Definition

Malnutrition is the condition that develops when the body does not get the right amount
of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and
organ function.

Description

Undernutrition

Malnutrition occurs in people who are either undernourished or overnourished.

Undernutrition is a consequence of consuming too few essential nutrients or using or
excreting them more rapidly than they can be replaced.

Infants, young children, and teenagers need additional nutrients. So do women who are
pregnant or breastfeeding. Nutrient loss can be accelerated by diarrhea, excessive
sweating, heavy bleeding (hemorrhage), or kidney failure. Nutrient intake can be
restricted by age-related illnesses and conditions, excessive dieting, food allergies, severe
injury, serious illness, a lengthy hospitalization, or substance abuse.

The leading cause of death in children in developing countries is protein-energy

malnutrition. This type of malnutrition is the result of inadequate intake of calories from
proteins, vitamins, and minerals. Children who are already undernourished can suffer
from protein-energy malnutrition (PEM) when rapid growth, infection, or disease
increases the need for protein and essential minerals. These essential minerals are known
as micronutrients or trace elements.

Two types of protein-energy malnutrition have been described-kwashiorkor and

marasmus. Kwashiorkor occurs with fair or adequate calorie intake but inadequate
protein intake, while marasmus occurs when the diet is inadequate in both calories and
protein.

About 1% of children in the United States suffer from chronic malnutrition, in

comparison to 50% of children in southeast Asia. About two-thirds of all the
malnourished children in the world are in Asia, with another one-fourth in Africa.

Causes

Poverty and lack of food are the primary reasons why malnutrition occurs in the United
States. Ten percent of all members of low income households do not always have enough
healthful food to eat. Protein-energy malnutrition occurs in 50% of surgical patients and
in 48% of all other hospital patients.

Loss of appetite associated with the aging process. Malnutrition affects one in four
elderly Americans, in part because they may lose interest in eating. In addition, such
dementing illnesses as Alzheimer's disease may cause elderly persons to forget to eat.
There is an increased risk of malnutrition associated with chronic diseases, especially
disease of the intestinal tract, kidneys, and liver. Patients with chronic diseases like
cancer, AIDS, intestinal parasites, and other gastric disorders may lose weight rapidly and
become susceptible to undernourishment because they cannot absorb valuable vitamins,
calories, and iron.

People with drug or alcohol dependencies are also at increased risk of malnutrition. These
people tend to maintain inadequate diets for long periods of time and their ability to
absorb nutrients is impaired by the alcohol or drug's affect on body tissues, particularly
the liver, pancreas, and brain.

Eating disorders. People with anorexia or bulimia may restrict their food intake to such
extremes that they become malnourished.

Food allergies. Some people with food allergies may find it difficult to obtain food that
they can digest. In addition, people with food allergies often need additional calorie
intake to maintain their weight.

Failure to absorb nutrients in food following bariatric (weight loss) surgery. Bariatric
surgery includes such techniques as stomach stapling (gastroplasty) and various intestinal
bypass procedures to help people eat less and lose weight. Malnutrition is, however, a
possible side effect of bariatric surgery.

Symptoms

Unintentionally losing 10 pounds or more may be a sign of malnutrition. People who are
malnourished may be skinny or bloated. Their skin is pale, thick, dry, and bruises easily.
Rashes and changes in pigmentation are common.

Hair is thin, tightly curled, and pulls out easily. Joints ache and bones are soft and tender.
The gums bleed easily. The tongue may be swollen or shriveled and cracked. Visual
disturbances include night blindness and increased sensitivity to light and glare.

Other symptoms of malnutrition include:

• anemia
• diarrhea
• disorientation
• night blindness
• irritability, anxiety, and attention deficits
• goiter (enlarged thyroid gland)
• loss of reflexes and lack of muscular coordination
• muscle twitches
• amenorrhea (cessation of menstrual periods)
• scaling and cracking of the lips and mouth.
Malnourished children may be short for their age, thin, listless, and have weakened
immune systems.

Diagnosis

Overall appearance, behavior, body-fat distribution, and organ function can alert a family
physician, internist, or nutrition specialist to the presence of malnutrition. Patients may be
asked to record what they eat during a specific period. X rays can determine bone density
and reveal gastrointestinal disturbances, and heart and lung damage.

Blood and urine tests are used to measure the patient's levels of vitamins, minerals, and
waste products. Nutritional status can also be determined by:

• Comparing a patient's weight to standardized charts

• Calculating body mass index (BMI) according to a formula that divides height
into weight
• Measuring skinfold thickness or the circumference of the upper arm.

