DISCUSSION 
of underfeeding, a seasonal shortage only, might reduce the 
figure of 10-15 per cent who are thought to get too few calories 
throughout the year. 
With regard to protein—a subject which has interested me 
from a paediatric point of view in the tropics—so far as I can 
see the question of whether 50 per cent of the world is poorly 
fed still turns basically on the larger figure of 30-40 per cent 
for protein malnutrition. The evidence very largely hinges on 
the fact that children in the underdeveloped areas do not grow 
as fast as they would if you improved their diet or as fast as 
their counterparts, the coloured people in the United States, 
grow. Secondly, the serum proteins in their blood show quite 
abnormal figures which are altered by improving the diet. 
Thirdly, from a very young age after weaning, the liver structure 
shows an abnormality in the opinion of practically all the best 
pathologists who have examined the question. That is to say, 
the majority of cases show an increase of cells and reticulin 
structure about the portal tracts in the liver. We have also got 
to remember that on what might be called the under-developed 
type of nutrition as seen in Africa certain diseases are rare, but 
others are common. Two of the relatively common conditions 
found in Africa are endomyocardial fibrosis, rarely seen in 
advanced countries, and periportal fibrosis of the liver and 
perhaps also primary cancer of the liver. On the other hand 
some diseases which are very common among those who eat 
high-grade diets are rare in underdeveloped countries. Thus 
coronary heart disorders, vascular disease of the brain, gall- 
stones, rheumatoid arthritis, osteitis deformans and disseminated 
sclerosis are rare in Africans in Africa, but not among their 
better-fed cousins in the United States. There has always been 
a tendency to set nutritional standards high, to fear deficiency 
and to discount excess. But we still lack satisfactory longitudinal 
studies in man of the end results of diet. I fear that we are giving 
our own European and American children too much; at the 
same time we are exaggerating the figure of 30-40 per cent for 
protein malnutrition in the world. At a guess I would halve 
this figure. 
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