Overview
Malnutrition continues to be the scourge of the world and a situation which has not changed through the ages. It is best to start with a solid definition and the World Health Organization (WHO) defines malnutrition:-
“The cellular imbalance between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific function.”
In the broader sense, malnutrition usually refers to a lack of nutrition but it also includes over nutrition as well. When people are under nourished their diet is not providing enough calories and protein for growth and maintenance or they cannot fully use their food intake because of illness and disease. They may also be over nourished if they consume too many calories.
Starvation
Starvation is also a term widely used to describe under nutrition. This occurs when the nutrient intake drops below what is needed to maintain body mass. The body starts to consume its own muscle and any other lean so that it can supply any nutrients to maintain metabolic function. As the process of starvation continues all the body’s organs are affected but the physical signs are apathy, weakness and lethargy and gradual muscle wasting.
If an adult drinks only water but stops feeding themselves any other form of nutrition, this type of starvation leads to death in 2 months.
Quite often, people when they diet are attempting to starve themselves which seems odd in the context of malnutrition but is a deliberate state of nutrition by reducing their calorie intake.
Conditions Associated With Malnutrition
Too few calories and protein in the diet is given the term protein-energy malnutrition (PEM) and sometimes called protein-calorie malnutrition (PCM). This leads to hypotrophy which is characterised by a wasting away of tissue with complete absence of any growth. Another condition is hypostature which is stunted growth and tissue sometimes called stunting. This is because bones cannot be built. Overall, there is a complete failure to thrive.
If we have too many calories we suffer from paratrophy which includes being overweight or suffering with obesity.
One of the worst conditions caused by acute malnutrition is to suffer from Marasmus and more severely but often in young children, Kwashiorkor. It is quite common to suffer both conditions.
Marasmus
Marasmus is the condition that occurs when there is a rapid deterioration in nutritional status over a short period of time. In this condition there is a very rapid loss of both muscle and fat because the body must break it down to produce energy. It is not technically a disease but such wasting way affects everyone, young and old.
It is the most common form of acute malnutrition and very often associated with nutritional emergencies. It is also associated with some of the most severe forms of anorexia. If not remedied quickly the only outcome is death.
Kwashiorkor
Probably the most severe form of acute nutrition is Kwashiorkor and is most common in young children.
Again, there is a loss of muscle mass, an inability to gain weight and show linear growth.
The most characteristic condition however is identified by what is termed bilateral pitting oedema because it affects both sides of the body, especially the lower legs and feet. As it develops over time, it starts to affect the stomach, arms, hands and face.
Oedema is the situation in the body caused by excessive accumulation of fluid in body tissues. The belly in particular swells because there is not only oedema but a peculiar build up of fat around the liver. There are changes in skin pigment called pellagra. The person loses pigment as the skin peels away in a process called desquamation. The skin also darkens as it becomes irritated and damaged. You will notice the hair thinning and becoming lighter too, and it becomes red and brittle.
Infection levels rise and even mild ones increase in severity with the development of diarrhea.
Nobody really knows how it is caused but it is a symptom of protein deficiency. It occurs most often in children over 2 years old once they are weaned off breast milk. It is reversed by feeding them special fortified milk. Whilst starvation itself will cause death through organ failure, it is usually secondary infection which is the leading cause of mortality. As the condition develops there is increasing apathy, irritability and lethargy.
As well as different forms of protein-energy malnutrition, there are conditions associated with micronutrient deficiency.
Nutrient Deficiency
There are two types of nutrient deficiency, Type I and Type II.
Type I is characterised by physical signs and include the following:-
- Anemia due to iron deficiency
- Beri Beri due to lack of vitamin B1 (thiamin)
- Pellagra due to lack of niacin.
- Xerophthalmia due to lack of vitamin A
Type II nutrient deficiency is characterised by a reduced overall growth. This is caused by a lack of the following nutrients:-
Chronic Illnesses Associated with Nutrition Deficiency
Over prolonged periods of poor nutrition, people especially children begin to suffer from a variety of conditions which include the following:
- Kidney failure
- Congenital heart disease
- Inflammatory bowel disease
- Neuromuscular disease
- Cystic fibrosis
Child Mortality
Malnutrition is the biggest contributor to child mortality. Approximately, 6 million children die from hunger every year. Also, 49% of the 10.4 million deaths that occur in children younger than 5 years old in developing children is associated with protein-energy malnutrition (PEM).
The Causes Of Primary Or Non-Organic Malnutrition
Throughout the world, children can suffer a type of malnutrition known as primary malnutrition. It can happen anywhere because it is largely caused by their parent’s behaviour. In a number of cases parents cannot give their children the food they need because they are too poor either through unemployment or illness. There are many cases where the parents neglect and abuse their children including the denial of food. In other cases, the parents are too poorly educated to know how to feed their children.
Treating Malnutrition
The simplest way of addressing malnutrition is to ensure anybody suffering from it rebalances their nutrient intake. In undernourishment, it is a case of simply making sure a person is adequately fed. In over nourishment of over feeding, it is a case of restricting the diet. For the more affluent, dieting is one of the major developments and a good part of modern nutrition is devoted to understanding what the best methods are to achieve the right weight.
Lack of nutrition might be more simply addressed by refeeding however that situation is not without its issues because of something called refeeding syndrome.
Refeeding Syndrome
Refeeding is not without controversy because of a syndrome which invariably leads to death if not managed properly. It occurs because of what can only be described as rapid and aggressive feeding of undernourished people. Being undernourished means that the body has adapted relatively well to existing in a calorie deprived state. A sudden surge of protein and calories in excess of the body’s needs produces acute metabolic imbalance. It is better to achieve refeeding by a slower introduction of nutrients than is perceived. This is best achieved in the first week of refeeding because it allows the body to adapt from its state of fasting and starvation.
Addressing Malnutrition
Malnutrition is highly complex.
“Malnutrition, both under and over, can no longer be addressed without considering global food insecurity, socioeconomic disparity, both globally and nationally, and global cultural, social and epidemiological transitions.”
This is a quote from an article by Darnton-Hill and Coyne which illustrate the multi-factorial nature of malnutrition and how it links to many other global aspects. Global action to address malnutrition means tackling all of these aspects to varying degrees.
References
Darnton-Hill and Coyne, E.T. Feast and famine: socioeconomic disparities in global nutrition and health.
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