What Is Malnutrition?
Malnutrition is a condition that results from eating a diet in which one or more nutrients are either not enough or are too much such that the diet causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough nutrients is called undernutrition or undernourishment while too much is called overnutrition. 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. Extreme undernourishment, known as starvation, may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and abdomen. People also often get infections and are frequently cold. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking.
Undernourishment is most often due to not enough high-quality food being available to eat. This is often related to high food prices and poverty. A lack of breastfeeding may contribute, as may a number of infectious diseases such as: gastroenteritis, pneumonia, malaria, and measles, which increase nutrient requirements. There are two main types of undernutrition: protein-energy malnutrition and dietary deficiencies.
Protein-energy malnutrition has two severe forms: marasmus (a lack of protein and calories) and kwashiorkor (a lack of just protein). Common micronutrient deficiencies include: a lack of iron, iodine, and vitamin A. During pregnancy, due to the body’s increased need, deficiencies may become more common. In some developing countries, overnutrition in the form of obesity is beginning to present within the same communities as undernutrition. Other causes of malnutrition include anorexia nervosa and bariatric surgery.
Efforts to improve nutrition are some of the most effective forms of development aid. Breastfeeding can reduce rates of malnutrition and death in children, and efforts to promote the practice increase the rates of breastfeeding. In young children, providing food (in addition to breastmilk) between six months and two years of age improves outcomes. There is also good evidence supporting the supplementation of a number of micronutrients to women during pregnancy and among young children in the developing world. To get food to people who need it most, both delivering food and providing money so people can buy food within local markets are effective. Simply feeding students at school is insufficient.
Management of severe malnutrition within the person’s home with ready-to-use therapeutic foods is possible much of the time. In those who have severe malnutrition complicated by other health problems, treatment in a hospital setting is recommended. This often involves managing low blood sugar and body temperature, addressing dehydration, and gradual feeding. Routine antibiotics are usually recommended due to the high risk of infection. Longer-term measures include: improving agricultural practices, reducing poverty, improving sanitation, and the empowerment of women.
Causes of Malnutrition
Malnutrition can result from various environmental and medical conditions.
1) Low intake of food
This may be caused by symptoms of an illness, for example, dysphagia, when it is difficult to swallow. Badly fitting dentures may contribute.
2) Mental health problems
Conditions such as depression, dementia, schizophrenia, anorexia nervosa, and bulimia can lead to malnutrition.
3) Social and mobility problems
Some people cannot leave the house to buy food or find it physically difficult to prepare meals. Those who live alone and are isolated are more at risk. Some people do not have enough money to spend on food, and others have limited cooking skills.
4) Digestive disorders and stomach conditions
If the body does not absorb nutrients efficiently, even a healthful diet may not prevent malnutrition. People with Crohn’s disease or ulcerative colitis may need to have part of the small intestine removed to enable them to absorb nutrients.
Celiac disease is a genetic disorder that involves a gluten intolerance. It may result in damage to the lining of the intestines and poor food absorption.
Persistent diarrhea, vomiting, or both can lead to a loss of vital nutrients.
5) Alcoholism
Addiction to alcohol can lead to gastritis or damage to the pancreas. These can make it hard to digest food, absorb certain vitamins, and produce hormones that regulate metabolism.
Alcohol contains calories, so the person may not feel hungry. They may not eat enough proper food to supply the body with essential nutrients.
6) Lack of breastfeeding
Not breastfeeding, especially in the developing world, can lead to malnutrition in infants and children.
Following the MUST screening, the following may happen:
Low risk: Recommendations include ongoing screening at the hospital and at home.
Medium risk: The person may undergo observation, their dietary intake will be documented for 3 days, and they will receive ongoing screening.
High risk: The person will need treatment from a nutritionist and possibly other specialists, and they will undergo ongoing care.
For all risk categories, help and advice on food choices and dietary habits should be offered.
