Nutritional disorders are not limited to the severe cases of malnutrition seen in developing countries. Children with varying degrees of malnutrition are seen in both the outpatient and hospital setting in industrialized nations. In a recent survey in a large children's hospital in the United States, the prevalence of acute protein-energy malnutrition (PEM) was 24.5% (1.3% severe, 5.8% moderate, and 17.4% mild) and the prevalence of chronic PEM was 27.3% (5.1% severe, 7.7% moderate, and 14.5% mild).<sup>24 Hendricks K.M., Duggan C., Gallagher L. , e al. Malnutrition in hospitalized pediatric patients Arch Pediatr Adolesc Med 1995 ;  149 : 1118

Cliccare qui per andare alla sezione Riferimenti</sup> Poor growth can be seen in 10% of the rural population.<sup>11 Bithoney W.G., Dubowitz H., Egan H. Failure to thrive/growth deficiency Pediatr Rev 1992 ;  13 : 453

Cliccare qui per andare alla sezione Riferimenti</sup>

The signs and symptoms of severe nutritional disorders are readily recognized. Milder nutritional deficiencies may be more difficult to identify. Many of the signs are nonspecific and may be due to a combination of nutrient deficiencies. The physical examination can provide clues to the existence of a deficiency (Table 1). To identify further the specific nutrient(s) involved, however, the physical findings must be viewed in the context of the diet history, associated symptoms, and laboratory findings. Therefore, although this discussion focuses primarily on the physical findings of specific nutrient deficiencies, pertinent symptoms and laboratory findings are mentioned.