Assessment of the nutritional status of the community.

A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with oedematous malnutrition. A likely cause of this continuing high mortality is faulty case-management. A survey of treatment centres worldwide (n = 79) showed that for acutely ill children, inappropriate diets that are high in protein, energy and sodium and low in micronutrients are commonplace. Practices that could have fatal consequences, such as prescribing diuretics for oedema, were found to be widespread. Evidence of outmoded and conflicting teaching manuals also emerged. Since low mortality levels from malnutrition can be achieved using appropriate treatment regimens, updated treatment guidelines, which are practical and prescriptive rather than descriptive, need to be implemented as part of a comprehensive training programme.

Why have mortality rates for severe malnutrition remained so high

In less developed countries protein-calorie malnutrition of early childhood is widespread. Severe syndromes such as kwashiorkor and marasmus are found in 1-7% of young children in some populations. Many more are affected by less severe manifestations. It has been estimated that there are 10-20 million young children with severe syndromes most of whom will die without treatment. Conversely infantile obesity is becoming a problem in more affluent populations. Recently the pattern of malnutrition has altered in many developing countries due to urbanization and a decline in breast-feeding. Nutritional marasmus with diarrhea in the 1st year of life is more common. Human milk as compared with cows milk contains a more abundant supply of nutriments most needed for the rapid growth and development of the central nervous system. Much illness in early childhood is related to infection which occurs more easily in those with malnutrition and aggravates that condition. Breast-feeding is known to have a contraceptive effect. Appropriate child spacing is thus aided. Human milk must be considered a resource priority in national development policy and in international planning for health. As an emergency measure in famine relief attention should be given to providing food for lactating women rather than to distributing formulas.

https://science.sciencemag.org/content/sci/188/4188/556.full.pdf

Human Milk, Nutrition, and the World Resource Crisis

A Short History of Nutritional Science: Part 4 (1945–1985)

Lactation, conception, and the nutrition of the nursing mother and child

Together with the changing environment (urbanisatior of the rural population, industrialization, loss of taditional pattern of life), malnutrition in the young will probably change from the pre‐school kwashiorkor‐type to the infant marasmus‐type. Because of the complex nature of the factors conditioning this change, purely nutritional measures cannot be expected to cope with infant malnutrition as it is seen today in the fast‐growing urban agglomerations of the economically underdeveloped countries. Early malnutrition carries the risk of permanent physical and mental damage. If it is not prevented, affected populations could have a greater impairment of their physical and mental capabilities which could prove to be an unsurmountable obstacle to the progress of the developing nations.

The changing pattern of malnutrition

Summary

The effect of enrichment of bread with lysine was studied on a group of Iranian village children receiving free school lunch over a period of 210 days. Two groups received typical dishes, which were purposely modified to make them limited by lysine; one with enriched and the other with non-enriched bread. The third group did not receive lunch and served as control to assess the changes in the nutritional status of the former groups. The food intake at the homes was not controlled.



Markedly greater increases in weight and mid-arm circumference were observed in groups which received the school lunch (with or without lysine) than in the control group. Lysine enrichment showed no significant effect in improving the nutritional status except that children who received the amino acid supplementation exhibited significantly higher increments in mid-arm circumferences. An increment in height and weight was observed in children of non-lysine group over those who received lysine which was significant in respect to height. The latter group also showed a small but significant decrease in serum albumin.

The effect of lysine fortification of iranian bread on the nutritional status of school children

Dehydration syndrome in malnourished Iranian children.

The ratios of non‐essential to essential amino acids (spots 1/7, 5 and 3/7) in the plasma of 22 children on normal diets, 16 marasmic children, and 6 children suffering from kwashiorkor were determined by the method of Whitehead. The ratios in both types of malnourished children were significantly different from the children on normal diets. The same ratios were also studied in red cell hemolysates using the method of Bjornesjo with similar results. The absolute values of the different spots in plasma and in the hemolysates were determined. A very significant increase in the concentration of the amino acids in the red cells of the malnourished children was evident. The increase was especially notable in the glycine. The ratio of distribution of amino acids between erythrocytes and plasma was significantly higher in the malnourished children.

G. Donoso

Papers

The changing pattern of malnutrition

The effect of lysine fortification of iranian bread on the nutritional status of school children

Dehydration syndrome in malnourished Iranian children.

Amino acid patterns in plasma and erythrocytes in Iranian children on normal diets and malnourished cases

Protein food mixture for Iran. Acceptability and tolerance in infants and preschool children.