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Malnutrition

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What is malnutrition?

Malnutrition is a term used to refer to any condition in which the body does not receive enough nutrients for proper function or a deficiency of certain vital nutrients in a person's diet. People who do not have enough food or who eat too much of the wrong type of food are malnourished or are undernourished.

  • Malnutrition may range from mild to severe and life-threatening.
  • It can be a result of starvation, in which a person has an inadequate intake of calories, or it may be related to a deficiency of one particular nutrient (for example, vitamin C deficiency).
  • Malnutrition can also occur because a person can not properly digest or absorb nutrients from the food they consume, as may occur with certain medical conditions.
  • Malnutrition remains a significant global problem, especially in developing countries.
  • Malnutrition commonly affects children and the elderly.
  • Undernutrition is an important determinant of maternal and child health, accounting for more than a third of child deaths and more than 10 percent of the total global disease burden according to 2008 studies.
  • Starvation is a severe deficiency in caloric energy intake, below the level needed to maintain an organism's life. It is the most extreme form of malnutrition.
    • As the definitions of starving and malnourished people are different, the number of starving people is different from that of malnourished. Generally, far fewer people are starving, than are malnourished.
    • Causes of hunger are related to poverty. There are inter-related issues causing hunger, which are related to economics and other factors that cause poverty. They include land rights and ownership, diversion of land use to non productive use, increasing emphasis on export oriented agriculture, inefficient agricultural practices, war, famine, drought, over fishing, poor crop yield, etc.
    • The basic cause of starvation is an imbalance between energy intake and energy expenditure. In other words, the body expends more energy than it takes in.
  • Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions.

Causes/Risks

  • Malnutrition can be caused by an unbalanced diet, insufficient food, or unhealthy foods.
  • Malnutrition also can be the result of an eating disorder, organ failure, severe infection, or physical trauma such as a head injury.
  • Major causes of malnutrition include poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors.
  • Diseases: Malnutrition was previously seen as something that exacerbates the problems of diseases such as measles, pneumonia and diarrhea, but malnutrition actually causes diseases, and can be fatal in its own right.
    • Malnutrition can be a consequence of health issues such as gastroenteritis[47] or chronic illness, especially the HIV/AIDS pandemic.
    • Diarrhea and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss.
      • A leading cause of diarrhea and intestinal worm infections in children in developing countries is lack of sanitation and hygiene.
    • Parasite infections, in particular intestinal worm infections (helminthiasis), can also lead to malnutrition.
    • People may become malnourished due to abnormal nutrient loss (due to diarrhea or chronic illness affecting the small bowel), such as Crohn’s disease or untreated coeliac disease.
  • Gender Issues: Women have unique nutritional requirements, and in some cases need more nutrients than men; for example, women need twice as much calcium as men.
    • Women in some societies are traditionally given less food than men since men are perceived to have heavier workloads.
    • During pregnancy and breastfeeding, women must ingest enough nutrients for themselves and their child, so they need significantly more protein and calories during these periods, as well as more vitamins and minerals (especially iron, iodine, calcium, folic acid, and vitamins A, C, and K)
  • Elderly Issues: Malnutrition frequently occurs in the older adult population, especially in those with dementia or Alzheimer’s disease. Approximately 14 percent of nursing home residents and upwards of 50 percent of rehab facility patients are malnourished.
    • Changes in body composition, organ functions, adequate energy intake and ability to eat or access food are associated with aging, and may contribute to malnutrition.
    • Many elderly people require assistance in eating, esp. related to changes in body function (handicaps, illness, paralysis, etc).
    • Sadness or depression can play a role, causing changes in appetite, digestion, energy level, weight, and well-being.
    • They forget to eat or how to feed themselves or if at home, finances may contribute to food choices (less nutritious foods may be less expensive).
    • Poor dental health, ill-fitting dentures, or chewing and swallowing problems can make eating difficult.
    • A study on the relationship between malnutrition and other conditions in the elderly found that malnutrition in the elderly can result from gastrointestinal and endocrine system disorders, loss of taste and smell, decreased appetite and inadequate dietary intake.
  • Malnutrition can cause or exacerbate any of the following:
    • high cholesterol, anemia, beriberi, pellagra, scurvy, rickets, diabetes, obesity, hypertension, osteoporosis, weakness, heart and artery disease, goiter, night blindness, high blood pressure, immune deficiency, liver disease, atherosclerosis, constipation, cognitive impairment, and hyperactivity.
    • Among other problems, malnutrition puts an added strain on the heart, puts the kidneys at risk because of the much higher likelihood of getting diabetes, which can also bring blindness. It interferes with breathing and may bring on sleep-apnea. It puts extra strain on the skeleton, the muscles and joints. It increases the chance of acid reflux. It causes problems in the legs' veins, sometimes bringing skin ulcers. It puts a strain on the liver due to localized fat buildup and can cause cirrhosis or liver-failure.

