What is Malnutrition?
Malnutrition is poor health or illness caused by an inadequate diet, so both semi starvation and overeating can be to blame. While two thirds of the world’s population has too little food, obesity is a major health hazard in richer countries.
Food intake must be correct in both quantity and quality, and in developing countries both are generally insufficient. The average calorie intake for populations may be only half the minimum required to stay healthy, and the food available often lacks proteins. This deficiency is so serious for children that in many countries half the population dies before age five.
Malnutrition is by no means restricted to developing countries, however. Poor people everywhere go hungry or have to buy cheap, starchy food to feel full—thus obesity is not the privilege of the very rich. Obesity is caused by taking in more calories than needed and storing them as fat. Children, especially those of preschool age, and old people are the most frequent victims of poverty based malnutrition. (David B. Jacoby, R. M. Youngson :Encyclopedia of Family Health; 2004 ; 1127-28)
Malnutrition and WHO
World Health Organization (WHO) defines malnutrition as:
Malnutrition essentially means “bad nourishment”. It concerns not enough as well as too much food, the wrong types of food, and the body’s response to a wide range of infections that result in malabsorption of nutrients or the inability to use nutrients properly to maintain health. Clinically, malnutrition is characterized by inadequate or excess intake of protein, energy, and micronutrients such as vitamins, and the frequent infections and disorders that result.
People are malnourished if they are unable to utilize fully the food they eat, for example due to diarrhoea or other illnesses (secondary malnutrition), if they consume too many calories (overnutrition), or if their diet does not provide adequate calories and protein for growth and maintenance (undernutrition or protein-energy malnutrition).
WHO also gives an outline about the extent f manutrition as:
Chronic food deficits affect about 792 million people in the world (2000), including 20% of the population in developing countries. Worldwide, malnutrition affects one in three people and each of its major forms dwarfs most other diseases globally (WHO, 2000). Malnutrition affects all age groups, but it is especially common among the poor and those with inadequate access to health education and to clean water and good sanitation. More than 70% of children with protein-energy malnutrition live in Asia, 26% live in Africa, and 4% in Latin America and the Caribbean (WHO 2000).
Aetiology and Pathophysiology of Malnutrition
Children may become malnourished simply because there is not enough food available, but sick malnourished individuals have no appetite for food. It seems paradoxical that a child who has obviously lost weight and needs to eat may refuse food even when it is readily available.
If food is forced there is the possibility that the child will become worse, or even die. In managing severe malnutrition appetite is one of the most important symptoms. A loss of appetite is an important protective mechanism against consuming food which is likely to stress the systems of the body.
In experimental studies there are to two major biological reasons why appetite is lost: a deficiency of a specific nutrient and infection. Severe malnutrition is a disorder which results from the interaction of three distinct but related processes, each of which appears to be related to the food consumed, but none of which can be easily understood simply by a consideration of food:
- Reactive adaptation
- Inflammatory and immune responses
- Specific nutrient deficiencies
Food helps meet the many needs for normal function, growth, and development in childhood, but also the ability to cope with environmental challenge. A diet which is adequate but marginal under normal circumstances is inadequate for the increased demands during recovery from frequent inter-current illness with the double burden of the need for catch up growth and to make good the unusual losses of nutrients during the infective episode itself. The time available for successful convalescence, before the next bout of infection, is too short to adequately make up the deficit.
Diseases caused by Malnutrition
Malnutrition increases the risk of disease and early death. Protein-energy malnutrition, for example, plays a major role in half of all under-five deaths each year in developing countries (WHO 2000). Severe forms of malnutrition include marasmus (chronic wasting of fat, muscle and other tissues); cretinism and irreversible brain damage due to iodine deficiency; and blindness and increased risk of infection and death from vitamin A deficiency.
