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Malnutrition occurs when an organism gets too few or too many
nutrient
A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excret ...
s, resulting in health problems. Specifically, it is "a deficiency
A deficiency is generally a lack of something. It may also refer to:
*A deficient number, in mathematics, a number ''n'' for which ''σ''(''n'') < 2''n''
* energy, protein and other nutrients" which adversely affects the body's tissues and form. Malnutrition is not receiving the correct amount of nutrition. Malnutrition is increasing in children under the age of five due to providers who cannot afford or do not have access to adequate nutrition.
Malnutrition is a category of diseases that includes undernutrition and overnutrition. Undernutrition is a lack of nutrients, which can result in stunted growth, wasting, and underweight. A surplus of nutrients causes overnutrition, which can result in obesity. In some developing countries, overnutrition in the form of obesity is beginning to appear within the same communities as undernutrition.
Most clinical studies use the term 'malnutrition' to refer to undernutrition. However, the use of 'malnutrition' instead of 'undernutrition' makes it impossible to distinguish between undernutrition and overnutrition, a less acknowledged form of malnutrition. Accordingly, a 2019 report by The Lancet Commission suggested expanding the definition of malnutrition to include "all its forms, including obesity, undernutrition, and other dietary risks." The World Health Organization and The Lancet Commission have also identified " e double burden of malnutrition," which occurs from "the coexistence of overnutrition (overweight and obesity) alongside undernutrition (stunted growth and wasting)."Ghattas, H., Acharya, Y., Jamaluddine, Z., Assi, M., El Asmar, K. and Jones, A., 2020. The child-level double burden of malnutrition in the MENA and LAC regions: Prevalence and social determinants. Maternal & Child Nutrition, 16(2).
double burden of malnutrition
''.
''Kwashiorkor'' is primarily caused by inadequate protein intake. Its symptoms include
Malnutrition weakens every part of the immune system. Protein and energy malnutrition increases susceptibility to infection; so do deficiencies of specific micronutrients (including iron, zinc, and vitamins). In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem.
Malnutrition plays a major role in the onset of active tuberculosis. It also raises the risk of HIV transmission from mother to child, and increases
Improving Child Nutrition – The achievable imperative for global progress
UNICEF
Overnutrition caused by overeating is also a form of malnutrition. In the United States, more than half of all adults are now overweight—a condition that, like hunger, increases susceptibility to disease and disability, reduces worker
Overeating leads to many diseases, such as
Reducing malnutrition is key part of the United Nations'
Food banks and
In response to child malnutrition, the
World Health Organization, 2005. See especially Ch. 4 "Management of Acute Diarrhoea (Without Blood)" and Ch. 8 "Management of Diarrhoea With Severe Malnutrition." Malnourished children also need both potassium and magnesium.National Guidelines for the Management of Severely Malnourished Children in Bangladesh
, Institute of Public Health Nutrition, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, May 2008, page 18 (19 in PDF) and following pages. Within two to three hours of starting rehydration, children should be encouraged to take food, particularly foods rich in potassium like bananas, green coconut water, and unsweetened fresh fruit juice. Along with continued eating, many homemade products can also help restore normal electrolyte levels. For example, early during the course of a child's diarrhea, it can be beneficial to provide cereal water (salted or unsalted) or vegetable broth (salted or unsalted). If available, vitamin A, potassium, magnesium, and zinc supplements should be added, along with other vitamins and minerals. Giving base (as in Ringer's lactate) to treat acidosis without simultaneously supplementing potassium worsens low blood potassium.
Oral Rehydration Solution, Scott Moses, MD, February 1, 2014. However, people with malnutrition have an excess of body sodium. To avoid worsening this symptom, ORS for people with severe undernutrition should contain half the usual amount of sodium and more potassium. Patients who do not drink may require fluids by nasogastric tube.
The figures provided in this section on epidemiology all refer to ''undernutrition'' even if the term malnutrition is used which, by definition, could also apply to too much nutrition.
The Global Hunger Index (GHI) is a multidimensional statistical tool used to describe the state of countries' hunger situation. The GHI measures progress and failures in the global fight against hunger. The GHI is updated once a year. The data from the 2015 report shows that Hunger levels have dropped 27% since 2000. Fifty two countries remain at serious or alarming levels. In addition to the latest statistics on Hunger and Food Security, the GHI also features different special topics each year. The 2015 report include an article on conflict and food security.
Mortality due to malnutrition accounted for 58 percent of the total mortality in 2006: "In the world, approximately 62 million people, all causes of death combined, die each year. 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.
According to the World Health Organization, malnutrition is the biggest contributor to
Undernutrition adversely affects the cognitive development of children, contributing to poor earning capacity and poverty in adulthood. The development of childhood undernutrition coincides with the introduction of complementary weaning foods which are usually nutrient deficient. The World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide, about 1 million children. There is a strong association between undernutrition and child mortality. 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.Prüss-Üstün, A., Bos, R., Gore, F., Bartram, J. (2008)
Safer water, better health – Costs, benefits and sustainability of interventions to protect and promote health
World Health Organization (WHO), Geneva, Switzerland Over 90% of the stunted children below five years of age live in sub-Saharan Africa and South Central Asia. Although access to adequate food and improving nutritional intake is an obvious solution to tackling undernutrition in children, the progress in reducing children undernutrition is disappointing.
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. These small-scale studies showed that female undernutrition prevalence rates exceeded male undernutrition prevalence rates in South/Southeast Asia and Latin America and were lower in Sub-Saharan Africa. Datasets for Ethiopia and Zimbabwe reported undernutrition rates between 1.5 and 2 times higher in men than in women; however, in India and Pakistan, datasets rates of undernutrition were 1.5–2 times higher in women than in men. Intra-country variation also occurs, with frequent high gaps between regional undernutrition rates. Gender inequality in nutrition in some countries such as India is present in all stages of life.
Studies on nutrition concerning gender bias within households look at patterns of food allocation, and one study from 2003 suggested that women often receive a lower share of food requirements than men. Gender discrimination, gender roles, and social norms affecting women can lead to early marriage and childbearing, close birth spacing, and undernutrition, all of which contribute to malnourished mothers.
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. Samples of 1000 women in India in 2008 demonstrated that malnutrition in women is associated with poverty, lack of development and awareness, and illiteracy. The same study showed that gender discrimination in households can prevent a woman's access to sufficient food and healthcare. How socialization affects the health of women in Bangladesh, Najma Rivzi explains in an article about a research program on this topic. In some cases, such as in parts of Kenya in 2006, rates of malnutrition in pregnant women were even higher than rates in children.
Women in some societies are traditionally given less food than men since men are perceived to have heavier workloads. Household chores and agricultural tasks can in fact be very arduous and require additional energy and nutrients; however, physical activity, which largely determines energy requirements, is difficult to estimate.
