Alternative term to PEM
Alternative term to PEM Ann Burgess 01.12.97
Re: Alternative term to PEM B.E.Golden 02.12.97
Re: Alternative term to PEM Anna Verster 03.12.97
Re[2]: Alternative term to PEM Djamil Benbouzid 03.12.97
Milk for infants/PEM Ann Burgess 19.12.97

Date: Tue, 02 Dec 1997 11:56:54 -0800

From: Ann Burgess <>

Subject: Alternative term to PEM



Can someone tell me whether an internationally agreed term to replace 'PEM' has been agreed yet? Severe malnutrition is OK for marasmus or kwash but what about the milder forms of PEM? I have, in the past, suggested 'Energy Nutrient Deficiency (END) but maybe 'general undernutrition' is better - although it is a bit of a mouthful and has no nice acronym. I'm needing this information for my contribution to a book that VSO is preparing for field workers.


Ann Burgess


Ann Burgess, Nutrition Consultant

Craiglea Cottage, Glenisla, Blairgowrie PH11 8PS, Scotland, UK

Ph: +44 1575 582218

From: barbara elaine golden <>

Subject: Re: Alternative term to PEM

Date: Tue, 2 Dec 1997 18:11:56 +0000 (GMT)


Good question, Ann! But I don't think END is the ideal alternative. I used to think 'primary undernutrition' described well the 'malnutrition' associated with poverty and being underweight.

Thus, secondary undernutrition would follow disease etc. Now, I don't think these are satisfactory terms either, one reason being that they won't catch on!

But do we really need acronyms?


Barbara G



Clinical Senior Lecturer, Child Health

From: "Verster, Dr Anna NFS" <>

Subject: RE: Alternative term to PEM

Date: Wed, 3 Dec 1997 15:39:53 +0200


I was told recently by Graeme Clugston that a lengthy discussion on the subject resulted in the decision to keep the "old" term. You can mail him at

Regards, Anna Verster


Glenisla, Blairgowrie PH11 8PS, Scotland, UK

Ph: +44 1575 582218

From: Djamil Benbouzid

Date: Wed, 3 Dec 1997 15:23:52 +0100

Subject: Re[2]: Alternative term to PEM


I am not quite sure if we really need an internationally agreed upon

term for milder forms of PEM. As you know, with Michael we decided to

replace PEM by severe malnutrition for the WHO manual. Actually since

more emphasis is given to micronutrient deficiency, PEM seems

limitative. Undernutrition might be acceptable, since children

assessed by their weight for age are classified as underweight. Not to

mention the fact that chronic (mild, moderate) energy deficiency (CED)

may be used assuming that energy comes from different sources,

including proteins.

Bon courage


Djamil Benbouzid NUT/WHO/HQ

Date: Fri, 19 Dec 1997 09:51:01 -0800

From: Ann Burgess <>

Subject: Milk for infants/PEM


Dear NGO Nuts


1. Does anyone know of any reliable scientific evidence which shows that it is essential for non-breastfed infants over the age of 6 months to have another type of milk (animal or soy) to ensure normal growth and development?


I was asked this question, which has obvious implications for the feeding of babies of HIV+ mothers, by Helen Armstrong of UNICEF and I don't know the answer. Hopefully one of you out there can help.


2. Thanks to everyone who responded to my query about the term PEM (although I note the email didn't seem to get through to several people on the network). I gather from a non-network colleague that the SCN is considering the issue but has not come to any conclusion. I was sorry to see the term used in the Press Release for the State of the World's Children.


While I agree that we, who read the international literature, know what PEM means, this is not always the case for middle or junior level health workers. I have met many who, understandably, thought the main cause of the condition was protein and advised families accordingly. This does not necessarily translate into an effective diet nor deal with the other immediate or underlying causes. Surely we need a term that gives correct information to these important frontline workers.

Merry Christmas to all



Ann Burgess, Nutrition Consultant

Craiglea Cottage, Glenisla, Blairgowrie PH11 8PS, Scotland, UK

Ph: +44 1575 582218