801 



state, the amount of nitrogen excreted by an adult equals the amount 

 of liis intake. But during acute or chronic infectious states the indi- 

 vidual suffers a negative nitrogen balance, exhausting protein faster 

 than he can take it in, even with a thoroughly adequate diet. If the 

 diet is inadequate, so often the case in the LDCs, an individual may 

 never achieve a nitrogen balance. His diet will never satisfy his re- 

 quirement for protein, and indeed, the gap between requirement and in- 

 take will continue to enlarge. 



The various yardsticks suggested by different governments, inter- 

 national organizations, and private groups appear to be predicated on 

 the good health of the population in the LDCs. It would seem impor- 

 tant to take some approximate account of the impact of disease as 

 it affects these standards. For example, respiratory tuberculosis in- 

 creases basic requirements about 20 percent, while malaria and dysen- 

 tery, in their acute stages, increase metabolic requirements 20 to 40 

 percent. In addition, worms and other parasites reduce the caloric 

 efficiency of ingested foods, and use up small amounts of iron and 

 protein. In the case of malaria and yaws, a drain of calories and pro- 

 tein is accompanied by a distinctive side effect : Highest incidence of 

 these diseases occurs during the planting season : agricultural workers 

 suffering one of these ailments may miss a planting (or harvesting) 

 season.^^ An epidemic of either disease can thus seriously deplete the 

 food supplies of the country or region in which it occurs. 



Protein deficiencies are reported to do permanent damage, especially 

 to small children. It has long been known that they contribute to 

 dwarfing or delayed physical maturity, even if an original insuffi- 

 ciency had been overcome. Now it appears that protein deficiency in 

 infancy or early childhood can result in permanent brain damage. 

 Furthermore, studies in Central and South America have found a 

 strong correlation between nutritional levels and physical and mental 

 development in preschool and school-age children. In Santiago, Chile, 

 a comparison was made of two groups of slum children and a group 

 of middle-class children. One group of slum children was put on a sup- 

 plemented diet, and received medical care. This group soon resem- 

 bled the middle-class group both in physical and mental development, 

 although apart from the food, the environment of the two groups of 

 slum children was very similar. "Of the malnourished children, only 

 51 percent reached the normal range of development, compared with 

 95 percent of the supplemented group and 97 percent of the middle 

 class group." '' In another study, a group of children who had had 

 marasmus (often defined as protein and calorie deficiency) as infants, 

 and then had been given medical care and supplemental food, were all 

 found to have an intelligence level considerably below normal 3 to 

 6 years later. Finally, although the results of animal studies can be 

 applied to hmnans only with considerable caution, studies on rats 

 suggest that malnourished mothers may produce children whose brain 

 development is impaired. 



Accordingly, the higher the incidence of disease, the more difficult 

 the task of the developing country seeking to provide its people with 



" This subsection down to this point is based on the remarks of Dr. Herbert Pollack at the 

 "Sympoeium on the Food/People Balance." sponsored by the National Academy of Engineer- 

 InK. April 29, 1970, and pages 3 and 4 of the summary report of its Panel on World Nutri- 

 tional Resources. 



•» Ehrllch and Bhrlich. "Population, Resources, Environment," op. cit., page 77. 



