Malnutrition

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Malnutrition Classification and external resources
The orange ribbon—an awareness ribbon for malnutrition.
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MeSH	D044342

Malnutrition is a general term for a medical condition caused by an improper or inadequate diet.^[1]

According to the World Health Organization, hunger and malnutrition is the gravest single threat to the world's public health and malnutrition is by far the biggest contributor to child mortality, present in half of all cases.^[2]

Contents 1 Terminology and classification 1.1 Undernutrition 1.2 Overnutrition 2 Politics 3 Effects 3.1 Mortality due to malnutrition 3.2 Biological effects 4 Action on Malnutrition 5 Statistics 6 Climate Change and Malnutrition 7 Overnourished vs undernourished 8 See also 9 References 10 External links

Terminology and classification

An individual will experience malnutrition if the appropriate amount of, or quality of nutrients comprising a healthy diet are not consumed.^[3] An extended period of malnutrition can result in starvation, disease, and infection.

Undernutrition

It most often refers to undernutrition resulting from inadequate consumption, poor absorption, or excessive loss of nutrients. Malnutrition often implies undernutrition, but the term hypoalimentation is available to reduce the ambiguity.

Undernutrition is the lack of sufficient nutrients to maintain healthy bodily functions and is typically associated with extreme poverty in economically developing countries. It is a common cause of reduced intelligence in parts of the world affected by famine. ^[4] Malnutrition as the result of inappropriate dieting, overeating or the absence of a "balanced diet" is often observed in economically developed countries (eg. as indicated by increasing levels of obesity).

Most commonly, malnourished people either do not have enough calories in their diet, or are eating a diet that lacks protein, vitamins, or trace minerals. Medical problems arising from malnutrition are commonly referred to as deficiency diseases. Scurvy is a well-known and now rare form of malnutrition, in which the victim is deficient in vitamin C.

Common forms of malnutrition include protein-energy malnutrition (PEM) and micronutrient malnutrition. PEM refers to inadequate availability or absorption of energy and proteins in the body. Micronutrient malnutrition refers to inadequate availability of some essential nutrients such as vitamins and trace elements that are required by the body in small quantities. Micronutrient deficiencies lead to a variety of diseases and impair normal functioning of the body. Deficiency in micronutrients such as Vitamin A reduces the capacity of the body to resist diseases. Deficiency in iron, iodine and vitamin A is widely prevalent and represent a major public health challenge. An array of afflictions ranging from stunted growth, reduced intelligence and various cognitive abilities, reduced sociability, reduced leadership and assertiveness, reduced activity and energy, reduced muscle growth and strength, and poorer health overall are directly implicated to nutrient deficiencies.

Hunger is the normal psychological response brought on by the physiological condition of needing food. Hunger can also affect the mental state of a person, and is often used as a metonym for general undernourishment.

Overnutrition

The term can also encompass overnutrition,^[5] resulting from overeating or excessive intake of specific nutrients.

A related term is hyperalimentation.

Politics

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As of 2008^[update], malnutrition continues to be a worldwide problem, particularly in lesser developed countries^[6]. According to the Food and Agriculture Organization of the United Nations, "850 million people worldwide were undernourished in 1999 to 2005, the most recent years for which figures are available" and the number of malnourished people has recently been increasing. Malnutrition can also be a result of unhealthy bodies not being able to retain the micronutrients and protein included in their diets. An orange awareness ribbon is used to raise awareness of malnutrition in the world.^[7] The FAO calculates undernourishment by comparing the amount of food available in a country at national level with how many people live in the country.

Some environmentalists claim that the fundamental issue causing malnutrition is that the human population exceeds the Earth's carrying capacity;^[8] however, Food First raises the issue of food sovereignty and claims that every country (with the possible minor exceptions of some city-states) has sufficient agricultural capacity to feed its own people, but that the "free trade" economic order associated with such institutions as the International Monetary Fund (IMF) and the World Bank prevent this from happening. At the other end of the spectrum, 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.

