WHAT IS MALNUTRITION ?
By OUR MEDICAL CORRESPONDENT
THE question of malnutrition in this country—as apart from the wider and much more complex problem in this respect in India and some of the Crown Colonies—has recently received much public attention ; and many rather divergent statements have been made about its existence and extent. It is therefore well, in considering the subject, to attempt some definition of the word. In the strictest sense, it would probably be true to say that a child was suffering from malnutrition whose health and growth were being im- paired as the result of some definite food factor—a lack of the right sort of foods in the right proportions, an excess of some particular sort of food or foods, or some inherent defect of digestion or absorption, whereby the foods taken are pre- vented from adequately fulfilling their purpose. An adult could be said to be suffering from malnutrition if his or her health or working capacity was impaired from the same causes. Thus defined, many wealthy as well as many per- sons of moderate or small means could be said to be suffer- ing from malnutrition. Obesity no less than emaciation could be a true expression of it.
The word is probably, however, most commonly used, and most commonly understood, as meaning a condition of sub- normal health or development due to a lack of enough of the right sorts of food, or, in other words, a condition of starvation or semi-starvation. And according to some estimates there are many hundreds of thousands or even millions of people in this country who are, in this sense, suffering from malnutri- tion. These very large estimates are usually based rather on inference than actual personal observation—the line of reasoning being that an adequate daily or weekly amount of the right sorts of food, according to present-day scientific standards and at present prices, costs a known amount of money ; and that, if an individual or family income does not admit of this expenditure, malnutrition must be the logical consequence. The incomes received, or stated to be received, by large numbers of families are then recorded with other data ; and the estimates of the numbers of sufferers from malnutrition are based on an analysis of the results.
If we do now in fact know the last word about food- values, and if we did in fact know the real exact income of the families canvassed and how it was spent, and if proper allowances were made for the age and occupational energy demands of each of the individuals concerned, this would, of course, be a very strong line of argument ; and, even as it is, it may to a certain extent be valid_ But, on the other hand, actual observation, especially in respect of the younger population, cannot be said to have revealed, except possibly in certain depressed or temporarily depressed areas, any very marked degree of general malnutrition.
It must be admitted, however, that the assessment of degrees of nutrition and malnutrition is by no means an easy matter. As regards children and young people, a commonly applied standard is that of stature, of comparative heights and weights at specified ages. But such a standard, though giving a certain amount of valuable information, cannot be said to be final. Both in children and adults there is a family and racial factor in stature apart altogether from diet and nutrition ; and a thin, wiry boy or girl may be just as healthy and innocent of malnutrition as a taller and heavier boy or girl.
Nevertheless, when it comes to averages, to the com- parison of large groups with one another, it would be diffi- cult to deny the relationship between adequate and proper food and height and weight. And from this point of view— and again especially in respect of the younger generation— most of the figures go to show, where such records exist and can be tested, a very considerable increase in average height and weight, at the same age, in the children and young people of today as compared with similar groups of thirty or sixty years ago. And this is probably true of all classes in the community. In the Eton of Praed, in the early eighteen- hundreds, a boy of five-foot-ten was sufficiently rare as to be worth remarking. That is certainly not the case today. And in any thousand contemporary public schoolboys, as in any thousand so-called working-class boys of eighteen years of age, there would almost certainly be found a far greater proportion of six-foot and eleven-stone boys than in equi- valent groups of the last and preceding generations.
Making every allowance for all other possible factors, this could hardly have come about if there had been a decline in national nutrition ; and indeed most of the comparative stature evidence at our disposal would seem to indicate that, relatively at any rate, there has in fact been a very marked improvement in this respect. The steady drop in the in- cidence and mortality rate of pulmonary tuberculosis—a disease largely conditioned by defective nutrition—would also appear to be confirmatory presumptive evidence of this.
It is justifiable, therefore, to be on guard against a too sweeping and too pessimistic view of the amount of national malnutrition. But that is not to advocate complacence. It has to be remembered that there is no absolute standard in this matter. We do not yet know what the right sort of food, in the right amounts, available for all the people in these islands, is still capable of achieving in terms of health, stature, and energy. And it is certainly the case that there are many thousands of children and adults amongst us who would be finer, more energetic, happier, and more beautiful human specimens if they had more and better—and it may be added better prepared—food at their disposal than they have at present. And whatever the means, social, financial, and educational, taken to achieve this end, there can be no doubt that the result would be a national investment of the highest order.
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