Prevention

Breastfeeding a baby for at least six months is considered the best way to prevent early-
childhood malnutrition. The United States Department of Agriculture and Health and
Human Service recommend that all Americans over the age of two:

• Consume plenty of fruits, grains, and vegetables

• Eat a variety of foods that are low in fats and cholesterols and contain only
moderate amounts of salt, sugars, and sodium
• Engage in moderate physical activity for at least 30 minutes, at least several times
a week
• Achieve or maintain their ideal weight
• Use alcohol sparingly or avoid it altogether.

Every patient admitted to a hospital should be screened for the presence of illnesses and
conditions that could lead to protein-energy malnutrition. Patients with higher-than-
average risk for malnutrition should be more closely assessed and reevaluated often
during long-term hospitalization or nursing-home care.

We've all seen news reports about people who are starving in countries plagued by war or
drought. Unfortunately, many people in the world go hungry because they can't get enough to
eat most of the time.

According to the UN World Food Programme, there are 400 million hungry children in the world
— that's more than the entire population of the United States. Children who are starving are
at risk of malnutrition, and malnourished kids don't develop normally.
What Are Hunger and Malnutrition?

We all feel hungry at times. Hunger is the way the body signals that it needs to eat. Once a
person is able to eat enough food to satisfy the body's needs, he or she stops being hungry.
Teens can feel hungry a lot because their rapidly growing and developing bodies demand extra
food.

People with malnutrition lack the nutrients necessary for their bodies to grow and stay
healthy. Someone can be malnourished for a long or short period of time, and the condition
may be mild or severe. Malnutrition can affect a person's physical and mental health. People
who are suffering from malnutrition are more likely to get sick; in very severe cases, they may
even die from its effects.

Kids who are malnourished don't grow as tall as they should (a condition referred to as
stunted growth) and they are underweight as well. (People can also become underweight
because they have an illness, and some are underweight because of their genes.)

What Causes Hunger and Malnutrition?

People suffer from hunger because they don't get enough food, and not getting enough food
over the long term can lead to malnutrition. But someone can become malnourished for
reasons that have nothing to do with hunger.

People who have plenty to eat may still be malnourished if they don't eat food that provides
the right nutrients, vitamins, and minerals.

Some people become malnourished because they have a disease or condition that prevents
them from digesting or absorbing their food properly. For example, someone with celiac
disease has intestinal problems that are triggered by a protein called gluten, which is found in
wheat, rye, barley, and oats. Celiac disease can interfere with the intestine's ability to absorb
nutrients, which may result in nutritional deficiencies.

People with cystic fibrosis have trouble absorbing nutrients because the disease affects the
pancreas, an organ that normally produces chemical substances called enzymes that are
necessary for digesting food. People who are lactose intolerant have difficulty digesting milk
and some other dairy products. By avoiding dairy products, they are at higher risk of
malnutrition because milk and dairy products provide 75% of the calcium in America's food
supply.
If you don't get enough of one specific nutrient, that's a form of malnutrition (although it
doesn't mean you will necessarily become seriously ill). The most common form of
malnutrition in the world is iron deficiency. The World Health Organization (WHO) estimates
that as many as 4 to 5 billion people — up to 80% of all people in the world — don't have
enough iron in their diets. Iron comes from foods like red meat, egg yolks, and fortified flour,
bread, and cereals.

Who Is at Risk for Hunger and Malnutrition?

No matter what country they live in, poor people are most likely to suffer from hunger and
malnutrition. In poor countries, natural disasters — such as the severe droughts that African
countries often experience — can contribute to malnutrition because they make it hard for
people to get the food that they need.

In the United States, food manufacturers fortify some common foods with vitamins and
minerals to prevent certain nutritional deficiencies. For example, the addition of iodine to salt
helps prevent some thyroid gland problems, the folic acid that's added to foods can help
prevent certain birth defects, and added iron can help prevent iron-deficiency anemia.

Malnutrition affects people of every age, although infants, children, and adolescents may
suffer the most because many nutrients are critical for growth. Older people may develop
malnutrition because aging, illness, and other factors can sometimes lead to a poor appetite,
so they may not eat enough.

Alcohol can interfere with nutrient absorption, so alcoholics may not benefit from the vitamins
and minerals they consume. People who abuse drugs or alcohol may also be malnourished or
underweight because they don't eat properly. If you know someone with anorexia, bulimia, or
another eating disorder, they're also at risk of malnutrition.

If you're on a special diet, you need to be careful about eating balanced meals and a variety of
foods to get the right nutrients. Vegetarians and vegans need to make sure they get enough
protein and vitamins like B12.

What Happens to Someone Who Is Malnourished?

