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Health Tips

Malnutrition

International Facts on Hunger and Poverty
Bread for the World
  • More than 800 million people in the world are malnourished-777 million of them are from the developing world. And 177 million of them are children.

  • Each day in the developing world, 30,100 children die from mostly preventable and treatable causes such as diarrhea, acute respiratory infections or malaria. Malnutrition is associated with over half of those deaths.

  • Malnutrition can severely affect a child's intellectual development. Children who have stunted growth due to malnutrition score significantly lower on math and language achievement tests than do healthy children.

  • The wealthiest fifth of the world's people consume an astonishing 86 percent of all goods and services, while the poorest fifth consumes one-percent.

  • Of the 6 billion people in today's world, 1.2 billion live below $1 per day

  • 2.4 billion people lack access to basic sanitation.

  • 900 million people lack access to adequate health services.
Domestic Facts on Hunger and Poverty
  • Thirty-three million people-including 13 million children-live in households that experience hunger or the risk of hunger. This represents one in ten households in the United States (10 percent).

  • 3.1 percent of U.S. households experience hunger: they frequently skip meals or eat too little, sometimes going without food for a whole day. Nearly 8.5 million people, including 2.9 million children, live in these homes.

  • 7.3 percent of U.S. households are at risk of hunger: they have lower quality diets or must resort to seeking emergency food because they cannot always afford the food they need. 24.7 million people, including 9.9 million children, live in these homes.
Malnutrition
Human Nutrition and Dietetics, Garrow, James, Ralph [2000]
  • Malnutrition is a wide spectrum of symptoms caused by an inadequate intake of nutrients.

  • Malnutrition in children (primary malnutrition) is caused by lack of dietary energy and protein; malnutrition in adults (secondary malnutrition) may be caused by diseases or conditions that interfere with nutrient intake or their use by the body.

  • Malnutrition may involve stunting of growth, marasmus and kwashiorkor in infants and young children.

  • Treatment is based on providing an adequate and balanced diet to redress any energy, protein, vitamin or mineral deficiencies.

  • Poverty alleviation and nutrition education are essential if malnutrition is to be prevented in disadvantaged communities.
Alternative Names

Primary malnutrition in children is also referred to as marasmus, kwashiorkor or protein-energy deficiency. In secondary malnutrition, the name of specific deficiency diseases is usually linked to the nutrients that are deficient in the diet e.g. iron deficiency, protein deficiency, energy deficiency, etc.

What Causes Malnutrition?

Human beings need a wide variety of nutrients to supply essential energy, protein, vitamins and minerals to the body. If any one of these nutrients is deficient in a person's diet, then malnutrition develops.

Generally, the most serious malnutrition occurs when the diet is deficient in energy and protein. In disadvantaged communities, diets are often lacking in energy and protein, which automatically also leads to deficiencies in most of the other essential nutrients: children suffering from energy and protein malnutrition also tend to have deficiencies of iron, calcium and other vitamins and minerals.

Adults with conditions that interfere with food uptake, such as insufficient stomach acid, a common condition in older individuals, may suffer from iron, calcium or zinc deficiencies, despite the fact that their diet may contain adequate quantities of these nutrients.

Who Gets Malnutrition and Who is at Risk?

Individuals who are dependent on others for their nourishment may be at risk for primary malnutrition, namely infants, children, the elderly, prisoners and persons who are disabled or mentally ill. Primary malnutrition is particularly prevalent in poor communities such as marginalised rural villages, urban squatter camps and refugee camps.

Secondary malnutrition may occur in people whose food intake is disturbed because of poor appetite or faulty digestion, absorption or use of nutrients in the body. Practically all diseases, including tuberculosis, eating disorders, HIV/AIDS, wasting illnesses such as cancer, and many surgical procedures can interfere with appetite or food uptake and cause malnutrition.

Anyone living with HIV/AIDS has an increased risk of malnutrition. When people with HIV/AIDS who have depressed appetites, and an increased requirement for certain nutrients, including energy, are also poor and not able to afford a variety of nutritious foods, they can develop multiple-nutrient malnutrition.

Symptoms and Signs of Malnutrition
  • Marasmus

    • pronounced weight loss with loss of muscle formation, particularly on the shoulders and buttocks

    • absence of fat under the skin

    • thin, papery skin hanging in folds

    • the skin may be darker, as if the child has sunburn

    • hair loss

    • a pinched, starved facial expression, which makes young children look old and wizened

    • infants appear apathetic and may lie still for long periods without moving or crying

  • Kwashiorkor

    • discoloured, fine, brittle hair that often has a copper sheen

    • skin rash or so-called "crazy-paving dermatitis", where the skin is darker in patches with pale areas in between

    • oedema or water accumulation, making the infant appear "round and healthy", but when pressure is applied to the skin it forms dents that take a long time to disappear

    • grossly swollen tummy

    • enlarged liver

    • apathy and listlessness

  • Stunting

    The child may look normal until his or her weight and height are compared to figures in standard growth charts, or to other children of the same age who are not malnourished. It will be evident that the child is grossly underweight and undersized for his or her age. Some of the other signs and symptoms of marasmus or kwashiorkor may be present, e.g. thinning hair, skin rash, apathy.

    Vitamin and mineral malnutrition is characterised by individual signs and symptoms depending on the vitamin or mineral that is deficient; for example, iron deficiency produces anaemia, tiredness, listlessness, hair loss, etc. (Please refer to individual deficiency diseases in the A-Z of Diseases).
How is Malnutrition Diagnosed?

