The cost to developing countries, for current and future generations, of not eradicating hunger and poverty - in terms of recurrent conflicts and emergencies, widening inequalities, depleted resources, ill health, and premature death - is enormous. Although strategies are underway to address certain problems in Africa and the Middle East, much remains to be done. Breaking the poverty cycle in these regions demands both local and international attention. Nutrition transition is a key factor, since many countries in the region also suffer the consequences of the excessive and unbalanced diets that are typical of developed countries. This paper reviews the experiences with facing malnutrition in Sub-Saharan and North Africa and the Middle East.

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The effects of restricting protein intake on plasma insulin were studied in pregnant pigs, fetuses and the developing offspring. Pregnant pigs were fed diets containing 18%, 3% or 0.5% protein throughout the gestation period. At 10, 13 and 15 weeks of gestation, fetuses were removed from the uterus after bleeding the dam. Plasma samples were used for insulin determination by a radioimmunoassay procedure. At week 15 of gestation, plasma insulin levels were significantly higher in pregnant pigs fed 18% protein and also in their fetuses than in the other two groups. There was a high correlation between fetal insulin level and fetal growth rate (r = 0.84). Two-day-pld pigs from another set of pregnant pigs fed the diet containing 18%, 3%, or 0.5% protein during gestation were cross-fostered to control nursing dams and weaned at 4 weeks of age to a standard diet. Plasma smaples obtained at regular intervals were used for insulin determination. Offspring of pigs fed 0.5% protein during gestation had consistently low insulin levels in postnatal life in spite of cross-fostering and standard feeding after weaning. It appears that one of the stimuli which control maternal insulin secretion and placenta transfer is the maternal protein intake while severe maternal protein restriction might contribute to the low levels of insulin in the progeny during postnatal life.

The effects of low protein diets on plasma growth hormone were studied in pregnant pigs, fetuses and the developing progeny. Pregnant pigs were fed 18%, 3% or 0.5% protein diet throughout the gestation period. At 10, 13 and 15 week of gestation, fetuses were removed from the uterus after the dam had been bled to death. Plasma samples were used for growth hormone determinations. In a second experiment, 2-day old pigs from another set of pregnant pigs fed the diet containing 18%, 3% or 0.5% protein during gestation were cross-fostered to control nursing dams and weaned at 4 weeks of age to a standard diet. Plasma obtained at regular intervals was used for growth hormone determination. Plasma growth hormone was significantly higher in dams fed 0.5% protein after week 13 of gestation. High growth hormone (ten times the dam GH level) was observed in all fetuses irrespective of maternal dietary manipulation. Offspring of severely protein deprived pits (0.5% protein) had significantly elevated growth hormone levels up to 12 weeks of age in spite of cross fostering to a control dam after birth. The data suggest that there is little or no effect of maternal protein restriction on fetal growth hormone levels but the persistent high growth hormone levels in the progeny of severely malnourished pigs indicate a possible impairment of the production, release or catabolism of growth hormone and/or its releasing factor.

A short-term N balance study was conducted in twelve healthy female adults aged 21-32 years to determine their protein requirement. Four dietary protein levels (0.3,0.4,0.5 and 0.6 g protein/kg per d) were used. Energy intake of the subjects was kept constant at 0.18 MJ/kg per d. All subjects maintained their normal activity throughout the study period. N excretion was determined from the measurements of N in a total collection of urine, faeces, sweat and menstrual fluid for each dietary period. N balance during the four protein levels were -15.15 ( There have been various reports of studies on human protein requirements for over a century (Munro, 1985) but the area is still under active investigation as new concepts and more information become available especially from developing countries. More recently attention has focused on protein requirements under conditions prevailing in developing countries where there are cultural, environmental, as well as dietary differences from developed or industrialized countries (United Nations University World Hunger Programme, 1979 ; Food and Agriculture Organization/World Health Organization/ United Nations University (FAO/WHO/UNU), 1985.The database from developing countries for setting recommended allowances for protein is increasing but, still, they are mostly based on studies of adult males. There is less extensive information available for adult females. The recent FAO/WHO/UNU (1985) Consultative Group had to depend on the conclusion of the Food and Agriculture Organization/World Health Organization (1 973) Expert Group, for values for the obligatory N losses of women (Bodwell et al. 1979) and results of Calloway & Kurzer (1982) based on N balance studies. The conclusion was reached that there was no justification for making a distinction between adult males and females when setting a safe intake of protein. Accordingly, the safe intake of good-quality, highly digestible protein was set at 0.75 g/kg per d for both sexes. There is the need to have more information on women so as to provide more material for future consultative groups on protein requirements.

1. The present study was carried out to estimate precisely, via the nitrogen balance technique, the protein requirement of Nigerians (earlier estimated via the obligatory N method) using graded levels of protein intake.2. Fifteen medical students of the University of Ibadan who volunteered to participate in the study were given graded levels of protein (0.3,0.45,0.6 and 075 g/kg body-weight per d) derived from foods similar to those usually consumed by the subjects.3. Each subject was given each of the dietary protein levels for a period of 10 d. Subjects were divided into two groups and the feeding pattern followed a criss-cross design with one group starting with the highest level of protein intake (0.75 g) and the second group starting with the lowest level of protein intake (03 g). Mean energy intake during each of the eleven experimental periods was maintained at 0 2 MJ/kg per d. After an initial 5 d adaptation period in each experimental period, 24 h urine and faecal samples were collected in marked containers for five consecutive days for N determination.4. Mean N balance during consumption of the four protein levels (030,045,06 and 075 g/kg) were -11.02 (SD 8.07), -990 (SD 6 9 , +9.70 (SD 4.15) and +513 (SD 4.62) respectively. Using regression analysis, the mean daily N requirement was estimated at 110.25 mg N/kg body-weight (0.69 g protein/kg body-weight). Estimates of allowances for individual variations to cover 97.5 % of the population adjusted this value to 0.75 g protein/kg body-weight. Net protein utilization for the diet at maintenance level was estimated at 57.5.The available internationally accepted information on protein requirements is based on premises not related to the physical biological and social factors unique to the Nigerian environment. The frequently cited minimum physiological nutrient requirement (the amount that is consistent with optimal health and above which no further improvement in health occurs) is at best a statistical approximation and usually derived from studies of privileged healthy Caucasians living under protected conditions.The often-quoted studies of Nicol & Phillips (1976) in Nigeria suggested that there may be adaptive changes in protein requirements in chronically undernourished Nigerians. These studies, conducted in the late 1950s, showed that Nigerian males were in positive nitrogen balance during short-term periods on a rice-protein intake of 0.44 g/kg body-weight per d. Ever since the study by Nicol & Phillips (1976) relatively few studies have been made in Nigeria in this interesting area of nutrient requirement, which for several reasons requires further examination. In a recent study by Atinmo et al. (1985), protein requirements of healthy Nigerian males were estimated, via the obligatory N loss method, to be 0.75 g/kg per d. Compared with the recommended value of 0.57 g/kg per d proposed by the Joint FAO/WHO ad hoc Expert Committee on Energy and Protein Requirements (World Health Organization, 1973) this level of requirement is quite high.The obligator...