The interrelationships between clinical diseases and malnutrition have long been recognised. Malnutrition due to starvation, disease or injury is a very common phenomenon, even in current times. Our predecessors in medicine were more familiar with clinical malnutrition than we are, since observation and physical examination played a much greater role in diagnosis in the past. Century-old textbooks provide detailed descriptions of physical changes that occur with malnutrition. Classic studies document the complex adaptations that occur in response to starvation as well as the metabolic alterations associated with stress and trauma.
The rationale that effective treatment of malnutrition may have clinical benefit has led to renewed interest in applying the tools of clinical nutrition. As such, caregivers may need to reac-
quaint themselves with the topic of clinical nutrition while investigators continue to make advances in those fields that are relevant in the current health care environment .
Malnutrition means 'badly nourished' but it is more than a measure of what we eat, or fail to eat. Clinically, malnutrition is characterised by inadequate intake of protein, energy and micronutri-ents, and by frequent infections or disease. Although often an invisible phenomenon, malnutrition casts long shadows, affecting close to 800 million people - 20% of all people in the developing world (Fig. 1) .
Although the greatest number of people worldwide are affected by iron deficiency and anaemia, protein-energy malnutrition (PEM) has by far the most lethal consequences, accounting for almost half of all premature deaths from nutrition-related diseases. Also, although trends differ (for example, iodine-deficiency disorder is rapidly declining
Fig. 1. Dimensions of malnutrition: casting long shadows of disability and death (Adapted from ). IDD, iodine-deficiency disorders; PEM, protein-energy manutrition; VAD, vitamin A deficiency; IUGR, intrauterine growth retardation while obesity is rapidly increasing), the overall dimension of malnutrition gives serious cause for concern .
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