Protein versus energy in protein energy malnutrition.

The balance of evidence indicates that protein deficiency is more constant than energy deficiency in cases of kwashiorkor. I suggest that well-conducted dietary histories with early home visits would confirm this in South African cases. In areas and groups from which kwashiorkor patients come, a pre-kwashiorkor state has to be detected by laboratory tests, e.g. plasma albumin measurement. Simple anthropometric measurements are not enough. Strategies for prevention must depend on local attitudes and resources, but throughout the world enthusiasm for protein-rich vegetable mixtures has waned. Selective provision of milk powder for sick children in clinics may be a cost-effective measure.