MALNUTRITION: THE LARGEST CONTRIBUTOR TO CHILD MORTALITY
June 8, 2017
The World Health Organization (WHO) says that malnutrition is by far the largest contributor to child mortality globally. Malnutrition is a broad term which refers to both undernutrition and overnutrition.
Individuals are malnourished, or suffer from undernutrition (also known as subnutrition or undernourishment) when an individual does not consume enough food. It may exist if the person has a poor diet that gives the wrong balance of basic food groups or the individual cannot fully utilize the food eaten due to illness.
People are also malnourished, or suffer from overnutrition if they consume too many calories, which results in obesity or overweight.
Malnutrition can also be defined as the insufficient, excessive or imbalanced consumption of nutrients.
Poor diet may lead to a vitamin or mineral deficiency, among other essential substances, sometimes resulting in scurvy, which is a condition where an individual has a vitamin C (ascorbic acid) deficiency.
Though scurvy is a very rare disease, it still occurs in some patients , usually elderly people, alcoholics, or those that live on a diet devoid of fresh fruits and vegetables. Similarly, infants or children who are on special or poor diets for any number of economic or social reasons may be prone to scurvy.
WHO adds that malnutrition during childhood usually results in worse health and lower educational achievements during adulthood. Malnourished children tend to become adults who have smaller babies.
Malnutrition is often used to specifically refer to undernutrition where an individual is not getting enough calories, protein, or micronutrients. If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development.
Signs and Symptoms of Malnutrition (subnutrition)
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
Symptoms of malnutrition include:
Breathing difficulties, a higher risk of respiratory failure
Higher susceptibility to feeling cold
Longer healing times for wounds
Longer recovery times from infections
Longer recovery from illnesses
Lower sex drive
Tiredness, fatigue, or apathy
Sometimes, severe malnutrition may lead to unresponsiveness (stupor)
If calorie deficiency continues for long enough, there may be heart, liver and respiratory failure
The signs include:
Face: Moon face (kwashiorkor), simian facies (marasmus)
People with long-term health conditions that affect appetite, weight and/or how well nutrients are absorbed by the gut, such as Crohn's disease
People with swallowing problems
People who need extra energy, such as those with cystic fibrosis, those recovering from a serious injury or burns, and those with tremors (uncontrollable shaking)
Elderly people, especially those who are hospitalized or in long-term institutional care
Individuals who are socially isolated
People on low incomes (poor people)
People with chronic eating disorders, such as bulimia or anorexia nervosa
Causes of Malnutrition
1) Poor diet
If a person does not eat enough food, or if what they eat does not provide them with the nutrients they require for good health, they suffer from malnutrition. Poor diet may be caused by one of several different factors. If the patient develops dysphagia (swallowing difficulties) because of an illness, or when recovering from an illness, they may not be able to consume enough of the right nutrients.
2) Mental health problems
Some patients with mental health conditions, such as depression, may develop eating habits which lead to malnutrition. Patients with anorexia nervosa or bulimia may develop malnutrition because they are ingesting too little food.
3) Mobility problems
People with mobility problems may suffer from malnutrition simply because they either cannot get out enough to buy foods, or find preparing them too arduous.
4) Digestive disorders and stomach conditions
Some people may eat properly, but their bodies cannot absorb the nutrients they need for good health. Examples include patients with Crohn's disease or ulcerative colitis. Such patients may need to have part of the small intestine removed (ileostomy).
Individuals who suffer from Celiac disease have a genetic disorder that makes them intolerant to gluten. Patients with Celiac disease have a higher risk of damage to the lining of their intestines, resulting in poorer food absorption.
Patients who experience serious bouts of diarrhea and/or vomiting may lose vital nutrients and are at higher risk of suffering from malnutrition.