Some other nutritional deficiency related diseases include:
|Vitamin or mineral||Diseases and disorders caused by a deficiency||Deficiency corrected by eating|
|Vitamin A||Skin disease severe conjunctivitis; night blindness||Milk; butter; cod liver oil; green vegetables|
|Vitamin B thiamine||Beriberi (weakness, swelling); heart failure||Bran and cereals|
|Vitamin B niacin||Pellagra (a skin disorder); diarrhea; dementia; skin blistering wit dermatitis||Liver; kidney yeast|
|Vitamin C||Anemia; scurvy; slow wound healing; hemorrhages from tooth sockets and into joints||Fresh fruits and vegetables|
|Vitamin D||Disorders of bone formation leading to swelling; softening and bowing of bones called Osteomalacia in adults and rickets in children||Milk; egg yolk; cod liver oil; action of sunlight on skin|
|Iron||Anemia||Lean meat; liver spinach; cabbage; egg yolk|
|Sodium||Disturbances of body chemistry||Salt|
|Iodine||Goiter; swelling of thyroid gland||Seafood|
Symptoms of Malnutrition
Malnutrition has general effects and also causes specific conditions that result from a lack of essential vitamins or minerals.
A malnourished child appears pale from anemia, and dull, small, and thin. The lack of protein can cause deficiency in antibodies. Starvation brings additional symptoms; dry, inelastic, cold skin and sparse hair. Adults who are semi starved can lose up to 70% of their body weight; some of this will be water but much of the weight will consist of protein that has been shed from the muscles, liver, intestines, and heart. A lack of calories can cause anemia, low blood pressure, apathy, irritability, and bouts of debilitating diarrhea.
Unfortunately, malnutrition is usually the forerunner of starvation, and it leaves the body unable to cope for long periods without food. The sufferer’s resistance to bacterial and parasitic infection is lowered, and damage from vitamin deficiency can be permanent, such as blindness caused by a lack of vitamin A.
Malnutrition during pregnancy quickly leads to anemia in the expectant mother. Complications at birth are more likely, and the quality of breast milk depends on the mother’s diet.
People who are obese are more likely to develop high blood pressure, to have coronary heart disease and arthritis of the hips, and to be at higher risk during surgical operations.
Screening: identification and prevention of malnutrition
Malnutrition is preventable condition and the early identification of those at risk and the implementation of interventions which correct underlying problems and prevent further deterioration is central to strategies for effective care.
Early growth failure can be detected by regular weighing, as an integral part of immunization and other health programmes. A series of plotted weights is most valuable and intervention is required for those whose weight crosses two growth centiles on successive measurements.
If measurements are only available for a single time point, then height for age and weight for height provide an indication of any past or ongoing growth failure. Advice and demonstration of best practice in child care and feeding may be sufficient to correct a mild degree of growth failure, but persistent or more severe growth failure requires closer investigation to exclude underlying problems. Poor anthropometry, with a history of poor appetite and weight loss, should always be taken very seriously and pursued until a cause has been identified and corrected. Severe malnutrition is a medical emergency.
Childhood malnutrition is a clinical problem for the individual, but is also a symptom of ineffective public health policy. Targeted interventions should address the immediate needs of the child, but should also embrace broader consideration. For the child, there is the need to effectively immunize against infection, recognize and treat infection in a timely way, and ensure an effective period of nutritional support following infection.
For the family, there is the need to enhance the child rearing skills of the parents, create a stimulating environment, acquire and practice simple skills in the hygiene and food preparation, and strengthen family dynamics and coping strategies. For the community, there is the need to improve the economic base of households, increase food purchasing power, increase food security or household food availability, and to treat specific nutrient deficiencies. Sound hygienic practices have to be strengthened at the group or household level, and where necessary the amount the quality of water and the safe and effective removal of solid waste improved.
Each activity can exert a beneficial effect on growth and development. Any one might be relatively easy to introduce, but the real difficulty is to ensure that all are sustained. The need is for a fundamental change in the health culture and the creation of a framework of behavior in which development activities become rooted and take place as a matter of course. A failure to establish and maintain an effective system of health care leads to a progressive deterioration in the clinical state of the most vulnerable infants leading eventually to severe malnutrition. (D. A. Warrell, Timothy M. Cox, John D. Firth; Oxford textbook of medicine, Volume 1; 2003; 1056).