Malnutrition and being underweight are more common in the elderly than in adults of other ages. If elderly people are healthy and active, the aging process alone does not usually cause malnutrition. However, 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. Sadness or depression can play a role, causing changes in appetite, digestion, energy level, weight, and well-being. 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. Poor dental health, ill-fitting dentures, or chewing and swallowing problems can make eating difficult. As a result of these factors, malnutrition is seen to develop more easily in the elderly.
Rates of malnutrition tend to increase with age with less than 10 percent of the "young" elderly (up to age 75) malnourished, while 30 to 65 percent of the elderly in home care, long-term care facilities, or acute hospitals are malnourished. Many elderly people require assistance in eating, which may contribute to malnutrition. However, the mortality rate due to undernourishment may be reduced. Because of this, one of the main requirements of elderly care is to provide an adequate diet and all essential nutrients. Providing the different nutrients such as protein and energy keeps even small but consistent weight gain. Hospital admissions for malnutrition in the United Kingdom have been related to insufficient social care, where vulnerable people at home or in care homes are not helped to eat.
In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission. Malnutrition and weight loss can contribute to
Action Against Hunger , ACF-USA
Action Against Hunger , ACF-UK
Hunger Relief International , HRI
Hunger Relief research on IssueLab
The Global Food Security and Nutrition Forum (FSN Forum)
Ten Things you can do to Fight World Hunger
''The Nation'', May 13, 2009
United Nation 2007 report
World Food Programme , WFP
UN
WFP
{{Authority control Global issues Wikipedia medicine articles ready to translate Wikipedia infectious disease articles ready to translate Health effects of food and nutrition Limbic system Motivation Neuropsychology Eating behaviors Hazards of outdoor recreation
Prevalence
It is estimated that nearly one in three persons globally has at least one form of malnutrition: wasting, stunting, vitamin or mineral deficiency, overweight, obesity, or diet-related noncommunicable diseases. Undernutrition is more common in developing countries. Stunting is more prevalent in urban slums than in rural areas.Murarkar, S., Gothankar, J., Doke, P., Pore, P., Lalwani, S., Dhumale, G., Quraishi, S., Patil, R., Waghachavare, V., Dhobale, R., Rasote, K., Palkar, S. and Malshe, N., 2020. Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health, 20(1). Studies on malnutrition have the population categorised into different groups including infants, under-five children, children, adolescents, pregnant women, adults and the elderly population. The use of different growth references in different studies leads to variances in the undernutrition prevalence reported in different studies. Some of the growth references used in studies include the National Center for Health Statistics (NCHS) growth charts, WHO reference 2007, Centers for Disease Control and Prevention (CDC) growth charts, National Health and Nutrition Examination Survey (NHANES), WHO reference 1995, Obesity Task Force (IOTF) criteria and Indian Academy of Pediatrics (IAP) growth charts.In children
The prevalence of undernutrition is highest among children under five. In 2020, 149 million children under five years old were stunted, 45 million were wasted, and 38.9 million were overweight or obese. The following year, an estimated 45% of deaths in children were linked to undernutrition. The prevalence of wasting among children under five in South Asia was reported to be 16% moderately or severely wasted. In Asia, India has one of the highest burden of wasting with over 20% wasted children. However, the burden of undernutrition among under-five children in African countries is much higher. A pooled analysis of the prevalence of chronic undernutrition among under-five children in East Africa was identified to be 33.3%. This prevalence of undernutrition among under-five children ranged from 21.9% in Kenya to 53% in Burundi. In Tanzania, the prevalence of stunting, among children under five varied from 41% in lowland and 64.5% in highland areas. Undernutrition by underweight and wasting was 11.5% and 2.5% in lowland and 22.% and 1.4% in the highland areas of Tanzania respectively. In South Sudan, the prevalence of undernutrition explained by stunting, underweight and wasting in under-five children were 23.8%, 4.8% and 2.3% respectively.Vitamin A deficiency
Vitamin A deficiency (VAD) or hypovitaminosis A is a lack of vitamin A in blood and tissues. It is common in poorer countries, especially among children and women of reproductive age, but is rarely seen in more developed countries. Nyctalopia (ni ...
affects one third of children under age 5 around the world,World Health Organization, Global prevalence of vitamin A deficiency in populations at risk 1995–2005, WHO orld health organisationglobal database on vitamin A deficiency. leading to 670,000 deaths and 250,000–500,000 cases of blindness.
In adults
As of June 2021, 1.9 billion adults were overweight or obese, and 462 million adults were underweight. Globally, two billion people had iodine deficiency in 2017. In 2020, 900 million women and children had anemia, which is often caused by iron deficiency. Certain groups have higher rates of undernutrition, includingelderly
Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...
people and women (in particular while pregnant
Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occur ...
or breastfeeding children
A child ( : children) is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. The legal definition of ''child'' generally refers to a minor, otherwise known as a person younger ...
under five years of age). Undernutrition is an increasing health problem in people aged over 65 years, even in developed countries, especially among nursing home residents and in acute care hospitals. In the elderly, undernutrition is more commonly due to physical, psychological, and social factors, not a lack of food. Age-related reduced dietary intake due to chewing and swallowing problems, sensory decline, depression, imbalanced gut microbiome, poverty and loneliness are major contributors to undernutrition in the elderly population.
Recent increase
There has been an increase in world hunger over the past decade. In 2015, 795 million people (about one in ten people on earth) had undernutrition. In 2020, one in nine people in the world—or 820 million people worldwide—was hungry. These increases are partially related to the ongoing COVID-19 pandemic, which continues to highlight the weaknesses of current food and health systems. It has contributed tofood insecurity
Food security speaks to the availability of food in a country (or geography) and the ability of individuals within that country (geography) to access, afford, and source adequate foodstuffs. According to the United Nations' Committee on World F ...
, increasing hunger worldwide; meanwhile, lower physical activity during lockdowns has contributed to increases in overweight and obesity. In 2020, experts estimated that by the end of the year, the pandemic could double the number of people at risk of suffering acute hunger. Similarly, experts estimate that the prevalence of moderate and severe wasting could increase by 14% due to COVID-19; coupled with reductions in nutrition and health services coverage, this could result in over 128,000 additional deaths among children under 5 in 2020 alone. Although COVID-19 is less severe in children than in adults, the risk of severe disease increases with undernutrition.
Other major causes of hunger include manmade conflicts, climate changes, and economic downturns.
Definitions
Undernutrition
Undernutrition can occur either due to protein-energy wasting or as a result ofmicronutrient
Micronutrients are nutrient, essential dietary elements required by organisms in varying quantities throughout life to orchestrate a range of physiological functions to maintain health. Micronutrient requirements differ between organisms; for exam ...
deficiencies.Morley, J., 2012. Undernutrition in older adults. Family Practice, 29(suppl 1), pp.i89-i93. It adversely affects physical and mental functioning, and causes changes in body composition and body cell mass. Undernutrition is a major health problem, causing the highest mortality rate in children, and is responsible for long-lasting physiologic
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
effects. It is a barrier to the complete physical and mental development of children.
