Malnutrition Causes, Effects and Treatment                

The things which come in our mind when we listen about malnutrition are starvation, poverty, and food insecurity but overweight and obesity are also increasingly becoming major public health issues all over the world. In developed countries like United States obesity is common due to an unhealthy diet. The obesity rate in the US is highest in the world. Around 160 million people in the US are obese or overweight. In China (46 million) and India (30 million) people are obese.

The malnutrition problem is so common that 795 million people suffered from chronic undernourishment between 2014 and 2016. Around 1.9 billion adults were overweight and 600 million were suffered from obesity.

 

According to WHO the co-existence of undernutrition and overweight is called the double burden of malnutrition. The imbalance in nutrients and minerals can weaken immunity power and body can be prone to many diseases.

What do you mean by malnutrition?

A person is said to be malnourished when there is inadequate, imbalance or deficiency of energy and nutrients in his or her diet. Mal-nutrition causes various health problems. There are two broad categories of malnutrition. Under-nutrition is a type of malnutrition where there is comparatively lack of nutrients or energy in the diet than what is normally required for a healthy person. Stunting, wasting, underweight and deficiencies (in minerals and vitamins) are various variants of under-nutrition. Overweight, obesity and diet which cause communicable diseases form part of over-nutrition. In the case of over-nutrition the amount of supply of nutrients or minerals exceeds the amount required for normal growth and development of the body.

What are the causes of malnutrition?

Development of malnutrition depends on availability, accessibility, affordability of nutritious food and various lifestyle habits. The type of malnutrition and its causes vary from one region of the earth to another region. For example, in the least and poor nations, lack of food is the main cause behind undernutrition.

 

In case of the developed world, even though there is an availability of adequate food and calorie but still poor diet may not have essential vitamins and minerals required for the healthy body. Earlier over-nutrition was seen a problem in the developed world but due to an unhealthy lifestyle, it is also becoming a major problem in developing world too.

 

According to the World Health Organization (WHO) out of 3 persons, one person lack at least one or more essential nutrients worldwide. The deficiency of vitamins and minerals cause harm to the body. For example deficiency in vitamin C causes Scurvy, iron deficiency causes anemia and iodine deficiency causes hypothyroidism.

 

The fast-food culture, processed food, snacks, high-fat food and lack of physical exercise contribute to weight gain and hence obesity. Poor people are also increasingly becoming overweight because they buy and take economically cheap processed and fast food which have high calorie.

 

Because of the hectic schedule and increasing, urbanization people prefer to buy readymade food than cooking at home. This behavior pattern is increasing at an exponential rate around the whole world. People are more comfortable buying low-cost food (although high in calorie) but lacking in essential minerals.

The increased globalization and liberalization are also changing food habits across the world. There is an increase of saturated fats, sugars, refined oils and less intake of fibrous food in daily diets. This growing trend is dangerous to public health.

Lack of affordable health services, unsafe drinking water, and poor hygienic conditions and inadequate care lead to under-nutrition. The infants and young children may suffer from under-nutrition if no proper breastfeeding is done.

On the time of natural calamities like floods, earthquake and other emergencies like conflict, war and ethnic clashes, the access to food are disrupted, crops and food are destroyed which leads to food insecurity.

Who is at more risk of under-nutrition?

Poor people, homeless, old citizens, refugees, psychiatric patients, infants, pregnant women, adolescents and people suffering from serious illness are more prone to the condition of undernutrition.

Many disorders like mala-absorption, depression, cancer, dental diseases may contribute to under-nutrition. Some drugs taken to treat diseases may contribute to under-nutrition because they decrease appetite, increase metabolism rate and hinder the absorption of the nutrients. People who drink too much alcohol may develop under-nutrition because it prevents the absorption of the nutrients in the body. Too much smoking may also contribute to it.

What is protein-energy under-nutrition?     

Deficiency of protein and calorie in a diet for a long time for any age group can result in protein-energy under-nutrition. However, it is more common in the children of poor nations. The children require more energy for their growth and development which is not available to them. Due to this type of under-nutrition, many infectious diseases are developed in children. More than half of the children die because of this. Marasmus disease can occur due to inadequate intake of both protein and energy, while Kwashiorkor is mainly caused by inadequate protein intake.

What are the effects of under-nutrition?

When required calories are not met from daily diet, the body uses stored fat for performing different functions. If stored fat is used the tissues like muscles and other tissues in organs are broken this can also lead to death.

Under-nutrition during pregnancy can have a permanent physical and mental problem. Extreme under-nourishment (starvation) can lead to short height, thin body, swelling of legs and abdomen. In children due to lack of proper breastfeeding diseases like pneumonia, malaria and measles may develop. Disturbance in the menstruation cycle may occur.

In poor countries protein, energy under-nutrition is common in children because they require more energy for their growth and development. In the short term the effects may be recurring illness, tiredness, slow growth, poor appetite, low weight, bones are protrude and hair fall. While long term effects can be short height or stunting, poor memory, and low birth weights of newborn babies.

What are the effects of over-nutrition?

Overconsumption of food and nutrients beyond required level is called over-nutrition. The over-nutrition may result in obesity which can cause serious non-communicable diseases like heart diseases, hypertension, and cancer and type-2 diabetes. The studies have shown that obesity can develop various type of cancer like oesophagus, colon, pancreas, breast, and kidney.Sometimes oversupply of micronutrient for a long time can lead to poisoning.