Alcoholism is a chronic (long-term) disease. Individuals who suffer from alcoholism can develop gastritis, or pancreas damage. These problems also seriously undermine the body's ability to digest food, absorb certain vitamins, and produce hormones which regulate metabolism. Alcohol contains calories, reducing the patient's feeling of hunger, so he/she consequently may not eat enough proper food to supply the body with essential nutrients.
6) Food shortages
In the poorer developing nations food shortages are mainly caused by a lack of technology needed for higher yields found in modern agriculture, such as nitrogen fertilizers, pesticides and irrigation. Food shortages are a significant cause of malnutrition in many parts of the world.
7) Food prices and food distribution
It is ironic that approximately 80% of malnourished children live in developing nations that actually produce food surpluses (Food and Agriculture Organization). Some leading economists say that famine is closely linked to high food prices and problems with food distribution.
8) Lack of breastfeeding
Experts say that lack of breastfeeding, especially in the developing world, leads to malnutrition in infants and children. In some parts of the world mothers still believe that bottle feeding is better for the child.
Another reason for lack of breastfeeding, mainly in the developing world, is that mothers abandon it because they do not know how to get their baby to latch on properly, or suffer pain and discomfort.
Overall appearance, behaviour, body-fat distribution and organ function can alert a physician, internist or nutrition specialist to the presence of malnutrition. Patients may be asked to record what they eat during a specific period.
Initial diagnostic laboratory studies include the following:
Complete blood count
Stool specimens should be obtained if the child has a history of abnormal stools or stooling patterns or if the family uses an unreliable or questionable source of water.
Blood and urine tests are used to measure the patient's levels of vitamins, minerals, and waste products.
X rays can determine bone density, reveal gastrointestinal disturbances, heart damage and lung damage.
Nutritional status can also be determined by:
Comparing a patient's weight to standardized charts
Calculating body mass index (BMI) according to a formula that divides height into weight
Measuring skinfold thickness or the circumference of the upper arm.
Treatments for Malnutrition
Treatment depends on the person’s general health and how severely malnourished they are.
The first dietary advice is usually:
eating "fortified" foods that are high in calories and protein
snacking between meals
having drinks that contain lots of calories
Children with chronic malnutrition may require caloric intakes of more than 120-150 kcal/kg/day to achieve appropriate weight gain. Most children with mild malnutrition respond to increased oral caloric intake and supplementation with vitamin, iron, and folate supplements. The requirement for increased protein is met typically by increasing the food intake.
In moderate to severe cases of malnutrition, enteral supplementation via tube feedings may be necessary.
Up to 10% of a person's body weight can be lost without side effects, but if more than 40% is lost, the situation is almost always fatal. Death usually results from heart failure, electrolyte imbalance, or low body temperature. Patients with semi-consciousness, persistent diarrhea, jaundice, or low blood sodium levels have a poorer prognosis.
Some children with protein-energy malnutrition recover completely. Others have many health problems throughout life,including mental retardation and the inability to absorb nutrients through the intestinal tract. Prognosis for all patients with malnutrition seems to be dependent on the age of the patient, and the length and severity of the malnutrition, with young children and the elderly having the highest rate of long-term complications and death.
The best way to prevent malnutrition is to eat a healthy, balanced diet.
You need to eat a variety of foods from the main food groups. These include:
Fruit and vegetables
Dairy - vegans are able to find abundant nutrients from non-animal sources
1. The average human should drink at least 1.2 litres of fluid per day.
2. Engage in moderate physical activity for at least 30 minutes, at least several times a
3. Achieve or maintain the ideal weight.
4. Use alcohol sparingly or avoid it altogether.
The prevention of malnutrition in children starts with an emphasis on prenatal nutrition and good prenatal care. Promotion of breastfeeding is particularly crucial in developing countries where safe alternatives to human milk are unavailable. Breastfeeding a baby for at least six months is considered the best way to prevent early-childhood malnutrition.
Health care providers should also counsel parents on the appropriate introduction of nutritious supplemental foods.