Undernutrition can manifest as stunting, wasting, and underweight. If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development. Extreme undernutrition can cause starvation
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. In humans, prolonged starvation can cause permanent organ damage and eventually, dea ...
, chronic hunger, Severe Acute Malnutrition
Global Acute Malnutrition (GAM) is a measurement of the nutritional status of a population that is often used in protracted refugee situations.
Along with the Crude Mortality Rate, it is one of the basic indicators for assessing the severity of a h ...
(SAM), and/or Moderate Acute Malnutrition
Moderate is an ideological category which designates a rejection of radical or extreme views, especially in regard to politics and religion. A moderate is considered someone occupying any mainstream position avoiding extreme views. In American p ...
(MAM).
The signs and symptoms
Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...
of micronutrient deficiencies
Micronutrient deficiency or dietary deficiency is not enough of one or more of the micronutrients required for optimal plant or animal health. In humans and other animals they include both vitamin deficiencies and mineral deficiencies, whereas in ...
depend on which micronutrient is lacking. However, undernourished people are often thin and short, with very poor energy levels; and swelling in the legs and abdomen is also common. People who are undernourished often get infections and frequently feel cold.
Micronutrient malnutrition
Micronutrient malnutrition results from inadequate intake of vitamins and minerals. Worldwide, deficiencies iniodine
Iodine is a chemical element with the symbol I and atomic number 53. The heaviest of the stable halogens, it exists as a semi-lustrous, non-metallic solid at standard conditions that melts to form a deep violet liquid at , and boils to a vi ...
, Vitamin A, and iron are the most common. Children and pregnant women in low-income countries
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
are at especially high risk for micronutrient deficiencies.
Anemia is most commonly caused by iron deficiency, but can also result from other micronutrient deficiencies and diseases. This condition can have major health consequences.
It is possible to have overnutrition simultaneously with micronutrient deficiencies; this condition is termed the 'double burden of malnutrition
''.
Protein-energy malnutrition
'Undernutrition' sometimes refers specifically to protein–energy malnutrition (PEM). This condition involves both micronutrient deficiencies and an imbalance of protein intake and energy expenditure. It differs from calorie restriction in that calorie restriction may not result in negative health effects. Hypoalimentation (underfeeding) is one cause of undernutrition. Two forms of PEM arekwashiorkor
Kwashiorkor ( , ) is a form of severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates. It is thought to be caused by sufficient calorie intake, but with insufficient protein consumption (or lack of goo ...
and marasmus
Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the a ...
; both commonly coexist.
''Kwashiorkor'' is primarily caused by inadequate protein intake. Its symptoms include edema
Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's Tissue (biology), tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels t ...
, wasting, liver enlargement, hypoalbuminaemia
Hypoalbuminemia (or hypoalbuminaemia) is a medical sign in which the level of albumin in the blood is low. This can be due to decreased production in the liver, increased loss in the gastrointestinal tract or kidneys, increased use in the body, o ...
, and steatosis; the condition may also cause depigmentation
Depigmentation is the lightening of the skin or loss of pigment. Depigmentation of the skin can be caused by a number of local and systemic conditions. The pigment loss can be partial (injury to the skin) or complete (caused by vitiligo). It can be ...
of skin and hair
Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals.
The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and f ...
. The disorder is further identified by a characteristic swelling of the belly, which disguises the patient's undernourished condition. 'Kwashiorkor' means 'displaced child' and is derived from the Ga language of coastal Ghana in West Africa. It means "the sickness the baby gets when the next baby is born," as it often occurs when the older child is deprived of breastfeeding and weaned to a diet composed largely of carbohydrates.
''Marasmus'' (meaning 'to waste away') can result from a sustained diet that is deficient in both protein and energy. This causes their metabolism to adapt in order to prolong survival. The primary symptoms are severe wasting, leaving little or no edema
Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's Tissue (biology), tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels t ...
; minimal subcutaneous fat; and abnormal serum albumin levels. It is traditionally seen in cases of famine
A famine is a widespread scarcity of food, caused by several factors including war, natural disasters, crop failure, Demographic trap, population imbalance, widespread poverty, an Financial crisis, economic catastrophe or government policies. Th ...
, significant food restriction, or severe anorexia. Conditions are characterized by extreme wasting of the muscles and a gaunt expression.
Overnutrition
Excessive consumption of energy-dense foods and drinks and limited physical activity causes overnutrition. It causes overweight, defined as abody mass index (BMI)
Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and hei ...
of 25 or more, and can lead to obesity (a BMI of 30 or more). Obesity has become a major health issue worldwide. Overnutrition is linked to chronic non-communicable diseases like diabetes, certain cancers, and cardiovascular diseases. Hence identifying and addressing the immediate risk factors has become a major health priority. The recent evidence on the impact of diet-induced obesity in fathers and mothers around the time of conception is identified to negatively program the health outcomes of multiple generations.
Classifying malnutrition
Definition by Gomez & Galvan
In 1956, Gómez and Galvan studied factors associated with death in a group of undernourished children in a hospital in Mexico City, Mexico. They defined three categories of malnutrition: first, second, and third degree. The degree of malnutrition is calculated based on a child's body size compared to themedian
In statistics and probability theory, the median is the value separating the higher half from the lower half of a data sample, a population, or a probability distribution. For a data set, it may be thought of as "the middle" value. The basic fe ...
weight for their age. The risk of death increases with increasing degrees of malnutrition.
An adaptation of Gomez's original classification is still used today. While it provides a way to compare malnutrition within and between populations, this classification system has been criticized for being " arbitrary" and for not considering overweight as a form of malnutrition. Also, height alone may not be the best indicator of malnutrition; children who are born prematurely may be considered short for their age even if they have good nutrition.
Definition by Waterlow
In the 1970s, John Conrad Waterlow established a new classification system for malnutrition. Instead of using just weight for age measurements, Waterlow's system combines weight-for-height (indicating acute episodes of malnutrition) with height-for-age to show the stunting that results from chronic malnutrition. One advantage of the Waterlow classification is that weight for height can be calculated even if a child's age is unknown. The World Health Organization frequently uses these classifications of malnutrition, with some modifications.Effects
Malnutrition weakens every part of the immune system. Protein and energy malnutrition increases susceptibility to infection; so do deficiencies of specific micronutrients (including iron, zinc, and vitamins). In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem.
Malnutrition plays a major role in the onset of active tuberculosis. It also raises the risk of HIV transmission from mother to child, and increases replication
Replication may refer to:
Science
* Replication (scientific method), one of the main principles of the scientific method, a.k.a. reproducibility
** Replication (statistics), the repetition of a test or complete experiment
** Replication crisi ...
of the virus. Malnutrition can cause vitamin-deficiency-related diseases like scurvy and rickets. As malnutrition worsens, those affected have less energy and experience impairment in brain functions. This can make it difficult (or impossible) for them to perform the tasks needed to acquire food, earn an income, or gain an education.