Amartya Sen won a 1998 Nobel Prize in part for his work suggesting that famine is not typically the product of a lack of food; rather, famine may arise from problems in food distribution networks or from governmental policies in the developing world.

The politics of food trade and food security are often difficult to grasp. Many people believe that sending food aid to the poor of the world is a worthy idea, but that each country should produce its own food.

Countries that have become more open to international trade in recent years (e.g. China, Vietnam or Peru) have greatly reduced the prevalence of undernourishment as measured by the FAO (food energy consumption below acceptable minimum) or as measured by the World Health Organization by the percentage of children under five who are stunted, wasted or underweight. Countries that remained closed to external trade (e.g. North Korea) have not improved or have worsened their food situation.

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Some anti-globalization groups advocate "food sovereignty", stating that each country should be physically self sufficient in every food item consumed by their people; by this measure the United States, United Kingdom, Sweden, Belgium, and in fact almost all other countries in the world would be food insecure, and a desert nation like Saudi Arabia (with its current population) would not be viable as a country at all. Vitamin A and Vitamin C deficiencies are the most dangerous aspects of malnutrtion in children, after protein-energy malnutrition.

One policy adopted in recent decades to alleviate world malnutrition is food aid, i.e. the physical donation of food from rich to poor countries. From the rich donor countries' point of view, this is a suitable way to reduce excess supply created by domestic agricultural subsidies, stabilizing farm prices in rich countries, even if the cost of supplying the food to its final beneficiaries is often disproportionately high. Food aid may be provided for short-term emergencies (natural disasters like earthquakes, tsunamis, droughts and floods, or human-made like war and refugee flows) or in the form of a long-term program for an extended period. From the viewpoint of recipient countries, the value of food-aid depends on the form it takes. Emergency food aid is welcome, though aid in cash may also be welcome because the food may often be purchased locally in zones not affected by the emergency, thus benefitting local farmers. Long-term foreign food aid has been criticized as discouraging local production and distorting markets. Instead, population control has been advocated as a much better approach to solve malnutrition/famine than merely providing food. ^[9]

Effects

Mortality due to malnutrition

See also: child mortality

According to the World Health Organization, hunger is the gravest single threat to the world's public health.^[2] According to Jean Ziegler (the United Nations Special Rapporteur on the Right to Food for 2000 to March 2008), mortality due to malnutrition accounted for 58% of the total mortality in 2006: "In the world, approximately 62 millions people, all causes of death combined, die each year. One in twelve people worldwide are malnourished.^[10] In 2006, more than 36 millions died of hunger or diseases due to deficiencies in micronutrients"^[11]. The World Health Organization estimates that one-third of the world is well-fed, one-third is under-fed and one-third is starving. Every 3.6 seconds someone dies of hunger. ^[12]

Hunger and malnutrition have an even bigger impact on children’s health than was previously thought. According to the World Health Organization, malnutrition is by far the biggest contributor to child mortality, present in half of all cases. Underweight births and inter-uterine growth restrictions cause 2.2 million child deaths a year. Poor or non-existent breastfeeding causes another 1.4 million. Other deficiencies, such as lack of vitamin A or zinc, for example, account for 1 million. According to The Lancet, malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower educational achievements. Their own children also tend to be smaller. Hunger was previously seen as something that exacerbates the problems of diseases such as measles, pneumonia and diarrhea. But malnutrition actually causes diseases as well, and can be fatal in its own right. This is the impact The Lancet seeks to identify.^[2]

Children are not only affected by the consequences of malnourishment, but the societies they live in suffer as well. Both severe and moderate cases of malnutrition have a significant impact on the outcomes children face for the remainder of their lives and are also a cause of severe illnesses leading to growth retardation both physical and mental, and possibly death. The risk of death is not limited to only those who suffer from severe forms of malnutrition, though the risk of death is higher among severely malnourished children. Considering the elevated risks of mortality among children that are associated with moderate forms of malnutrition, combined with a high prevalence worldwide, it would seem more appropriate to distinguish that the deaths of children as a result of malnourishment is attributable to moderate, rather than severe conditions of malnutrition. Another factor that largely keeps malnutrition from being properly treated is a lack of education in many developing countries. This lack of education allows cultures of superstitions to persist. For example, in some cases in China, breast-feeding started at a very late stage. As such, there is an increasing wide effort to implement an access for education about proper feeding methods.

