Assessment of Marginal Malnutrition

Abstract

MANY tests have been proposed for the early detection of protein–calorie malnutrition (PCM) of early childhood; the latest is based on morphological changes in the root of the hair from the head¹. The tests may be classed as biochemical (for example, amino-acid ratio in plasma², serum transferrin³, hydroxyproline excretion in urine⁴, urinary creatinine/height ratio⁵, urinary urea/creatinine ratio⁶); anthropometric (a single measurement like weight, mid-arm circumference, or a ratio—chest/head circumference, weight/height, weight/head circumference⁷); or miscellaneous (buccal mucosal changes⁸, auricular cartilage elasticity⁹ or hair root morphology¹). Tests on young children, frequently of uncertain age, pose practical problems. Ideally, any biochemical test should require only a small (capillary) sample of blood or “spot” sample of urine and a minimum of equipment and skilled personnel. Other variables often influence the results of these tests; for example, infections and infestations, age, time and nature of meal before test^10–12 and for the blood tests the degree and type of PCM (refs. 3, 13). Anthropometry has the advantage of being easy to perform, rousing no antagonism and requiring only simple apparatus. But all of the measurements proposed hitherto are to some extent age-dependent. Mid-arm circumference is least affected, because it changes only slightly between 1 and 4 years⁷. Weighing requires a relatively expensive and delicate piece of apparatus that is often used incorrectly by junior personnel.