Malnutrition and dietary protein: evidence from China and from international comparisons.

Malnutrition, as measured by anthropometric status, is a powerful risk factor for illness and elevated death rates throughout life. Understanding the relative importance of disease, dietary quantity, and dietary quality in causing malnutrition is therefore of major importance in the design of public policy. This paper contributes to the understanding of the relative importance of quantity and quality of diet by utilizing aggregate data to complement previously reported individual-level studies. Three compilations of anthropometric data--one involving subjects from 13 provinces in China, another involving subjects from 64 counties in China, and a third involving 41 populations in 40 countries--are used to examine the relative importance for human growth of inadequacies of dietary energy and protein. The analysis involves regressing average adult heights and weights against estimates of average energy and protein availability (by province, county, or country) and per capita incomes. We use protein availability in part as a marker for overall quality of the diet, while recognizing that protein is far from perfectly correlated with dietary fat or micronutrient availability. The paper discusses issues of both data quality and statistical methodology, and points to relevant resulting caveats to our conclusions. Subject to these limitations, all three analyses suggest that, at the levels of dietary intake in these populations, lower protein intake is related to growth failure whereas lower levels of energy availability are not. The protein effect appears stronger for males than for females.