Adult malnutrition
Adult malnutrition Veronica Tuffrey 18.11.97
re: Adult malnutrition Beatrice L. Rogers 19.11.97
re: Adult malnutrition Veronica Tuffrey 19.11.97
re: Adult malnutrition Mike Golden 19.11.97

Date: Tue, 18 Nov 1997 18:37:00 +0100

From: "Tuffrey, Veronica (ESNP)" <>

Subject: Adult malnutrition


Dear colleagues,

We would like to ask your advice. One of us (VT) is developing guidelines at FAO for integrating household food security and nutrition into relief and rehabilitation, and the other (AZ) is about to go to Burundi as a consultant for UNICEF to help coordinate nutritional activities.

Please could you let us know what is the latest thinking, and if there are any references, about field methods of assessment of adult malnutrition, and protocols for adult therapeutic feeding.

We realise this is a big topic, but it seems there is very little practical guidance which has been published, and so would appreciate your input.

Thanks in advance,


Veronica Tuffrey

Adriana Zarrelli

Date: Tue, 18 Nov 97 12:46:01 EST

From: "Beatrice L. Rogers" <>

Subject: re: Adult malnutrition


I am interested that your introductory remark has to do with household food security, but your question has to do with therapeutic feeding and assessment of malnutrition.

Household food security is related to access to food (actually, according to the dogma: availability, access, and utilization), right? Assessing it would require a whole different set of questions from the assessment of current nutritional status and the need for nutritional rehabilitation---such a question would have more to do with food provisioning, distribution, access to outside markets; security of supplies inside the home; availability of resources to produce, purchase, or barter for food; ability to earn or obtain money or other trading material.

Anyway, that's my off the cuff reaction.

Date: Wed, 19 Nov 1997 12:32:00 +0100

From: "Tuffrey, Veronica (ESNP)" <>

Subject: re: Adult malnutrition


Thanks to Beatrice Rogers, for her feedback.

Actually in the guidelines we are trying to prepare for FAO we are trying to get away from thinking about household food security in isolation, in order to move towards ways to addresss household food security and nutrition in an integrated way. Simply looking at availability of food in the household and constraints on this, will leave out the other important influences on nutritional status i.e. what happens within the household (how this food is selected, prepared, and divided up between the individual household members) and the health of the family members (influencing their nutritional requirements, appetite, and wastage of nutrients through non-absorbtion.)

Assessment of current nutritional status is surely a necessary input into building up a picture of the nutrition and food security situation as a whole, together with all the other factors you mentioned, and those to do with access to means to prepare the food (e.g. fuelwood, utensils), caring practices and many others. Nutritional rehabilitation is just one of the activities which may be appropriate depending on the findings of the assessment.

If Beatrice or anyone else reading this has material which could be used as case studies about integrating nutritional and food security information in assessment, please let us know.

Many thanks.

Veronica Tuffrey

Date: Wed, 19 Nov 1997 10:07:19 +0000

From: Michael Golden <>

Subject: Re: Adult malnutrition


Dear Veronica,

The management of adult malnutrition is the same as for childhood malnutrition in terms of correcting the underlying pathology, the phases, the products used etc. Indeed, adults can be very successfully managed with the milk/oil/sugar/mineral/vitamin diets used for children only! The differences are that their maintenance requirements are less per kilo so that in the initial stages less should be offered (or given by ng tube).

They also have a strong psychological need for recognizable solid food, so that this is usually introduced earlier along with the milk based diet - but should be taken AFTER they have consumed the standard liquid therapeutic diet. They also have a much higher defaulting rate than children - usually because their families "require" them to return home as soon as they look as if they are getting better.

Adult malnutrition is covered in

"Golden MH. Severe Malnutrition. In: Weatherall DJ, Ledington JGG, Warrell DA, eds. Oxford Textbook of Medicine, 3rd ed. Oxford: Oxford University Press, 1996: 1278-1296." which you might find useful.

For use in Francophone countries this chapter has been translated into French by André Briend and published as:

"Briend A, Golden MH. Malnutrition sévère de l'enfant. In: Encyclopedie Medico Chirurgicale, Endocrinologie et Nutrition, Paris: Elesvier, 1997: 10-377-A10-10-377-A20."

Adult malnutritin is also covered in the pending (when?) manual that WHO promises - however both contain more or less the same information.

The formulae in the publications for deriving height from demi-span (sternal notch to finger tip) were derived from a caucasian population and have not been validated for other populations.

Best wishes,


Prof. Michael H.N.Golden