Although over-nutrition so characteristic of obesity could be considered a type of malnutrition, such diagnosis is usually reserved for the deficiency syndromes. In all parts of the world various deficiencies of vitamins, minerals, protein, or calories can be seen.

Deficiencies are naturally more prevalent in countries where food supply is limited and poverty abounds. Careful analysis of food intake and any form of intemperance—such as manifested in alcohol consumption, bizarre food practices, food faddism, or the abuse of drugs— are productive to evaluate these conditions.

Repeated closely spaced pregnancies and psychological disturbances manifested by a change in food intake should be assessed. Chronic infection, anorexia, or diarrhea likewise may profoundly affect the nutrient balance. Measurement of height and weight should never be omitted.

These are the most commonly used measurements of growth in children and adolescents. Other body measurements include skin fold thickness, head circumference, and biochemical tests measuring blood levels of various nutrients, such as proteins, vitamins and minerals.

At times, therapeutic trials of replacement nutrients play a role in the diagnosis of deficiencies. In general, however, nutrient stores must be depleted before low blood levels of any nutrients are found. Changes in the body chemistry and functional neurologic defects occur late in the course of a deficiency.

Take a careful history for invaluable help in the initial phase of treatment. Then combine this with a high index of suspicion for various nutrient-related disorders. In spite of modern technology and transportation, there are still large areas in our world where famine is epidemic.

In fact, the risk of mass starvation in many countries is all too real, and often associated with other diseases. Body changes during the starvation reflect physiologic attempts to adapt to undernutrition. Fat stores are utilized first in order to spare structural protein. Thus, body fat diminishes more rapidly than does muscle.

Extensive losses occur later in other organs, especially the liver and intestines. Fortunately, the central nervous system and circulation maintain themselves, whatever the cost to less essential parts of the organism. The person during starvation also conserves calories by reducing his output of energy.

Voluntary physical activity decreases, as does the metabolic rate. A semi-starved patient complains of feeling tired, irritable, and depressed. He may also show lack of ambition, and narrowing of interests, then develops muscle soreness and cramps. The hair begins to fall out, and cuts and wounds heal slowly.

Cold temperatures are poorly tolerated. Ultimately, the individual looks haggard, pale, and emaciated. At times swelling (edema), particularly of the eyelids and cheeks appear, masking the degree of weight loss. The pulse weakens and the eyes become dull, looking like unglazed porcelain.

Without relief and too often alone, the hapless victim of starvation then dies on the street of some large city. The rehabilitation diet for patients recovering from starvation must begin with small quantities of the simplest food, taken at frequent intervals. A natural diet is preferable to the use of “predigested” end products.

Vitamin and protein supplementation are ordinarily unnecessary. General dietary allowances should be approximately 100% of those recommended on the basis of the patient’s “desirable” weight. Recovery from starvation, however, advances at a very slow pace.

Weakness, fatigability and muscle aches, as well as depression, may persist for weeks to months. Recovery of strength and working capacity is slow. Eventually, recovery is sure, and a life has been saved. Protein Calorie Malnutrition is another type of disorder seen in early childhood.

One such syndrome, called kwashiorkor, appears most commonly between the ages of one and three years. This tragic disorder occurs frequently in Africa in children displaced from their mother’s breast by subsequent pregnancies. Conditioning factors, such as diarrhea, parasites, and skin rash may be seen.

Edema is the principal sign. It is associated with low serum proteins. The child’s face may appear round and moon-like. The hair changes with lightening of color, straightening of curly hair, and stripes of lightened color that attest to oscillating levels of good and poor nutrition in the past.

The other major type of malnutrition is called nutritional marasmus. This compares with severe semi-starvation in adults. It most commonly affects infants during the first year of life. The most conspicuous features in marasmus are wasting of muscle and fat, with growth retardation.

Affected infants appear prematurely old, and often suffer from vitamin deficiency. Both types of malnutrition respond to a careful feeding regimen of simple foods, given first at frequent intervals, containing both adequate protein and calories.