Signs and symptoms of Malnutrition
undernutrition include:
- lack of appetite or interest in food or drink
- tiredness and irritability
- inability to concentrate
- always feeling cold
- loss of fat, muscle mass, and body tissue
- higher risk of getting sick and taking longer to heal
- longer healing time for wounds
- higher risk of complications after surgery
- depression
- reduced sex drive and problems with fertility
In more severe cases:
- breathing becomes difficult
- skin may become thin, dry, inelastic, pale, and cold
- the cheeks appear hollow and the eyes sunken, as fat disappears from the face
- hair becomes dry and sparse, falling out easily
Eventually, there may be respiratory failure and heart failure, and the person may become unresponsive. Total starvation can be fatal within 8 to 12 weeks
Children may show a lack of growth, and they may be tired and irritable. Behavioral and intellectual development may be slow, possibly resulting in learning difficulties.
Even with treatment, there can be long-term effects on mental function, and digestive problems may persist. In some cases, these may be lifelong.
Adults with severe undernourishment that started during adulthood usually make a full recovery with treatment.
Overnutrition
The main signs of overnutrition are overweight and obesity, but it can also lead to nutrient deficiencies.
Research shows that people who are overweight or obese are more likely to have inadequate intakes and low blood levels of certain vitamins and minerals compared to those who are at a normal weight (11Trusted Source, 12Trusted Source).
One study in 285 adolescents found that blood levels of vitamins A and E in obese people were 2–10% lower than those of normal-weight participants (13Trusted Source).
This is likely because overweight and obesity can result from an overconsumption of fast and processed foods that are high in calories and fat but low in other nutrients (14Trusted Source, 15Trusted Source).
A study in over 17,000 adults and children found that those who ate fast food had significantly lower intakes of vitamins A and C and higher calorie, fat and sodium consumption than those who abstained from this type of food (16Trusted Source).
Assessing Malnutrition
Symptoms of malnutrition are assessed by healthcare providers when they screen for the condition.
Tools that are used to identify malnutrition include weight loss and body mass index (BMI) charts, blood tests for micronutrient status and physical exams (17Trusted Source, 18Trusted Source, 19).
If you have a history of weight loss and other symptoms associated with undernutrition, your doctor may order additional tests to identify micronutrient deficiencies.
Identifying nutrient deficiencies that result from overnutrition, on the other hand, can be more difficult.
If you’re overweight or obese and eat mostly processed and fast foods, you may not get enough vitamins or minerals. To find out if you have nutrients deficiencies, consider discussing your dietary habits with your doctor.
Treatment types for Malnutrition
The type of treatment will depend on the severity of the malnutrition, and the presence of any underlying conditions or complications.
The healthcare provider will prepare a targeted care plan, with specific aims for treatment. There will normally be a feeding program with a specially planned diet, and possibly some additional nutritional supplements.
People with severe malnourishment or absorption problems may need artificial nutritional support, either through a tube or intravenously.
The patient will be closely monitored for progress, and their treatment will be regularly reviewed to ensure their nutritional needs are being met.
Diet
A dietitian will discuss healthful food choices and dietary patterns with the patient, to encourage them to consume a healthy, nutritious diet with the right number of calories. Those who are undernourished may need additional calories to start with.
Monitoring progress
Regular monitoring can help ensure an appropriate intake of calories and nutrients. This may be adjusted as the patient’s requirements change. Patients receiving artificial nutritional support will start eating normally as soon as they can.
Prevention of Malnutrition
Food security
The effort to bring modern agricultural techniques found in the West, such as nitrogen fertilizers and pesticides, to Asia, called the Green Revolution, resulted in increased food production and corresponding decreases in prices and malnutrition similar to those seen earlier in Western nations. This was possible because of existing infrastructure and institutions that are in short supply in Africa, such as a system of roads or public seed companies that made seeds available. Investments in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces food prices.
For example, in the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced against World Bank strictures, farmers produced record-breaking corn harvests as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter.