Malnutrition can also cause acute problems, like hypoglycemia (low blood sugar). This condition can cause lethargy, limpness, seizures, and loss of consciousness. Children are particularly at risk and can become hypoglycemic after 4 to 6 hours without food. Dehydration can also occur in malnourished people, and can be life-threatening, especially in babies and small children.
Signs
There are many different signs of dehydration in malnourished people. These can include sunken eyes; a very dry mouth; decreased urine output and/or dark urine; increased heart rate with decreasing blood pressure; andaltered mental status
An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment.
A mildly depressed level of consciousne ...
.
Cognitive development
Protein-calorie malnutrition can cause cognitive impairments. This most commonly occurs in people who were malnourished during a "critical period ... from the final third ofgestation
Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregna ...
to the first 2 years of life". For example, in children under two years of age, iron deficiency anemia is likely to affect brain function acutely, and probably also chronically. Similarly, folate deficiency has been linked to neural tube defects.
Iodine deficiency is "the most common preventable cause of mental impairment worldwide." "Even moderate odinedeficiency, especially in pregnant women and infant
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
s, lowers intelligence by 10 to 15 I.Q. points, shaving incalculable potential off a nation's development." Among those affected, very few people experience the most visible and severe effects: disabling goiters, cretinism and dwarfism
Dwarfism is a condition wherein an organism is exceptionally small, and mostly occurs in the animal kingdom. In humans, it is sometimes defined as an adult height of less than , regardless of sex; the average adult height among people with dw ...
. These effects occur most commonly in mountain villages. However, 16 percent of the world's people have at least mild goiter (a swollen thyroid gland
The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobe (anatomy), lobes. The lower two thirds of the lobes are connected by a thin band of Connective tissue, tissue cal ...
in the neck)."
Causes & risk factors
Social and political
Social conditions have a significant influence on the health of people. The social determinants of undernutrition mainly include poor education, poverty, disease burden and lack of women's empowerment.Bhutta, Z., Ahmed, T., Black, R., Cousens, S., Dewey, K., Giugliani, E., Haider, B., Kirkwood, B., Morris, S., Sachdev, H. and Shekar, M., 2008. What works? Interventions for maternal and child undernutrition and survival. The Lancet, 371(9610), pp.417-440. Identifying and addressing these determinants can eliminate undernutrition in the long term. Identification of the social conditions that causes malnutrition in children under five has received significant research attention as it is a major public health problem. Undernutrition most commonly results from a lack of access to high-quality, nutritious food. The household income is a socio-economic variable that influences the access to nutritious food and the probability of under and overnutrition in a community. In the study by Ghattas et al. (2020), the probability of overnutrition is significantly higher in higher-income families than in disadvantaged families. High food prices is a major factor preventing low income households from getting nutritious food For example, Khan and Kraemer (2009) found that in Bangladesh, lowsocioeconomic status
Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic access to resources and social position in relation to others. When analyzing a family's ...
was associated with chronic malnutrition since it inhibited purchase of nutritious foods (like milk, meat, poultry, and fruits). Food shortages may also contribute to malnutritions in countries which lack technology. However, in the developing world, eighty percent of malnourished children live in countries that produce food surpluses, according to estimates from the Food and Agriculture Organization (FAO). The economist Amartya Sen observes that, in recent decades, famine has always been a problem of food distribution
Food distribution is the process where a general population is supplied with food. The Food and Agriculture Organization (FAO) considers food distribution as a subset of the food system. The process and methodology behind food distribution varies ...
, purchasing power, and/or poverty, since there has always been enough food for everyone in the world.
There are also sociopolitical
Political sociology is an Interdisciplinarity, interdisciplinary field of study concerned with exploring how governance and society interact and influence one another at the micro to macro Level of analysis, levels of analysis. Interested in the ...
causes of malnutrition. For example, the population of a community might be at increased risk for malnutrition if government is poor and the area lacks health-related services. On a smaller scale, certain households or individuals may be at an even higher risk due to differences in income levels, access to land, or levels of education. Community plays a crucial role in addressing the social causes of malnutrition. For example, communities with high social support and knowledge sharing about social protection programs can enable better public service demands. Better public service demands and social protection programs minimise the risk of malnutrition in these communities.
It is argued that commodity
In economics, a commodity is an economic good, usually a resource, that has full or substantial fungibility: that is, the market treats instances of the good as equivalent or nearly so with no regard to who produced them.
The price of a comm ...
speculators are increasing the cost of food. As the real-estate bubble
A real-estate bubble or property bubble (or housing bubble for residential markets) is a type of economic bubble that occurs periodically in local or global real-estate markets, and typically follow a land boom. A land boom is the rapid increase ...
in the United States was collapsing, it is said that trillions of dollars moved to invest in food and primary commodities, causing the 2007–2008 food price crisis
Food is any substance consumed by an organism for nutritional support. Food is usually of plant, animal, or fungal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals. The substance is inge ...
.
The use of biofuel
Biofuel is a fuel that is produced over a short time span from biomass, rather than by the very slow natural processes involved in the formation of fossil fuels, such as oil. According to the United States Energy Information Administration (E ...
s as a replacement for traditional fuels raises the price of food. The United Nations special rapporteur on the right to food, Jean Ziegler proposes that agricultural waste, such as corn cobs
Maize ( ; ''Zea mays'' subsp. ''mays'', from es, maíz after tnq, mahiz), also known as corn (North American and Australian English), is a cereal grain first domesticated by indigenous peoples in southern Mexico about 10,000 years ago. Th ...
and banana leaves, should be used as fuel instead of crops.
In some developing countries, overnutrition (in the form of obesity) is beginning to appear in the same communities where malnutrition occurs. Overnutrition increases with urbanisation, food commercialisation and technological developments and increases physical inactivity. Variations in the health status of individuals in the same society are associated with the societal structure and an individual's socioeconomic status which leads to income inequality, racism, educational differences and lack of opportunities.
Diseases & conditions
Infectious diseases
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
which increase nutrient requirements, such as gastroenteritis
Gastroenteritis, also known as infectious diarrhea and gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydra ...
, pneumonia, malaria, and measles
Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
, can cause malnutrition. So can some chronic illnesses, especially HIV/AIDS.
Malnutrition can also result from abnormal nutrient loss due to diarrhea or chronic small bowel illnesses, like Crohn's disease
Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension ...
or untreated coeliac disease. "Secondary malnutrition" can result from increased energy expenditure.
In infants, a lack of breastfeeding may contribute to undernourishment. Anorexia nervosa and bariatric surgery
Bariatric surgery (or weight loss surgery) includes a variety of procedures performed on people who are obese. Long term weight loss through the standard of care procedures ( Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion ...
can also cause malnutrition.
