From Definition, To Geography, To Action, To Reaction: The Case of Protein-Energy Malnutrition

Abstract

Protein-Energy Malnutrition (PEM) illustrates the way that definitions within the health sciences may influence geographical understanding and the development of both curative and preventive interventions. When in the early 1950s medical analysts recognized that a nutritional disorder termed kwashiorkor existed among infants and young children in parts of Asia, Africa, and Latin America, they singled out protein as the key missing ingredient. The implied cause was weaning practices in tropical settings where low-protein building starchy foods prevailed, and this led to initiatives aimed at increasing protein supplies in these regions. Meanwhile, ongoing research revealed a much more complicated situation that was defined under the rubric Protein-Calorie Malnutrition (later Protein-Energy Malnutrition). First, investigators recognized marasmus as another, but discrete, nutritionally based disorder resulting from extreme caloric inadequacy. As investigators puzzled over the seemingly different etiologies and geographies of kwashiorkor and marasmus, further evidence suggested that PEM actually consisted of a multiplicity of syndromes, with causes dominated by energy deficient diets and concurrent infections set within a context of poverty. This evidence notwithstanding, the paramount concern remained the closing of the presumed “protein gap,” an effort that in the 1970s led to accusations that a “protein fiasco” had been created. Although interventions have now begun to reflect PEM's complexity, the task of specifying its geography has been complicated by reliance on controversial growth norm data. Furthermore, a fuller appreciation of PEM's true incidence may entail looking beyond infants and young children in Asia, Africa, and Latin America.

Key Words:

• diet
• infants
• kwashiorkor
• marasmus
• nutrition interventions
• poverty
• protein fiasco
• protein gap
• protein-energy malnutrition
• young children