This lowered food prices and increased wages for farm workers. Such investments in agriculture are still needed in other African countries like the Democratic Republic of the Congo. The country has one of the highest prevalence of malnutrition even though it is blessed with great agricultural potential John Ulimwengu explains in his article for D+C. Proponents for investing in agriculture include Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa’s farmers. In Nigeria, the use of imported Ready to Use Therapeutic Food (RUTF) has been used to treat malnutrition in the North. Soy Kunu, a locally sourced and prepared blend consisting of peanut, millet and soya beans may also be used.
New technology in agricultural production also has great potential to combat undernutrition. By improving agricultural yields, farmers could reduce poverty by increasing income as well as open up area for diversification of crops for household use. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.
Economics
There is a growing realization among aid groups that giving cash or cash vouchers instead of food is a cheaper, faster, and more efficient way to deliver help to the hungry, particularly in areas where food is available but unaffordable. The UN’s World Food Program, the biggest non-governmental distributor of food, announced that it will begin distributing cash and vouchers instead of food in some areas, which Josette Sheeran, the WFP’s executive director, described as a “revolution” in food aid. The aid agency Concern Worldwide is piloting a method through a mobile phone operator, Safaricom, which runs a money transfer program that allows cash to be sent from one part of the country to another.
World population
Restricting population size is a proposed solution. Thomas Malthus argued that population growth could be controlled by natural disasters and voluntary limits through “moral restraint.” Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth. The interdependence and complementarity of population growth with poverty and malnutrition (as well as the environment) is also recognised by the United Nations. More than 200 million women worldwide do not have adequate access to family planning services. According to the World Health Organisation, “Family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts”.
Food sovereignty
One suggested policy framework to resolve access issues is termed food sovereignty—the right of peoples to define their own food, agriculture, livestock, and fisheries systems, in contrast to having food largely subjected to international market forces. Food First is one of the primary think tanks working to build support for food sovereignty. Neoliberals advocate for an increasing role of the free market.
Breastfeeding
As of 2016 is estimated that about 823,000 deaths of children less than five years old could be prevented globally per year through more widespread breastfeeding. In addition to reducing infant death, breast milk feeding provides an important source of micronutrients, clinically proven to bolster the immune system of children, and provide long-term defenses against non-communicable and allergic diseases. Breastfeeding has also been shown to improve cognitive abilities in children, with a strong correlation to individual educational achievements.
Barriers to breastfeeding
Breastfeeding is noted as one of the most cost-effective medical interventions for providing beneficial child health. While there are considerable differences within developed and developing countries: income, employment, social norms, and access to healthcare were found to be universal determinants of whether a mother breast or formula-fed their children. Community-based healthcare workers have helped alleviate the financial barriers faced by newly made mothers and provided a viable alternative to traditional and expensive hospital-based medical care. Recent studies based upon surveys conducted from 1995–2010 shows exclusive breastfeeding rates have gone up globally, from 33% to 39%. Despite the growth rates, medical professionals acknowledge the need for improvement given the importance of exclusive breastfeeding.
Frequently Asked Questions about Malnutrition
What are malnutrition and starvation?
Malnutrition comes in many forms. Simply put, it means poor nutrition. It includes:
- undernutrition: when a person does not get enough food to eat, causing them to be wasted (this is also called acute malnutrition when someone is too thin for their height) and/or stunted (this is also called chronic malnutrition when someone is too short for their age). Undernutrition increases the risk of infectious diseases like diarrhea, measles, malaria, and pneumonia, and chronic malnutrition can impair a young child’s physical and mental development.
- micronutrient deficiencies: when a person does not get enough important vitamins and minerals in their diet. Micronutrient deficiencies can lead to poor health and development, particularly in children and pregnant women.
- overweight and obesity: linked to an unbalanced or unhealthy diet resulting in eating too many calories and often associated with lack of exercise. Overweight and obesity can lead to diet-related noncommunicable diseases such as heart disease, high blood pressure (hypertension), stroke, diabetes and cancer.