The doctor or clinic sister will weigh patients and measure their height and skin fold thickness for comparison with growth charts. If these simple procedures identify a child or adult who is grossly underweight or stunted, a full physical examination should be performed. The doctor or nurse will check for signs of water retention, changes in skin and hair, liver enlargement and abdominal swelling. The doctor will also take a blood sample and request a number of biochemical tests to identify protein, vitamin and mineral deficiencies.

Can Malnutrition be Prevented?

Protein-energy malnutrition can be prevented if the underlying causes of poverty, lack of food, education and hygiene can be eliminated. Even poor families can prevent malnutrition in their children by making sure that they eat the following regularly:
  • an unrefined staple food (unsifted maize meal, brown rice or brown bread, which have a much higher nutritive content than highly processed staples)

  • small quantities of protein-rich foods like eggs, meat or fish (keeping chickens or goats, or fishing, can provide protein-rich foods at low cost)

  • fresh, dried or sour milk (using skim milk powder or keeping goats or a cow)

  • fruits and vegetables (growing your own or bartering from neighbours)

  • some margarine or oil (soft margarine or sunflower oils are best).
Education plays an important role in ensuring that populations do not develop malnutrition. When funds are in short supply, it is essential that caregivers spend money on buying nutritious foods and do not waste it on alcohol, sweets, cold drinks or high-fat, high-salt snack foods. Education should also be used to help poor communities grow their own food and keep livestock.

Food aid programmes, if effectively implemented, can be used to help supply starving populations with essential foods to prevent malnutrition. The food aid that is pouring into refugee camps in Pakistan at the moment is an example of an international attempt to prevent mass malnutrition in Afghan refugees of all ages.

How is Malnutrition Treated?

Infants and children suffering from acute malnutrition, kwashiorkor or marasmus are often hospitalised and given intravenous or tube feeding. Once the child has been stabilised, he or she is fed an energy and protein-rich diet together with a vitamin and mineral supplement to try to redress nutritional imbalances.

These infants and children often recover well while in hospital, only to be discharged and returned to their original poverty-stricken environment where they quickly deteriorate and become as malnourished as before. This underlines why poverty alleviation and nutrition education are so essential in preventing malnutrition.

People suffering from malnutrition associated with various medical conditions should receive dietetic counselling and/or food or vitamin and mineral supplements. For example, people who have had part of their duodenum (upper intestine) removed should be counselled by a dietician to ensure they eat a balanced diet that is easy to absorb and does not cause abdominal distress. They will also need to take a vitamin and mineral supplement to provide any essential nutrients they may no longer be able to absorb.

What is the Outcome of Malnutrition?

If acute, severe malnutrition is not treated in infants and children, they may die or be permanently physically and mentally stunted, thus never reaching their full potential. Chronic malnutrition also stunts physical and mental development. Malnutrition involving one or more nutrients can have a variety of effects, most of which delay recovery and may result in additional complications. For example, if a person is not able to absorb fat-soluble vitamins because of removal of part of the intestine, then he or she may develop deficiencies of vitamins A, E, K and D. Prevention is essential and relatively easy to achieve by taking extra fat-soluble vitamin supplements.

The Risk of Malnutrition is Increased by:
British Nutrition Foundation
  • Increased requirements. It is more difficult to meet nutritional needs during periods of increased requirements. For example, some women have very high requirements for iron, eg if menstrual losses are high; if they cannot obtain enough in their diet they may develop iron deficiency anaemia.

  • Restricted range of foods. A diet based on a narrow range of foods is more likely to lack nutrients. For example poorly balanced slimming diets or vegetarian diets.

  • Reduction in availability of food. Famine is an extreme example.

  • Income. Lack of money may make it difficult to purchase an adequate diet. Cultural practices may mean that not everyone in a family gets a fair share of the food available.

  • Other substances in foods. Very high intakes of some substances, for example fibre, reduce absorption of some nutrients from food.

  • Medical conditions. Some may affect food intake or the absorption of nutrients from foods. Some medicines affect appetite.

  • Psychological problems. Some may affect food intake.
Who Is at Risk for Undernutrition?
The Merck Manual of Medical Information
  • Infants and young children whose appetite is poor

  • Adolescents experiencing rapid growth spurts

  • Pregnant and breastfeeding women

  • Elderly people

  • People who have a chronic disease of the gastrointestinal tract, liver, or kidneys, particularly if they have recently lost 10 to 15 percent of their body weight.

  • People on fad or crash diets for a long time

  • Vegetarians

  • People with alcohol or drug dependency who don't eat adequately

  • People who have AIDS

  • People taking drugs that interfere with appetite or with absorption or excretion of nutrients

  • People who have anorexia nervosa

  • People who have a prolonged fever, hyperthyroidism, burns, or cancer
How Starvation Affects Body Systems
The Merck Manual of Medical Information
  • Digestive system

    • Low acid production by the stomach

    • Frequent, often fatal diarrhea

  • Cardiovascular system (heart and blood vessels)

    • Reduced heart size, reduced amount of blood pumped, slow heart rate, and low blood pressure

    • Ultimately, heart failure

  • Respiratory system

    • Slow breathing, reduced lung capacity

    • Ultimately, respiratory failure

  • Reproductive system

    • Reduced size of ovaries in women and testes in men

    • Loss of sex drive (libido)

    • Cessation of menstrual periods

  • Nervous system

    • Apathy and irritability, although intellect remains intact

  • Muscular system

    • Low capacity for exercise or work because of reduced muscle size and strength

  • Hematologic system (blood)

    • Anemia

  • Metabolic system

    • Low body temperature (hypothermia), frequently contributing to death

    • Fluid accumulation in the skin, resulting mainly from disappearance of fat under the skin

  • Immune system

    • Impaired ability to fight infections and repair wounds




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