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Classification of Protein-Energy Malnutrition in Industrialized Countries-Reply

Am J Dis Child. 1986;140(9):852-853. doi:10.1001/archpedi.1986.02140230022010.
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In Reply.—We are delighted that our report on malnutrition1 has provoked discussion on this important and underdiscussed problem. We believe that Boland and Patrick's reaction to the definition of kwashiorkor in our report arises from the fact that the patients we described were atypically young when compared with most of the cases of malnutrition in the literature. Our decision to include hypoalbuminemia as equivalent to edema was based on observations made on severely malnourished children in the Warsaw Ghetto during World War II ("hunger disease").2 Edema was rarely evident in these children prior to 2 years of age. As our goal was to identify all children under 18 months of age with severe malnutrition, this expanded use of the Wellcome Trust definitions was employed.3 It may be that in this age group pure kwashiorkor simply does not occur, but that linear catchup growth does. These are


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