Malnutrition harms people both physically and mentally. The more malnourished someone is —
in other words, the more nutrients they're missing — the more likely it is that person will have
physical problems. (People who are only slightly to moderately malnourished may show no
outward physical signs at all.)
The signs and symptoms of malnutrition depend on which nutritional deficiencies a person has,
although they can include:

• fatigue and low energy

• dizziness
• poor immune function (which can cause the body to have trouble fighting off
infections)
• dry, scaly skin
• swollen and bleeding gums
• decaying teeth
• slowed reaction times and trouble paying attention
• underweight
• poor growth
• muscle weakness
• bloated stomach
• bones that break easily
• problems with organ function

When a pregnant woman is malnourished, her child may weigh less at birth and have a
smaller chance of survival.

Vitamin A deficiency is the biggest cause of preventable blindness in the developing world.
Children in developing countries who have a severe vitamin A deficiency as a result of
malnutrition have a greater chance of getting sick or of dying from infections such as diarrhea
and measles.

Iodine deficiency, another form of malnutrition, can cause mental retardation, delayed
development, and even blindness in severe cases. Iron deficiency can cause a person to be
less active and less able to concentrate. Students who are malnourished often have trouble
keeping up in school.

What Can Doctors Do?

Fortunately, many of the harmful effects of malnutrition can be reversed, especially if a person
is only mildly or briefly malnourished. If you or your parents think you aren't getting enough
of the right nutrients, you can seek advice from your doctor, who may look for signs of
malnutrition in several ways. He or she will ask about how you are feeling, do a physical exam,
and probably ask about the types and amounts of food in your diet.

When checking for malnutrition, a doctor may do one of several things:

 • look at a person's height and weight or body mass index (BMI) to get an idea of
whether their weight is in the healthy range for their height and age
• use blood tests to check for abnormalities
• take X-rays or other types of images to look for signs of malnutrition in organs and
bones
• check for diseases or conditions that might be the underlying cause of malnutrition

To correct problems related to malnutrition, a doctor or dietitian will recommend specific

changes in the types and quantities of foods that a person eats. Sometimes he or she will
prescribe dietary supplements, such as vitamins and minerals. Other treatment may be
necessary for people who are found to have a specific disease or condition causing their
malnutrition.

Few teens in the United States and other developed nations suffer from serious malnutrition
like that seen in Third World countries. Over time, even people who are very finicky eaters
usually will get enough calories and nutrients to develop a healthy body. But if you're worried
that you're not eating right or you're not feeling as well as you should, talk about your
concerns with your parents, your doctor, or another trusted adult.
Philippines

SUMMARY

Protein-energy malnutrition (PEM) and micronutrient deficiencies remain the leading

nutritional problems in the Philippines. The general declining trend in the prevalence
of underweight, wasting and stunting among Filipino children noted in the past 10
years was countered with the increase in the prevalence rate in 1998. About 4 million
(31.8%) of the preschool population were found to be underweight-for-age, 3 million
(19.8%) adolescents and 5 million (13.2%) adults, including older persons were
found to be underweight and chronically energy deficient, respectively.

The status of micronutrient malnutrition is likewise an important concern in the

country. The vitamin A status of the country is considered severe subclinical
deficiency affecting children 6 months - 5 years (8.2%) and pregnant women
(7.1%). Iron deficiency anemia is the most alarming of the micronutrient deficiencies
affecting a considerable proportion of infants (56.6%), pregnant women (50.7%),
lactating women (45.7%) and male older persons (49.1%). Prevalence of IDD was
mild (71mg/L). However, 35.8% children 6 – 12 years old still suffer from moderate
and severe IDD.
Overweight and obesity are also prevalent in the country affecting a significant
proportion of children, adolescents and adults, which predispose them to certain
nutrition and health risks. This is evident in the rising trend in the prevalence of
diseases of the heart and the vascular system.

Malnutrition in the Philippines is caused by a host of interrelated factors – health,

physical, social, economic and others. Food supply and how it is distributed and
consumed by the populace have consequent impact on nutritional status. While
reports indicate that there are enough food to feed the country, many Filipinos
continue to go hungry and become malnourished due to inadequate intake of food
and nutrients. In fact, except for protein, the typical Filipino diet was found to be
grossly inadequate for energy and other nutrients. In order to compensate for the
inadequate energy intake, the body utilizes protein as energy source. Thus, the
continuing PEM problem in the country.

The present economic situation of the country further aggravates the malnutrition
problem with about 28 million Filipinos unable to buy food to meet their nutritional
requirements and other basic needs. While it was reported that the health status of
Filipinos improved in terms of the decrease in the mortality rates of mothers and
infants, the rising incidence of infectious diseases such as diarrhea and respiratory
diseases contributed to the poor nutritional status of many Filipinos. The effect of the
1997 Asian financial crisis as well as the El Niño phenomenon was also manifested in
the increase in the prevalence of malnutrition in the national nutrition survey of
1998.