An inadequate supply of macronutrients and micro-nutrients (protein, fat, carbohydrates, and vitamins and minerals) results in protein-energy malnutrition (PEM), the most common form of malnutrition, especially among infants and young children. There are two types of growth failure associated with PEM: wasting (acute malnutrition) and stunting (chronic malnutrition). Wasted individuals (children, adolescents, or adults) are extremely thin, whereas stunted individuals are short for their age as a result of impaired growth during childhood. Severe PEM has a high case fatality rate and is often classified into two forms: marasmus and kwashiorkor. Both are identifiable by severe weight loss; however, the oedema associated with kwashiorkor can mask the otherwise dramatic skeletal appearance of marasmic individuals (Table 1).
Nutritional issues among refugees vary greatly from one region of the world to another. Rates of wasting, defined as weight for height less than —2 standard deviations of the reference population, have been as high as 50% in the Horn of Africa and as low as 5% in Southeast Asia, Malawi, and the Persian Gulf. Mortality rates in some of these populations during the acute phase of displacement have been extremely high—up to 60 times the expected rates.
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