Waterlow J C
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Clin Nutr. 1997 Mar;16 Suppl 1:3-9. doi: 10.1016/s0261-5614(97)80043-x.
The paper begins by describing how the names 'protein malnutrition' and 'protein-energy malnutrition' (PEM) developed from the local name 'Kwashiorkor'. The central feature of severe PEM is oedema; the classical theory suggests that the cause is a deficiency of protein, but other factors are also involved. In the community mild-moderate PEM is defined by deficits in growth. A distinction has to be made between low weight for height (wasting) and low height for age (stunting), Stunting in particular affects some 50% of children worldwide. Its causes and consequences are briefly discussed. In adults, severe PEM has essentially the same features as in children and includes the condition'famine oedema' or 'hunger oedema'; there are again controversies about its cause. In the community, chronic malnutrition is assessed by the body mass index (BMI) (Wt/Ht(2)). Grades of deficiency have been defined and examples are given of functional consequences of a low BMI. Secondary malnutrition differs from primary PEM because of the role played by cytokines and other concomitants of illness or injury. The importance is emphasized of chronicity or duration in determining the clinical picture.
本文开篇描述了“蛋白质营养不良”和“蛋白质 - 能量营养不良”（PEM）这两个名称是如何从当地名称“夸休可尔症”演变而来的。严重PEM的核心特征是水肿；经典理论认为其病因是蛋白质缺乏，但其他因素也有涉及。在社区中，轻度至中度PEM通过生长发育缺陷来定义。必须区分身高别体重低（消瘦）和年龄别身高低（发育迟缓），发育迟缓尤其影响全球约50%的儿童。文中简要讨论了其成因和后果。在成年人中，严重PEM与儿童基本具有相同的特征，包括“饥荒水肿”或“饥饿水肿”这种情况；其病因同样存在争议。在社区中，慢性营养不良通过体重指数（BMI）（体重/身高²）来评估。已经定义了缺乏等级，并给出了低BMI的功能后果示例。继发性营养不良与原发性PEM不同，因为细胞因子以及疾病或损伤的其他伴随因素起了作用。文中强调了慢性或持续时间在决定临床表现方面的重要性。