Dietary practices
Undernutrition
Undernutrition due to lack of adequate breastfeeding is associated with the deaths of an estimated one million children annually. Illegal advertising ofbreast-milk substitute
Infant formula, baby formula, or simply formula (American English); or baby milk, infant milk or first milk (British English), is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepar ...
s contributed to malnutrition and continued three decades after its 1981 prohibition under the ''WHO International Code of Marketing Breast Milk Substitutes''.
Maternal malnutrition can also factor into the poor health or death of a baby. Over 800,000 neonatal deaths have occurred because of deficient growth of the fetus in the mother's womb.
Deriving too much of one's diet from a single source, such as eating almost exclusively potato, maize or rice, can cause malnutrition. This may either be from a lack of education about proper nutrition, or from only having access to a single food source.
It is not just the total amount of calories that matters but specific nutritional deficiencies such as vitamin A deficiency, iron deficiency or zinc deficiency can also increase risk of death.UNICEF (2013)Improving Child Nutrition – The achievable imperative for global progress
UNICEF
Overnutrition
Overnutrition caused by overeating is also a form of malnutrition. In the United States, more than half of all adults are now overweight—a condition that, like hunger, increases susceptibility to disease and disability, reduces worker productivity
Productivity is the efficiency of production of goods or services expressed by some measure. Measurements of productivity are often expressed as a ratio of an aggregate output to a single input or an aggregate input used in a production proces ...
, and lowers life expectancy. Overeating is much more common in the United States, since most people have adequate access to food. Many parts of the world have access to a surplus
Surplus may refer to:
* Economic surplus, one of various supplementary values
* Excess supply, a situation in which the quantity of a good or service supplied is more than the quantity demanded, and the price is above the equilibrium level determ ...
of non-nutritious food. Increased sedentary lifestyles also contribute to overnutrition. Yale University psychologist Kelly Brownell calls this a "toxic food environment
A food environment is the "physical presence of food that affects a person’s diet, a person’s proximity to food store locations, the distribution of food stores, food service, and any physical entity by which food may be obtained, or a connect ...
," where fat- and sugar-laden foods have taken precedence over healthy nutritious foods.
In these developed countries, overnutrition can be prevented by choosing the right kind of food. More fast food is consumed per capita in the United States than in any other country. This mass consumption of fast food results from its affordability and accessibility. Fast food, which is low in cost and nutrition, is high in calories. Due to increasing urbanization and automation, people are living more sedentary lifestyles. These factors combine to make weight gain difficult to avoid.
Overnutrition also occurs in developing countries. It has appeared in parts of developing countries where income is on the rise. It is also a problem in countries where hunger and poverty persist. Economic development, rapid urbanisation and shifting dietary patterns have increased the burden of overnutrition in the cities of low and middle-income countries. In China
China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
, consumption of high-fat foods has increased, while consumption of rice and other goods has decreased.
Overeating leads to many diseases, such as heart disease
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
and diabetes, that may be fatal.
Agricultural productivity
Local food shortages can be caused by a lack of arable land, adverse weather, and/or poorer farming skills (like inadequate crop rotation). They can also occur in areas which lack the technology or resources needed for the higher yields found in modern agriculture. These resources include fertilizers,pesticide
Pesticides are substances that are meant to control pests. This includes herbicide, insecticide, nematicide, molluscicide, piscicide, avicide, rodenticide, bactericide, insect repellent, animal repellent, microbicide, fungicide, and lampri ...
s, irrigation, machinery
A machine is a physical system using power to apply forces and control movement to perform an action. The term is commonly applied to artificial devices, such as those employing engines or motors, but also to natural biological macromolecule ...
, and storage facilities. As a result of widespread poverty, farmers and governments cannot provide enough of these resources to improve local yields.
Additionally, the World Bank and some wealthy donor countries have pressured developing countries to use free market policies. Even as the United States and Europe extensively subsidized their own farmers, they urged developing countries to cut or eliminate subsidized agricultural inputs, like fertilizer. Without subsidies, few (if any) farmers in developing countries can afford fertilizer at market prices. This leads to low agricultural production, low wages, and high, unaffordable food prices. Fertilizer is also increasingly unavailable because Western environmental groups have fought to end its use due to environmental concerns. The Green Revolution pioneers Norman Borlaug and Keith Rosenberg cited as the obstacle to feeding Africa by .
Future threats
In the future, variety of factors could potentially disrupt global food supply and cause widespread malnutrition. Global warming is of importance to food security. Almost all malnourished people (95%) live in the tropics andsubtropics
The subtropical zones or subtropics are geographical and climate zones to the north and south of the tropics. Geographically part of the temperate zones of both hemispheres, they cover the middle latitudes from to approximately 35° north and ...
, where the climate is relatively stable. According to the latest Intergovernmental Panel on Climate Change
The Intergovernmental Panel on Climate Change (IPCC) is an intergovernmental body of the United Nations. Its job is to advance scientific knowledge about climate change caused by human activities. The World Meteorological Organization (WMO) a ...
reports, temperature increases in these regions are "very likely." Even small changes in temperatures can make extreme weather conditions occur more frequently. Extreme weather events, like drought, have a major impact on agricultural production, and hence nutrition. For example, the 1998–2001 Central Asian drought killed about 80 percent of livestock in Iran and caused a 50% reduction in wheat and barley crops there. Other central Asian nations experienced similar losses. An increase in extreme weather such as drought in regions such as Sub-Saharan Africa
Sub-Saharan Africa is, geographically, the area and regions of the continent of Africa that lies south of the Sahara. These include West Africa, East Africa, Central Africa, and Southern Africa. Geopolitically, in addition to the List of sov ...
would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productivity of many crop species, and decreases food security in these regions.
Another threat is colony collapse disorder, a phenomenon where bee
Bees are winged insects closely related to wasps and ants, known for their roles in pollination and, in the case of the best-known bee species, the western honey bee, for producing honey. Bees are a monophyly, monophyletic lineage within the ...
s die in large numbers. Since many agricultural crops worldwide are pollinated by bees, colony collapse disorder represents a threat to the global food supply.
Prevention
Reducing malnutrition is key part of the United Nations' Sustainable Development Goal 2
Sustainable Development Goal 2 (SDG 2 or Global Goal 2) aims to achieve "zero hunger". It is one of the 17 Sustainable Development Goals established by the United Nations in 2015. The official wording is: "End hunger, achieve food security and im ...
(SDG2
Sustainable Development Goal 2 (SDG 2 or Global Goal 2) aims to achieve "zero hunger". It is one of the 17 Sustainable Development Goals established by the United Nations in 2015. The official wording is: "End hunger, achieve food security and i ...