Symptoms

  • 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.
  • cheeks will appear hollow and the eyes sunken as fat disappears from the face.
  • hair becomes dry and sparse, falling out easily
  • respiratory and heart failure
  • unresponsiveness

Treatment

  • Treatment for malnutrition depends on the underlying cause and how malnourished a person is. The underlying cause of the malnutrition may also need to be treated.
  • In response to child malnutrition, the Bangladeshi government recommends ten steps for treating severe malnutrition.
    • They are to prevent or treat dehydration, low blood sugar, low body temperature, infection, correct electrolyte imbalances and micronutrient deficiencies, start feeding cautiously, achieve catch-up growth, provide psychological support, and prepare for discharge and follow-up after recovery. Among those who are hospitalized, nutritional support improves protein, calorie intake and weight.

Food

  • Specially formulated foods do appear useful for those from the developing world with moderate acute malnutrition.
    • In young children with severe acute malnutrition it is unclear if ready-to-use therapeutic food differs from a normal diet. They may have some benefits in humanitarian emergencies as they can be eaten directly from the packet, do not require refrigeration or mixing with clean water, and can be stored for years.
    • In those who are severely malnourished, feeding too much too quickly can result in refeeding syndrome. This can result regardless of route of feeding and can present itself a couple of days after eating with heart failure, dysrhythmias and confusion that can result in death

Micronutrients

  • Fortifying foods with micronutrients (vitamins and minerals), improves lives at a lower cost and shorter time than other forms of aid, according to the World Bank. The Copenhagen Consensus, which look at a variety of development proposals, ranked micronutrient supplements as number one.

In those with diarrhea

  • The World Health Organization (WHO) recommends rehydrating a severely undernourished child who has diarrhea relatively slowly. Once an initial four-hour rehydration period is completed, zinc supplementation is recommended. Daily zinc increases the chances of reducing the severity and duration of the diarrhea and continuing with daily zinc for ten to fourteen days makes diarrhea less likely recur in the next two to three months.
    • In addition, malnourished children need both potassium and magnesium which can be obtained by following the above recommendations for the dehydrated child to continue eating within two to three hours of starting rehydration.
  • A malnourished child with diarrhea, from any cause, should receive foods rich in potassium such as bananas, green coconut water, and unsweetened fresh fruit juice.

Statistics & Mortality:

