Protein-energy interactions in the management of severe malnutrition.

The three syndromes of childhood malnutrition are contrasted with respect to protein. It is concluded that stunting and wasting are the outcomes of protein deficiency, and that kwashiorkor is not due to protein deficiency, rather it is related to unopposed oxidant stress. Formula for the energy and protein requirements are derived and contour plots of the amounts needed to sustain high rates of weight gain at different body compositions generated. It is suggested that all nutrients be expressed with energy as the denominator. No more than 12.5% of protein energy is required to sustain maximum likely rates of weight gain. Using this approach to design a diet, high rates of weight gain are achieved under field conditions in refugee camps.