Starvation is a severe lack of food which can result in death.
How big a problem is a malnutrition in emergencies?
In emergencies, people are at higher risk of undernutrition and micronutrient deficiencies. Those whose nutrition was poor before the crisis is even more vulnerable. Acute malnutrition weakens the immune system, which then becomes more susceptible to developing diseases that can be fatal.
Undernutrition and micronutrient deficiencies can be widespread among refugees and displaced people, as adequate food and health services are often not readily accessible.
Inadequate nutrition and repeated bouts of infection during the first 1000 days of a child’s life can cause stunting, which has irreversible long-term effects on the physical and mental development of children. Worldwide in 2015, there were 156 million stunted children, about 45% of them living in fragile and conflict-affected countries.
Emergencies can also aggravate diet-related noncommunicable diseases, such as heart disease, high blood pressure (hypertension), diabetes and cancer. Healthy foods may not be regularly available and appropriate medical care may not be accessible, leading to the interruption or cessation of treatments for these diseases. Given that many populations have high levels of noncommunicable diseases, emergencies can cause a significant increase in illness and even death from these diseases.
Who is most vulnerable to undernutrition and starvation during emergencies?
Young children and women who are pregnant or breastfeeding are most vulnerable to undernutrition. Their bodies have a greater need for nutrients, such as vitamins and minerals, and are more susceptible to the harmful consequences of deficiencies.
Children are at the highest risk of dying from starvation. They become undernourished faster than adults. Severely wasted children are 11 times more likely to die than those with a healthy weight. Undernourished children catch infections more easily and have a harder time recovering because their immune systems are impaired. Globally, undernutrition is an underlying factor in more than half of child deaths from pneumonia and malaria, and more than 40% of measles deaths.
How should severe acute malnutrition be treated in an emergency?
Severe acute malnutrition is when a person is extremely thin and at risk of dying. They need immediate treatment. The response to acute malnutrition is broad and includes several elements such as medical, food, water and hygiene, and social services.
Children who still have an appetite can stay at home and receive outpatient care. They need treatment with specially-formulated foods, and their recovery must be monitored regularly by a trained health worker.
Children who have medical problems and do not have an appetite need inpatient care in a clinic or hospital. They need specially-formulated milk and treatment for infections or other potential complications.
Why is it so important for infants to breastfeed during emergencies?
Breastfeeding can be life-saving for young children in emergencies.
Breastfeeding in all environments has major health benefits for both children and mothers. Breast milk gives infants all the nutrients they need for healthy growth and development. It is readily available and contains antibodies that protect infants from common childhood illnesses. Breastfeeding also reduces mothers’ risks of breast and ovarian cancer, type II diabetes, and postpartum depression.
Breastfeeding becomes even more critical for child survival in humanitarian emergencies. Young children in emergencies face higher risks of diarrhea, pneumonia, and undernutrition. Lack of food, unsafe water, poor sanitation, overcrowding, and overburdened health systems put infants and young children at greater risk.
WHO recommends that all babies should be fed only breast milk for the first 6 months, after which they should continue breastfeeding (as well as eating other foods) until 2 years of age, and potentially for longer, even in emergency situations.
What are the challenges to breastfeeding in emergency situations?
Often the poor physical and mental health of mothers in emergencies leads to poor breastfeeding outcomes. Displaced mothers may struggle to find comfortable, private places to breastfeed and their support network of family and friends is often not accessible in emergencies. Health workers who would usually offer support may be redeployed to cope with other aspects of the emergency response.
Well-meaning donors may distribute breast-milk substitutes (such as infant formula) in emergencies. This can undermine breastfeeding and if there is a lack of clean water to make formula or clean bottles and teats, put children at increased risk of infections which can be deadly.
Governments and humanitarian organizations have a key role to play in protecting, promoting and supporting breastfeeding in emergencies.