  1. World Health Rankings: Malnutrition (Lists Death Rate per 100,000 for 183 Countries worldwide -- from #1 Somalia, with the most, to #181-183 Belarus, Moldova, & Singapore with NONE)
  • Malnutrition affects people in every country.
  • According to the World Health Organization (WHO), malnutrition is the gravest single threat to global public health and it contributes to 45 percent of deaths of children ages 5 and under. In addition, 462 million people worldwide are malnourished, and stunted development due to poor diet affects 159 million children globally.
  • Around 1.9 billion adults worldwide are overweight, while 462 million are underweight.
  • An estimated 41 million children under the age of 5 years are overweight or obese, while some 159 million are stunted and 50 million are wasted.
  • There are 528 million or 29% of women of reproductive age around the world affected by anemia, for which approximately half would be amenable to iron supplementation.
  • There are an estimated 3 million malnourished people in the UK at any time, with many more at risk of becoming malnourished..
  • Mortality due to malnutrition accounted for 58 percent of the total mortality in 2006
  • One in twelve people worldwide is malnourished and according to the Save the Children 2012 report, one in four of the world’s children are chronically malnourished.
  • In 2006, more than 36 million died of hunger or diseases due to deficiencies in micronutrients.
  • In 2010 protein-energy malnutrition resulted in 600,000 deaths down from 883,000 deaths in 1990.
  • Other nutritional deficiencies, which include iodine deficiency and iron deficiency anemia, result in another 84,000 deaths.
  • In 2010 malnutrition caused about 1.5 million deaths in women and children.
  • Six million children die of hunger every year.
  • Underweight births and intrauterine 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.
  • Malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower education achievement. Their own children tend to be smaller.
  • The World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide, about 1 million children. Another estimate also by WHO states that childhood underweight is the cause for about 35% of all deaths of children under the age of five years worldwide.
  • Maternal malnutrition can also factor into the poor health or death of a baby. Over 800,000 neonatal death have occurred because of deficient growth of the fetus in the mother's womb.
  • In 2015 we see that only one country, Haiti, has greater than 50 percent of the population defined as undernourished. In 1991, there were nine countries with more than half of the population undernourished.
  • Today, the majority of countries have prevalence levels below 35 percent, with the highest prevalence across Sub-Saharan Africa (particularly in the East) and a number of countries across Asia. In 1991, only a select number of developing countries had undernourishment levels <5%. In 2015, many countries achieved this, particularly across Latin America, the Middle East and North Africa.
  • In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission.
  • Researchers from the Centre for World Food Studies in 2003 found that the gap between levels of undernutrition in men and women is generally small, but that the gap varies from region to region and from country to country.
  • Total starvation can be fatal within 8 to 12 week.
    • 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.

Notable people who died of malnutrition

  1. Ranker’s list of famous people who died of malnutrition
  • H. P. Lovecraft - (1890-1937) In early 1937, he was diagnosed with cancer of the small intestine and suffered from malnutrition as a result. He lived in constant pain until his death on March 15, 1937 in Providence.
  • Kurt Friedrich GÖDEL - (1906-1978) One of the most important and influential logicians in history, Kurt Gödel was obsessed with people poisoning him, and would therefore refuse to eat any food that wasn't made by his wife, Adele. Unfortunately, she became sick and was hospitalized for six months. Unable to feed him, Gödel refused to eat anything, starving himself to death. He weighed only 65 (About 30 kg) pounds when he died.
  • Marie Prevost - (1898-1937) a famous silent film actor from the 1910's, 20's and 30's, became a severe alcoholic and began gaining weight dramatically after her mother died in 1926 and after being let go from Warner Brothers. Her weight gain kept Prevost from snagging lead roles, and her declining career only made the weight gain and drinking worse. She began to crash diet to be accepted for small bits and died from starvation and acute alcoholism in 1937 at the age of 38.
  • Juan Sebastiàn ELCANO DEL PUERTO - (1476-1526) was a famous Spanish explorer in the 16th century, who completed the first circumnavigation around the globe in 1522. In 1525, he set sail on the Loaisa Expedition, destined for the East Indies. It was in the Pacific Ocean that he and several other crew members died of malnutrition.
  • Anneliese Michel - (1952-1976) a Catholic-American who underwent 67 exorcisms a year after being diagnosed with epilepsy as a child and after seeking psychiatric help for depression and hearing demonic voices. Her parents stopped seeking medical and psychiatric treatment, relying solely on the exorcisms. She died in 1976, weighing only 68 pounds, and was in a semi-starvation state for most of the year because of the exorcisms. Additionally, she had been suffering from pneumonia, and the day before she died had broken both knees from continuously kneeling on the ground. (Wikipedia - Anneliese Machel)

References and Additional Reading

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