Biological effects

An extended period of malnutrition can result in starvation or deficiency diseases such as scurvy. Malnutrition increases the risk of infection and infectious disease; for example, it is a major risk factor in the onset of active tuberculosis.^[13]

Malnutrition appears to increase activity and movement in many animals - for example an experiment on spiders showed increased activity and predation in starved spiders, resulting in larger weight gain.^[14] This pattern is seen in many animals, including humans while sleeping.^[15] It even occurs in rats with their cerebral cortex or stomachs completely removed.^[16] Increased activity on hamster wheels occurred when rats were deprived not only of food, but also water or B vitamins such as thiamine^[17] This response may increase the animal's chance of finding food, though it has also been speculated the emigration response relieves pressure on the home population.^[15]

Action on Malnutrition

There are several different approaches in combating under-nutrition including nutritional education and medical nutrition which consists of micro-nutrient supplementation, immunizations and food fortifications. Nutritional education is a preventative measure used to decrease the prevalence of malnutrition by creating sustainable nutrition within developing communities. Nutritional education attempts to tackle the problem of malnutrition before it occurs and progresses into chronic malnutrition which can only be treated medically. It focuses on raising awareness on what foods are necessary for the body to gain the nutrients which their body needs in order to function. It is a means of educating members of a community who then have the ability to empower generations that follow with the knowledge which they have gained in order to change their lifestyles.Nar4 (talk) 02:05, 18 November 2008 (UTC) Nutritional education is especially beneficial for communities which lack a health system that can support medical nutrition.

In recent years many foods, such as Spirulina and peanut butter, have been developed or refined for mass-production in hopes of combatting malnutrition and its effects. See IIMSAM and Plumpy'nut for more on these efforts.

Breast-feeding advice, food supplements and better hygiene all make a big difference. Most countries know what to do and run pilot programs that work. But they rarely find the money for full-scale national efforts; the international outfits that might help are, in the words of the medical journal,The Lancet, fragmented and dysfunctional.

According to The Lancet's research, money for improving nutrition would be the most effective sort of aid. Aid in the form of money is much more beneficial for a developing country due to the various options it provides such as nutritional education. Compared to other types of aid such as food, money can bestow the possibility of a long term future if used in the right way. At the moment, roughly $300 million of aid goes to basic nutrition each year, less than $2 for each child below two in the 20 worst affected countries. In contrast, HIV/AIDS, which causes fewer deaths than child malnutrition, received $2.2 billion—$67 per person with HIV in all countries, including rich ones.^[2]

Statistics

Number of undernourished people (million) in 2001-2003, according to the FAO, the following countries had 5 million or more undernourished people [1]:

Country	Number of Undernourished (million)
India	217.00
China	150.0
Bangladesh	43.1
Democratic Republic of Congo	37.0
Pakistan	35.2
Ethiopia	31.5
Tanzania	16.1
Philippines	15.2
Brazil	14.4
Indonesia	13.8
Vietnam	13.8
Thailand	13.4
Nigeria	11.5
Kenya	9.7
Sudan	8.8
Mozambique	8.3
North Korea	7.9
Yemen	7.1
Madagascar	7.1
Colombia	5.9
Zimbabwe	5.7
México	5.1
Zambia	5.1
Angola	5.0

Note: This table measures "undernourishment", as defined by FAO, and represents the number of people consuming (on average for years 2001 to 2003) less than the minimum amount of food energy (measured in kilocalories per capita per day) necessary for the average person to stay in good health while performing light physical activity. It is a conservative indicator that does not take into account the extra needs of people performing extraneous physical activity, nor seasonal variations in food consumption or other sources of variability such as inter-individual differences in energy requirements.

Malnutrition and undernourishment are cumulative or average situations, and not the work of a single day's food intake (or lack thereof). This table does not represent the number of people who "went to bed hungry today."

