Malnutrition

Malnutrition Classification and external resources
The orange ribbon—an awareness ribbon for malnutrition.
eMedicine	ped/1360
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]

In addition to infant mortatlity risks, lifelong malnutrition can begin in utero and is typically associated with the mother's stature (associated with her childhood nutritional status), her nutritional status prior to conception, and diarrheal disease, intestinal parasites, and/or respiratory infection status. Multiple studies have shown that nutritional status of adults is substantially influenced by their nutritional experience from conception through early childhood. Even if individuals have had adequate nutrition from childhood on, their health outcomes are still impacted ^[3]

Terminology and classification

An individual will experience malnutrition if the appropriate amount of, or quality of nutrients comprising a healthy diet are not consumed.^[4] An extended period of malnutrition can result in starvation, disease, and infection.

Although hunger and malnutrition are often used interchangibly, hunger is properly conceived of as the feeling in the stomach while malnutrition is the physiological condition where there is not the right amount of nutrients and minerals for physiological development and maintenance.

Most press coverage and public attention are often paid to episodes of severe hunger and malnutrition, such as famines, but chronic hunger and malnutrition are in fact much more prevelant ^[5].

While chronic malnutrition and hunger is typically most prevalent in "developing" countries, one often underappreciated fact is that malnutrition is still widely prevalent in "developed" countries such as the United States. Hunger and malnutrition in the U.S.A. is deeply influenced by poverty, cultural beliefs about poverty and government assistance, and by cultural eating patterns. Many of the poor live in food desert areas--where access to food is problematic--and they struggle with steady income to provide steady nutrition (often being forced to make tradeoffs, like paying rent instead of getting good food). In addition, many of the poor follow dominant U.S. cultural ideas and practices that include consumption of highly processed, calorie dense, and nutrient poor foods. The prevalence of the compounding problems of obesity and malnutrition in poor communities has been attributed to this combination of political-economic and cultural factors ^[6].

The causes of malnutrition are complex. Lack of Food security in impoverished communities creates paradoxical circumstances that can lead to malnutrition and hunger but also overnutrition and obesity. Thus there is a double burden of malnutrition caused by the interrelationship of hunger, poverty, and food insecurity ^[7]

One study argues that social, cultural, economic, and family genetic interactions should not be considered separately when confronting malnutrition. They found that the appearance of discretionary income in poor households can be an indicator for risk of undernutrition, overnutrition, and nutrient imbalance. Without stable levels of discretionary income people tend to be undernourished, but simply adding one dollar of discretionary income can lead to obesity problems if people try to emulate eating habits of a new culture or the perceived eating habits of wealthier social groups. Thus, education and access to healthy food choices also become important ^[8]

Overnutrition

The term can also encompass overnutrition,^[9] resulting from overeating or excessive intake of specific nutrients.

A related term is hyperalimentation.

Politics

Survivors of Mauthausen-Gusen concentration camp after the liberation

As of 2008^[update], malnutrition continues to be a worldwide problem, particularly in lesser developed countries^[10]. 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.^[11] 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;^[12] 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. 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. ^[13]

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.^[14] In 2006, more than 36 millions died of hunger or diseases due to deficiencies in micronutrients"^[15]. 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. ^[16]

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.^[17]

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.^[18] This pattern is seen in many animals, including humans while sleeping.^[19] It even occurs in rats with their cerebral cortex or stomachs completely removed.^[20] Increased activity on hamster wheels occurred when rats were deprived not only of food, but also water or B vitamins such as thiamine^[21] 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.^[19]

Socio-political Causes of Malnutrition

In the late eighteenth and early nineteenth century, the English economist Thomas Malthus noted how increases in food production were likely to occur along a slow arithmetic progression due to the law of diminishing returns while population growth follows much faster, geometric progressions. His theory argued that this lag in productivity caused food shortages, that it would lead to famines worldwide as humans surpassed the carrying capacity of the land, and that it would create checks on socio-cultural systems in the forms of poverty and misery as humans would earn and live off of just enough to subsist and survive. This Malthusian argument has long since been refuted on several grounds but has none the less served as a backdrop for understanding of the causes of malnutrition.

The actual causes of malnutrition can be varied and complex and are difficult to encapsulate in a single theory. Certainly, as Malthus suggests, lack of agricultural productivity combined with increases in population can cause and are often correlated to malnutrition. Over-cultivation, overgrazing, and deforestation lead to desertification or otherwise impoverished soils that can not support crops or cattle for subsistence agriculture ^[22] but this scenario only accounts for malnutrition in certain, specific instances and does not consider larger social issues such as the influence of political inequality. Further, malnutrition can stem from impacts of natural disasters, from the results of conflict and war, as an impact of the HIV/AIDS pandemic ^[23] as a consequence of other health issues such as diarrheal disease or chronic illness [1] from lack of education regarding proper nutrition, or from countless other potential factors.

Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community may be at risk if it lacks health-related services, but on a smaller scale certain households or individuals may be at even higher risk due to differences in income levels, access to land, or levels of education ^[24]. Also within the household, there may be differences in levels of malnutrition between men and women, and these differences have been shown to vary significantly from one region to another with problem areas showing relative deprivation of women ^[25]. Children and the elderly tend to be especially susceptible. Approximately 27 percent of children under 5 in developing world are malnourished, and in these developing countries, malnutrition claims about half of the 10 million deaths each year of children under 5.

Often the consequences of malnutrition exacerbate its causes and form a vicious downward spiral. For example, in cases of malnourishment, lack of sufficient nutrients can weaken the immune system and invite infectious disease ^[26] , and by compromising digestive function, many of these diseases can intensify malnutrition. In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem. Lower energy and impaired function of the brain also represent the downward spiral of malnutrition as victims are less able to perform the tasks they need to in order to acquire food, earn an income, or gain an education.

Since the time of Malthus, various new theories and approaches have developed for understanding the truly complex mechanisms and underlying causes of malnutrition. Most famous among recent theorists is the Indian economist and philosopher Amartya Sen whose breakthrough 1981 book Poverty and Famines: An Essay on Entitlement and Deprivation went beyond the Malthusian argument that lack of food production led to hunger and demonstrated that malnutrition and famine were more related to problems of food distribution ^[27] A person’s entitlements, according to Sen, are “commodity bundles that a person in society can command using the totality of rights and opportunities that he or she faces,” (p.8) and famine can then be described as a collapse of entitlements for a certain segment of society and the failure of the state to protect those entitlements. Similar to the idea of market failure, Sen would describe the inability of individuals to acquire sufficient food through trade as an exchange entitlement failure. Despite wide spread acceptance, Sen’s theories have also been subject to various criticisms, and an assortment of new or revised approaches have been used and suggested. --Raboin (talk) 17:52, 4 December 2008 (UTC)

Responses to Malnutrition

Societal responses to malnutrition vary depending upon which “cause” one subscribes to. While most responses are targeted to address under nutrition, there are several that also respond to over nutrition.

If the principal cause of malnutrition is that humans have populated the earth (or a specific geographic region) beyond its carrying capacity, then a restricted population size is the solution. This is an argument that is espoused by people of both liberal and conservative persuasions. In the late 1700’s, Thomas Malthus originally argued that nothing could be done as only natural disasters could check population growth, but he later included the possibility of voluntary limits through “moral restraint.”^[28]1 More recently, Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth.^[29] Garret Hardin takes an anti-immigration, isolationist approach arguing that “…all sovereign states must accept the responsibility of solving their population problems in their own territories.”^[30] Hardin also asserts that immigration acts as a sort of pressure release valve which allows countries to continue to ignore solving their population problems.

Others, Amartya Sen among them argue that other social and economic factors, such as declining wages, unemployment, rising food prices, and poor food-distribution systems, rather than population numbers per se, lead to malnutrition and in severe cases famine. For Sen, “no matter how a famine is caused, methods of breaking it call for a large supply of food in the public distribution system. This applies not only to organizing rationing and control, but also to undertaking work programmes and other methods of increasing purchasing power for those hit by shifts in exchange entitlements in a general inflationary situation.”^[31]

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.

One policy adopted in recent decades to alleviate world malnutrition is direct humanitarian aid in the form of food. For the rich donor countries, this is a way to reduce domestic 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 high. Food aid may be provided for short-term emergencies (natural disasters or human-made like war) or in the form of a long-term program for an extended period. For recipient countries, 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.

Neoliberals advocate for an increasing role of the free market. 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.

There are several different technical 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 that focuses on raising awareness on what foods are necessary for the body to gain the nutrients needed to function. In recent years many foods, such as Spirulina and peanut butter, have been developed or refined for mass-production in hopes of combating malnutrition and its effects. See IIMSAM and Plumpy'nut for more on these efforts.

Statistics

Percentage of population affected by undernutrition by country, according to United Nations statistics.

Number of undernourished people (million) in 2001-2003, according to the FAO, the following countries had 5 million or more undernourished people [2]:

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.[3]

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."^[32] Even small changes in temperatures can lead to increased frequency of extreme weather conditions.^[33] 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.^[34] 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.^[35]

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.^[36] 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.^[37] 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