), "Zero Hunger," which aims to reduce malnutrition, undernutrition, and stunted child growth. Managing severe acute undernutrition in a community setting has received significant research attention.
Food security
In the 1950s and 1960s, the Green Revolution aimed to bring modern Western agricultural techniques (like nitrogen fertilizers andpesticide
Pesticides are substances that are meant to control pests. This includes herbicide, insecticide, nematicide, molluscicide, piscicide, avicide, rodenticide, bactericide, insect repellent, animal repellent, microbicide, fungicide, and lampri ...
s) to Asia. Investment
Investment is the dedication of money to purchase of an asset to attain an increase in value over a period of time. Investment requires a sacrifice of some present asset, such as time, money, or effort.
In finance, the purpose of investing i ...
s in agriculture, such as fund fertilizers and seeds, increased food harvest
Harvesting is the process of gathering a ripe crop from the fields. Reaping is the cutting of grain or pulse for harvest, typically using a scythe, sickle, or reaper. On smaller farms with minimal mechanization, harvesting is the most labor-i ...
s and thus food production. Consequently, food prices and malnutrition decreased (as they had earlier in Western nations).
The Green Revolution was possible in Asia because of existing infrastructure
Infrastructure is the set of facilities and systems that serve a country, city, or other area, and encompasses the services and facilities necessary for its economy, households and firms to function. Infrastructure is composed of public and priv ...
and institution
Institutions are humanly devised structures of rules and norms that shape and constrain individual behavior. All definitions of institutions generally entail that there is a level of persistence and continuity. Laws, rules, social conventions a ...
s, such as a system of roads and public seed companies that made seeds available. These resources were in short supply in Africa, decreasing the Green Revolution's impact on the continent.
For example, almost five million of the 13 million people in Malawi used to need emergency food aid. However, in the early 2000s, the Malawian government changed its agricultural policies, and implemented subsidies for fertilizer and seed introduced against World Bank strictures. By 2007, farmers were producing record-breaking corn harvests. Corn production leaped to 3.4 million in 2007 compared to 1.2 million in 2005, making Malawi a major food exporter. Consequently, food prices lowered and wages for farmworkers rose. Such investments in agriculture are still needed in other African countries like the Democratic Republic of the Congo (DRC). Despite the country's great agricultural potential, the prevalence of malnutrition in the DRC is among the highest in the world. Proponents for investing in agriculture include Jeffrey Sachs, who argues that wealthy countries should invest in fertilizer and seed for Africa's farmers.
Imported Ready to Use Therapeutic Food (RUTF) has been used to treat malnutrition in northern Nigeria. Some Nigerians also use ''soy'' ''kunu
Kunu (also known as ''kununzaki'') is a popular drink consumed throughout Nigeria, mostly in the North. It is usually made from a grain such as millet or sorghum, although it can be made from maize as well. As a grain based beverage Kunu is a memb ...
,'' a locally sourced and prepared blend consisting of peanut, millet
Millets () are a highly varied group of small-seeded grasses, widely grown around the world as cereal crops or grains for fodder and human food. Most species generally referred to as millets belong to the tribe Paniceae, but some millets al ...
and soybeans.
New technology in agricultural production has great potential to combat undernutrition. It makes farming easier, thus improving agricultural yields. By increasing farmers' incomes, this could reduce poverty. It would also open up area which farmers could use to diversify crops for household use.
The World Bank claims to be part of the solution to malnutrition, asserting that countries can best break the cycle of poverty and malnutrition by building export-led economies, which give them the financial means to buy foodstuffs on the world market.
Economics
Many aid groups have found that giving cash assistance (or cash vouchers) is more effective than donating food. Particularly in areas where food is available but unaffordable, giving cash assistance is a cheaper, faster, and more efficient way to deliver help to the hungry. In 2008, the UN's World Food Program, the biggest non-governmental distributor of food, announced that it would begin distributing cash and vouchers instead of food in some areas, whichJosette Sheeran
Josette Sheeran (born 12 June 1954) is an American non-profit executive and diplomat who served in the United States Department of State. Sheeran serves as the seventh president and CEO of Asia Society since June 10, 2013. Sheeran was also the Un ...
, the WFP's executive director, described as a "revolution" in food aid. The aid agency Concern Worldwide
Concern Worldwide (often referred to as Concern) is Ireland's largest aid and humanitarian agency. Since its foundation 50 years ago it has worked in 50 countries. According to its latest annual report, Concern helped 28.6 million of the world's ...
piloted a method of giving cash assistance using a mobile phone operator, Safaricom, which runs a money transfer program that allows cash to be sent from one part of a country to another.
However, during a drought, delivering food might be the most appropriate way to help people, especially those who live far from markets and thus have limited access to them. Fred Cuny
Frederick C. Cuny (November 14, 1944 – April 15, 1995) was an American humanitarian whose work spanned disaster relief, refugee emergency management, recovery from war and civil conflict as well as disaster and emergency preparedness, mitigation ...
stated that "the chances of saving lives at the outset of a relief operation are greatly reduced when food is import
An import is the receiving country in an export from the sending country. Importation and exportation are the defining financial transactions of international trade.
In international trade, the importation and exportation of goods are limited ...
ed. By the time it arrives in the country and gets to people, many will have died." U.S. law requires food aid to be purchased at home rather than in the countries where the hungry live; this is inefficient because approximately half of the money spent goes for transport. Cuny further pointed out that "studies of every recent famine have shown that food was available in-country—though not always in the immediate food deficit area" and "even though by local standards the prices are too high for the poor to purchase it, it would usually be cheaper for a donor to buy the hoarded food at the inflated price than to import it from abroad."
Food banks and soup kitchen
A soup kitchen, food kitchen, or meal center, is a place where food is offered to the Hunger, hungry usually for free or sometimes at a below-market price (such as via coin donations upon visiting). Frequently located in lower-income neighborhoo ...
s address malnutrition in places where people lack money to buy food. A basic income has been proposed as a way to ensure that everyone has enough money to buy food and other basic needs. This is a form of social security in which all citizens or residents of a country regularly receive an unconditional sum of money, either from a government or some other public institution, in addition to any income received from elsewhere.
Successful initiatives
Ethiopia pioneered a program that later became part of the World Bank's prescribed method for coping with a food crisis. Through the country's main food assistance program, the Productive Safety Net Program, Ethiopia provided rural residents who were chronically short of food a chance to work for food or cash. Foreign aid organizations like the World Food Program were then able to buy food locally from surplus areas to distribute in areas with a shortage of food. Aid organizations now view the Ethiopian program as a model of how to best help hungry nations. Successful initiatives also include Brazil's recycling program fororganic waste
Biodegradable waste includes any organic matter in waste which can be broken down into carbon dioxide, water, methane or simple organic molecules by micro-organisms and other living things by composting, aerobic digestion, anaerobic digestion ...