The U.S. Department of Agriculture reported that in 2003, only 1 out of 200 U.S. households with children became so severely food insecure that any of the children went hungry even once during the year. A substantially larger proportion of these same households (3.8 percent) had adult members who were hungry at least one day during the year because of their households' inability to afford enough food.[2]

Climate Change and Malnutrition

With 95% of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics, climate change is of great importance to food security in these regions. According to the latest IPCC reports, temperature increases in these regions are "very likely."^[18] Even small changes in temperatures can lead to increased frequency of extreme weather conditions.^[19] Many of these have great impact on agricultural production and hence nutrition. For example, the 1998-2001 central Asian drought brought about an 80% livestock loss and 50% reduction in wheat and barley crops in Iran.^[20] Similar figures were present in other nations. An increase in extreme weather such as drought in regions such as Sub-Saharan would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productiveness of many crop species, also decreasing food security in these regions.^[21]

Overnourished vs undernourished

In 2006, Professor Popkin from the University of North Carolina, said there were now more overweight people across the world than undernourished people.^[22] He told the International Association of Agricultural Economists the number of overweight people had topped one billion (of which 300 million are obese), compared with 800 million undernourished.^[23] He added this transition from a starving world to an obese one was accelerating.

See also

• List of countries by percentage of population suffering from undernourishment
• Anorexia nervosa
• Auxology
• Cachexia
• Copenhagen Consensus
• Dehydration
• Essential nutrient
• Famine
• Famine response
• Food price crisis
• Hunger
• Illnesses related to poor nutrition
• Nutrition
• NutritionDay
• Plumpy'nut
• Poverty
• List of famines
• United Nations World Food Programme
• Food
• Underweight

References

External links

• Action Against Hunger - Giving the most basic of Human Rights - The right to Food
• The CE-DAT Complex Emergency Database - A source of data on malnutrition and mortality in conflict-affected populations
• A Life Saver Called "Plumpynut", CBS 60 Minutes, October 21, 2007
• MSF Warns More Food Will Not Save Malnourished Children Group Calls for Increased and Expanded Use of New, Innovative Nutritional Products
• Micro-algae Algosophette
• Intergovernmental Institution for the use of Micro-algae Spirulina Against Malnutrition (IIMSAM)
• Reports on World Nutrition Situation The annual reports prepared by UN Standing Committee on Nutrition contain detailed information on common challenges, extent of malnutrition, efforts being taken to address them, and a wealth of other useful information.
• Physical Growth & Nutritional status
• World Hunger Map (from United Nations World Food Programme)
• FAO country statistics
• HungryKids Info on malnutrition from HungryKids
• Fighting Hunger and poverty in Ethiopia (Peter Middlebrook)
• Meds & Food for Kids - Fighting malnutrition in Haiti one child at a time.
• Malnutrition
• And why not Spirulina as solution?
• GAIN - Global Alliance for Improved Nutrition
• School Feeding Programs for Children Interviews with World Food Programme officials about the status of school feeding programs for children in developing countries

v • d • e Nutrition disorders (E40-68, 260-269) Hypoalimentation/ malnutrition Protein-energy malnutrition Kwashiorkor · Marasmus · Catabolysis Avitaminosis B vitamins B1: Beriberi/Wernicke's encephalopathy · B2: Ariboflavinosis · B3: Pellagra · B6: Pyridoxine deficiency · B7: Biotin deficiency · B9: Folate deficiency · B12: Vitamin B12 deficiency Other vitamins A: Vitamin A deficiency/Bitot's spots · C: Scurvy · D: Rickets/Osteomalacia · E: Vitamin E deficiency Mineral deficiency Zinc deficiency · Iron deficiency · Magnesium deficiency · Chromium deficiency · Selenium deficiency (Keshan disease) Hyperalimentation Obesity Obesity hypoventilation syndrome Vitamin poisoning Hypervitaminosis A · Hypervitaminosis D · Hypervitaminosis E Mineral overload see inborn errors of metal metabolism, toxicity