ABSTRACT. The accuracy of identifying children with growth failure and/or clinically severe protein‐energy malnutrition (PEM) from a single measure of length or weight for age from birth to 36 months was determined. Growth data were treated cross‐sectionally and compared with National Center for Health Statistics growth standards in order to determine the sensitivity, specificity and positive predictive value of a single cross‐sectional measure of weight‐for‐age or length‐for‐age in identifying children diagnosed via longitudinal records. Under 6 months of age, neither weight nor length for age was an adequate predictor of growth failure or clinical malnutrition; from 12 to 36 months, screening measures based on anthropometry were much improved. It was concluded that a single measure of weight or length for age taken close to the first birthday could identify up to 78% of the future second and third year cases of clinically severe PEM. Implications and limitations are discussed.

The effects of severe protein-energy malnutrition (PEM) upon the growth of children was studied in a 13-month cohort. The serial records of 19 PEM children from the cohort were compared to those of cohort children with the same growth history (either failing or non-failing growth), but without severe PEM. When the comparison was made on the basis of age, no differences in growth were found except for arm muscle circumference at one age. Using Z-scores, comparisons were also made according to months before or after the diagnosis of PEM. When compared to children with the same growth history, PEM children showed short-term differences in weight and arm muscle circumference and a mild retardation in growth in length which was not significant. Any growth effects following the episode of severe PEM were accounted for by growth status preceding its onset.

A total of 72 of 276 children from a rural Mexican village were chronically undernourished as judged by their growth failure between 6 and 36 months of age. Fourteen of the 72 and five of the remaining 204 children developed clinically severe protein-energy malnutrition (PEM) as judged by clinical signs other than weight or length. This amounted to an 8-fold higher prevalence of PEM in the group of children with growth failure. When children were grouped into quartiles of length at 6 months by sex, quartile was not related to the subsequent occurrence of PEM or to the age when PEM developed. However, analysis indicated that the growth of children with PEM and growth failure had slowed relative to their quartiles before PEM developed; they were also retarded according to the Harvard standards. The children with PEM were then compared to others with a similar growth history (growth failure, no growth failure) who never developed PEM. PEM children did not differ significantly in over weight or length and displayed a significant difference in upper arm muscle circumference at only one age. The 14 with growth failure and PEM had poorer overall growth, including arm muscle circumference, than the five with PEM and no growth failure.

At the community level, malnutrition--more specifically protein-calorie malnutrition--is a man-made disorder characteristic of the lower socioeconomic segments of society, particularly of the preindustrial societies, where the social system consciously or unconsciously creates malnourished individuals, generation after generation, through a series of social mechanisms among which limited access to goods and services, limited social mobility, and restricted experiential opportunities at crucial points in life play a major role.

There has been a tendency to consider that, in situations in which food provision for infants and young children is marginal, intrinsically larger infants would presumably have higher nutritional requirements and are, therefore, at greater risk for the development of severe malnutrition.1 From the public health point of view, an analysis of the relation between size at birth and the subsequent occurrence of severe malnutrition in early childhood is important. If size at birth helps to define the likelihood with which a child would develop severe malnutrition during infancy and the preschool years, such knowledge would be valuable in identifying children at risk and, potentially, for prevention.

Although interest in the possible harm of malnutrition on mental function in humans had received sporadic attention in several countries since the 1920s, the value of systematic investigation belongs to the present decade.1-4One of the main reasons for the apparent lack of interest in the past probably arises from awareness that infant malnutrition as it is commonly encountered is invariably associated with other factors that are in themselves capable of delaying or arresting mental growth and development. Since most of the individuals susceptible to malnutrition belong to the underprivileged segments of society, it was believed that differences in mental performance between well-nourished and malnourished subjects were an expression of social class. Although it was recognized that behavioral disturbances were prominent features of malnutrition, and during the development of chronic malnutrition from the mild-moderate to the severe forms failure to re