, which benefits farmers, the urban poor, and the city in general. City residents separate organic waste from their garbage, bag it, and then exchange it for fresh fruit and vegetables from local farmers. This reduces the country's waste while giving the urban poor a steady supply of nutritious food.
World population
Restricting population size is a proposed solution to malnutrition. Thomas Malthus argues thatpopulation growth
Population growth is the increase in the number of people in a population or dispersed group. Actual global human population growth amounts to around 83 million annually, or 1.1% per year. The global population has grown from 1 billion in 1800 to ...
can be controlled by natural disaster
A natural disaster is "the negative impact following an actual occurrence of natural hazard in the event that it significantly harms a community". A natural disaster can cause loss of life or damage property, and typically leaves some econ ...
s and by voluntary limits through "moral restraint." Robert Chapman suggests that government policies are a necessary ingredient for curtailing global population growth. The United Nations recognizes that poverty and malnutrition (as well as the environment) are interdependent and complementary with population growth. According to the World Health Organisation, "Family planning
Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...
is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts". However, more than 200 million women worldwide lack adequate access to family planning services.
There are different theories about what causes famine. Some theorists, like the Indian economist Amartya Sen, believe that the world has more than enough resources to sustain its population. In this view, malnutrition is caused by unequal distribution of resources and under- or unutilized arable land. For example, Sen argues that "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."
Food sovereignty
Food sovereignty is one suggested policy framework to resolve access issues. In this framework, people (rather than international market forces) have the right to define their own food, agricultural, livestock, andfishery
Fishery can mean either the enterprise of raising or harvesting fish and other aquatic life; or more commonly, the site where such enterprise takes place ( a.k.a. fishing ground). Commercial fisheries include wild fisheries and fish farms, both ...
systems. Food First is one of the primary think tanks working to build support for food sovereignty. Neoliberals
Neoliberalism (also neo-liberalism) is a term used to signify the late 20th century political reappearance of 19th-century ideas associated with free-market capitalism after it fell into decline following the Second World War. A prominent fa ...
advocate for an increasing role of the free market.
Health facilities
Another possible long-term solution to malnutrition is to increase access to health facilities in rural parts of the world. These facilities could monitor undernourished children, act as supplemental food distribution centers, and provide education on dietary needs. Similar facilities have already proven very successful in countries such as Peru and Ghana.Breastfeeding
In 2016, estimates suggested that more widespread breastfeeding could prevent about 823,000 deaths annually of children under age 5. In addition to reducing infant deaths,breast milk
Breast milk (sometimes spelled as breastmilk) or mother's milk is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates ( lacto ...
provides an important source of micronutrients - which are clinically proven to bolster children's immune systems - and provides long-term defenses against non-communicable and allergic diseases. Breastfeeding improves cognitive abilities in children, and correlates strongly with individual educational achievements. As previously noted, lack of proper breastfeeding is a major factor in child mortality
Child mortality is the mortality of children under the age of five. The child mortality rate, also under-five mortality rate, refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births.
It en ...
rates, and is a primary determinant of disease development for children. The medical community recommends exclusively breastfeeding infants for 6 months, with nutritional whole food supplementation and continued breastfeeding up to 2 years or older for overall optimal health outcomes. Exclusive breastfeeding is defined as giving an infant only breast milk for six months as a source of food and nutrition. This means no other liquids, including water or semi-solid foods.
Barriers to breastfeeding
Breastfeeding is noted as one of the most cost-effective medical interventions benefiting child health. While there are considerable differences among developed and developing countries, there are universal determinants of whether a mother breastfeeds or usesformula
In science, a formula is a concise way of expressing information symbolically, as in a mathematical formula or a ''chemical formula''. The informal use of the term ''formula'' in science refers to the general construct of a relationship betwee ...
; these include income, employment, social norm
Social norms are shared standards of acceptance, acceptable behavior by groups. Social norms can both be informal understandings that govern the behavior of members of a society, as well as be codified into wikt:rule, rules and laws. Social normat ...
s, and access to healthcare. Many newly made mothers face financial barriers; community-based healthcare workers have helped to alleviate these barriers, while also providing a viable alternative to traditional and expensive hospital-based medical care. Recent studies, based upon surveys conducted from 1995 to 2010, show that exclusive breastfeeding rates have risen globally, from 33% to 39%. Despite the growth rates, medical professionals acknowledge the need for improvement given the importance of exclusive breastfeeding.
21st century global initiatives
Starting around 2009, there was renewed international media and political attention focused on malnutrition. This resulted in part from spikes in food prices and the2008 financial crisis
8 (eight) is the natural number following 7 and preceding 9.
In mathematics
8 is:
* a composite number, its proper divisors being , , and . It is twice 4 or four times 2.
* a power of two, being 2 (two cubed), and is the first number of t ...
. Additionally, there was an emerging consensus that combating malnutrition is one of the most cost-effective ways to contribute to development. This led to the 2010 launch of the UN's ''Scaling up Nutrition'' movement (SUN).
In April 2012, a number of countries signed the Food Assistance Convention
The Food Assistance Convention is an international treaty relating to food aid, food assistance. It was adopted on 25 April 2012 in London. The treaty aims at "addressing the food and nutritional needs of the most vulnerable populations" and inclu ...
, the world's first legally binding
A contract is a legally enforceable agreement between two or more parties that creates, defines, and governs mutual rights and obligations between them. A contract typically involves the transfer of goods, services, money, or a promise to tran ...
international agreement on food aid. The following month, the Copenhagen Consensus recommended that politicians and private sector philanthropists should prioritize interventions against hunger and malnutrition in order to maximize the effectiveness of aid spending. The Consensus recommended prioritizing these interventions ahead of any others, including the fights against malaria and AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...
.
In June 2015, the European Union and the Bill & Melinda Gates Foundation
The Bill & Melinda Gates Foundation (BMGF), a merging of the William H. Gates Foundation and the Gates Learning Foundation, is an American private foundation founded by Bill Gates and Melinda French Gates. Based in Seattle, Washington, it was l ...
launched a partnership to combat undernutrition, especially in children. The program was first implemented in Bangladesh, Burundi
Burundi (, ), officially the Republic of Burundi ( rn, Repuburika y’Uburundi ; Swahili language, Swahili: ''Jamuhuri ya Burundi''; French language, French: ''République du Burundi'' ), is a landlocked country in the Great Rift Valley at the ...
, Ethiopia, Kenya, Laos
Laos (, ''Lāo'' )), officially the Lao People's Democratic Republic ( Lao: ສາທາລະນະລັດ ປະຊາທິປະໄຕ ປະຊາຊົນລາວ, French: République démocratique populaire lao), is a socialist ...
and Niger. It aimed to help these countries improve information and analysis about nutrition, enabling them to develop effective national nutrition policies.