 

The obesogenic culture across the globe is on the rise. This environment encourages people to eat a healthy diet containing high calorie without having enough physical exercises. This promotes high energy intake and low energy expenditure. People take lifts and escalators instead of staircases. The public places are full of shops selling burgers, sugary drinks, and sweets. Obesity affects more than 500 million people worldwide and is the leading contributor to the burden of diseases in the US. Obesity causes chronic diseases like cardiovascular, diabetes and cancers which are the major cause of mortality and morbidity. 

 

The atherogenic diet which is rich in trans and saturated fat, cholesterol, sodium, sugar and poor in fibers, PUFA and MUFA increases the risk of heart attack. Consuming too much fat, protein and carbohydrates can increase cholesterol and high blood pressure, therefore, increasing the risk of heart disease.

 

If fat-soluble vitamins like A, D, E, and K are used in excessive amount then they can accumulate to toxic levels. If vitamin A is consumed very much than required level then it can lead to blurred vision, dizziness and birth effects. Excessive water-soluble vitamins can also create a problem like a kidney stone (due to excess of vitamin C), Niacin can cause flashing and the large amount of B-6 can damage nerves. 

How malnutrition affects children and pregnant women?

Children less than 3 years of age, pregnant and lactating women are at more risk due to malnutrition. Malnutrition is the main cause of child mortality (under 5 years of age). The ill effects of malnutrition include mental impairment, low IQ level, wasting, stunting, and deficiency in iron, vitamin A and iodine. Lack of vitamin A causes many cases of blindness in children every year. Lack of iodine can cause stunted height, mental delays, and goiters. Children suffering under-nutrition are more vulnerable to HIV/AIDS infection because they already have low immunity. 

Maternal malnutrition leads to premature births, low weight infants, postpartum and maternal mortality. The poor development of girl child because of malnutrition passes this ill to next generations. Iron deficiency can increase the risk of hemorrhaging during childbirth.

Which nations are most hit by under-nutrition?

It is more common in poor nations of sub-Saharan Africa and South Asia. Almost 2/3rd people suffering from under-nutrition are from just seven countries, India, Pakistan, China, Indonesia, Ethiopia, and the Democratic Republic of Congo. Due to harsh climatic conditions in the sub-Saharan region, the food production is very less to meet the demand of the local people. The war and conflict areas face a shortage of food and many people suffer from under-nutrition.

How to diagnose malnutrition?

Malnutrition can easily be diagnosed by appearance, information about diet, height and weight, mid-upper arm diameter measurement and measuring body mass index (BMI). The blood test can be done to find the level of albumin and white blood cells. The skin test can be performed to check the immune system. Different nutrients deficiency can be known by blood tests.

How to treat under-nutrition?

Dietary monitoring and tracking food consumption at population may help in addressing the problem of malnutrition. Patients are given food in an incremental way. Initially, small diets are given then the amount of food is increased. People having problem in digesting solid food are given liquid diet. Those who cannot eat through mouth then help of the tube can be used. Depending on the situation vitamin and minerals supplements can be given.

How does obesity develop?

Body Mass Index (BMI) is used to determine obesity or overweight. People having BMI between 25 and 30 are said to be overweight while BMI equal or over 30 lead to obesity. When BMI exceeds 23 risks associated with heart, diabetes, cancer, osteoarthritis and kidney increases. Obesity can develop when there is excessive consumption of food which is rich in calorie, carbohydrate, and fat but there is no adequate physical exercise to burn the extra fat. To avoid obesity more fruits and vegetables should be included in the diet and junk foods should be avoided.

What is the obesity rate in the US among adults?

Adults are most affected by obesity. The obesity rate was 39.8% in the US (2015-16) and affected 93.3 million adults. The obesity rate was 35.7% among adults (20-39 years), 42.8% among middle-aged adults and 41.0% among people older more than 60 years. The annual cost due to obesity in the US was around $147 in 2008.

The nature of malnutrition is global and a threat to healthy life and workforce. Malnutrition affects individually and socially and works as a hurdle for growth and development. Countless productive hours are lost. It is multi-factor problem caused by poverty, lack of education, unplanned urbanization, poor health services, and individual behavior. The burden of malnutrition on India is huge. For example, 45 % of children under 5 years of age are stunted and more than 70% are anemic. Due to poor diet and hygiene and lack of sanitation in slums of India diseases like obesity, dyslipidemia and diabetes are developing.

 

Urban women are more obsessed than rural women. Children living in poor regions where are susceptible to underweight and wasting. Stunting and underweight are common problems in undernourished children. Infants and young children suffer from under-nutrition due to continuous vomiting and diarrhea.

 

Every country is affected by one or more forms of malnutrition. Combating all forms of malnutrition from the whole globe is a very daunting task. The UN Decade of Action on nutrition calls for a multidimensional approach. It calls for creating a healthy food system, awareness about healthy diet and social protection for all people. The trade and investment policies should be aimed at healthy nutritious products. The problem of malnutrition can be solved if healthy foods are made available at affordable prices to poor, people adopt healthy lifestyles and good public health services are made available.