Dietary Factors in Malnutrition: Quality and quantity of Diet in Relation to Child Development

Introduction: food as a factor in malnutrition s y n d 7 m s Until some 45 years ago the origin was obscure of the childhood syndrome typically including oedema, 'flaky paint' skin rashes, dyspigmented hair and hepatomegaly.Suggested causes at that time included renal failure and multivitamin deficiency.Williams (1933) not only c d e d the syndrome kwashiorkor, the local Ghananian name for it, but established that it was cured by milk and not by vitamins.Thus a nutritional cause for kwashiorkor was claimed with a further tentative suggestion that '. . .some amino acid or protein deficiency cannot be excluded'.The view that kwashiorkor was caused specifically by protein deficiency gradually became the accepted view with little definite dietary evidence.Childhood malnutrition, which later became known as protein calorie malnutrition and more recently protein energy malnutrition (PEM), includes a range of conditions from kwashiorkor through to marasmus, in which oedema, skin and hair changes are rare and is characterized by stunting, wasting and very little subcutaneous fat.The classic dietary hypothesis held for many years was that kwashiorkor was caused by protein deficiency and marasmus by energy deficiency. Factors in the persistence of the 'low protein' theoryThe general acceptance of the 'low protein' theory as the cause of kwashiorkor was greatly enhanced by the WHO report of Brock & Autret (1952), which was based on their survey of malnutrition in Africa shortly after the war.The accepted estimates for protein requirements at that t h e ((US) National Research Council, 1974) for a I-year-old child were 13.2 net protein energy as a percentage of total energy.This level is nearly 2 .5 times the current estimates of 5.4 net protein energy as a percentage of total energy.Many traditional vegetable-based diets are protein deficient as judged by the high level of requirement, whereas very few are now reckoned to be so by the lower level.Waterlow & Payne (1975) argue this to be an important factor in the persistence of the 'low protein' theory.McLaren (1975) in his stimulating review of this topic entitled 'The great protein fiasco' also stresses the reinforcing effect of large nutrition-intervention programmes by the United Nations and other agencies, which were based on highprotein foods such as dried skim milk or on high-protein mixtures such as maize, soya and dried skim milk.In many countries large industries were developed to 0029