much greater problem affecting the communities from which these children came. With the knowledge then available on the epidemiology of PCM, we were also starting to explore some specific measures for its prevention. I would like now to review what progress we have made, if any, in the understanding of the nature and magnitude of the problem, its epidemiology, and in designing preventive measures.