Also in 2015, the UN's Food and Agriculture Organization created a partnership aimed at ending hunger in Africa by 2025. The African Union's Comprehensive Africa Agriculture Development Programme (CAADP) provided the framework for the partnership. It includes a variety of interventions, including support for improved food production, a strengthening of social protection, and integration of the right to food into national legislation.
The EndingHunger campaign is an online communication campaign whose goal is to raise awareness about hunger. The campaign has created viral videos depicting celebrities voicing their anger about the large number of hungry people in the world.
After the Millennium Development Goals expired in 2015, the Sustainable Development Goals
The Sustainable Development Goals (SDGs) or Global Goals are a collection of 17 interlinked objectives designed to serve as a "shared blueprint for peace and prosperity for people and the planet, now and into the future".United Nations (2017) R ...
became the main global policy focus to reduce hunger and poverty. In particular, Goal 2: Zero Hunger sets globally agreed-upon targets to wipe out hunger, end all forms of malnutrition, and make agriculture sustainable. The partnership Compact2025 develops and disseminates evidence-based advice to politicians and other decision-makers, with the goal of ending hunger and undernutrition by 2025. The International Food Policy Research Institute
The International Food Policy Research Institute (IFPRI) is an international agricultural research center founded in the early 1970s to improve the understanding of national agricultural and food policies to promote the adoption of innovations ...
(IFPRI) led the partnership, with the involvement of UN organisations, non-governmental organizations (NGOs), and private foundation
A private foundation is a tax-exempt organization not relying on broad public support and generally claiming to serve humanitarian purposes. The Bill & Melinda Gates Foundation is the largest private foundation in the U.S. with over $38 billion ...
s.
Treatment
Improving nutrition
Efforts to improve nutrition are some of the common forms of development aid. Interventions often promote breastfeeding in order to reducerates
Rate or rates may refer to:
Finance
* Rates (tax), a type of taxation system in the United Kingdom used to fund local government
* Exchange rate, rate at which one currency will be exchanged for another
Mathematics and science
* Rate (mathema ...
of malnutrition and death in children. Some of these interventions have been successful. For example, interventions with commodities such as ready to use therapeutic foods, micronutrient intervention and vitamin supplementation were identified to significantly improve nutrition, reduce stunting and prevent diseases in communities with severe acute malnutrition. In young children, outcomes improve when children between six months and two years of age receive complementary food (in addition to breast milk). There is also good evidence that supports giving supplemental micronutrients to pregnant women and young children in the developing world.
Sending food and money is a common form of development aid, aimed at feeding hungry people. Some strategies help people buy food within local markets. Simply feeding students at school is insufficient.
Longer-term measures include improving agricultural practices, reducing poverty, and improving sanitation.
Identifying malnourishment
Measuring children is crucial to identifying malnourishment. In 2000, the United States Centers for Disease Control and Prevention (CDC) established the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) program. It tested children for malnutrition by conducting a three-dimensional scan, using an iPad or atablet
Tablet may refer to:
Medicine
* Tablet (pharmacy), a mixture of pharmacological substances pressed into a small cake or bar, colloquially called a "pill"
Computing
* Tablet computer, a mobile computer that is primarily operated by touching the s ...
. Its objective was to help doctors provide more efficient treatments. There may be some chance of error when using this method.
A systematic review
A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...
of 42 studies found that many approaches to mitigating acute malnutrition are equally effective; thus, intervention decisions can be based on cost-related factors. Overall, evidence for the effectiveness of acute malnutrition interventions is not robust. The limited evidence related to cost indicates that community and outpatient management of children with uncomplicated malnutrition may be the most cost-effective strategy.
Medical management
It is often possible to manage severe malnutrition within a person's home, using ready-to-use therapeutic foods. In people with severe malnutrition complicated by other health problems, treatment in a hospital setting is recommended. In-hospital treatment often involves managing low blood sugar, maintaining adequate body temperature, addressing dehydration, and gradual feeding. Routineantibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s are usually recommended because malnutrition weakens the immune system, causing a high risk of infection. Additionally, broad spectrum antibiotic
A broad-spectrum antibiotic is an antibiotic that acts on the two major bacterial groups, Gram-positive and Gram-negative, or any antibiotic that acts against a wide range of disease-causing bacteria. These medications are used when a bacterial in ...
s are recommended in all severely undernourished children with diarrhea requiring admission to hospital.
A severely malnourished child who appears to have dehydration, but has not had diarrhea, should be treated as if they have an infection.
Among malnourished people who are hospitalized, nutritional support improves protein intake, calorie intake, and weight.
Bangladeshi model
In response to child malnutrition, the Bangladeshi government
The Cabinet of Bangladesh ( bn, বাংলাদেশের মন্ত্রিসভা) is the chief executive body of the People's Republic of Bangladesh. The cabinet is the collective decision-making body of the entire government under ...
recommends ten steps for treating severe malnutrition:
# Prevent or treat dehydration
# Prevent or treat low blood sugar
# Prevent or treat low body temperature
# Prevent or treat infection;
# Correct electrolyte imbalances
# Correct micronutrient deficiencies
# Start feeding cautiously
# Achieve catch-up growth
# Provide psychological support
# Prepare for discharge and follow-up after recovery
Therapeutic foods
Due in part to limited research on supplementary feeding, there is little evidence that this strategy is beneficial. A 2015 systematic review of 32 studies found that there are limited benefits when children under 5 receive supplementary feeding, especially among younger, poorer, and more undernourished children. However, specially formulated foods do appear to be useful in treating moderate acute malnutrition in the developing world. These foods may have additional benefits in humanitarian emergencies, since they can be stored for years, can be eaten directly from the packet, and do not have to be mixed with clean water or refrigerated. In young children with severe acute malnutrition, it is unclear if ready-to-use therapeutic food differs from a normal diet. Severely malnourished individuals can experiencerefeeding syndrome
Refeeding syndrome is a metabolic disturbance that occurs as a result of reinstitution of nutrition in people and animals who are starved, severely malnourished, or metabolically stressed because of severe illness. When too much food or liquid nut ...
if fed too quickly. Refeeding syndrome can result regardless of whether food is taken orally or parenterally
A route of administration in pharmacology and toxicology is the way by which a drug, fluid, poison, or other substance is taken into the body.
Routes of administration are generally classified by the location at which the substance is applied. ...
. It can present several days after eating with potentially fatal heart failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
, dysrhythmias, and confusion.
Some manufacturers have fortified
A fortification is a military construction or building designed for the defense of territories in warfare, and is also used to establish rule in a region during peacetime. The term is derived from Latin ''fortis'' ("strong") and ''facere'' ...
everyday foods with micronutrients before selling them to consumers. For example, flour has been fortified with iron, zinc, folic acid, and other B vitamins like thiamine, riboflavin, niacin and vitamin B12. Baladi bread ( Egyptian flatbread
A flatbread is a bread made with flour; water, milk, yogurt, or other liquid; and salt, and then thoroughly rolled into flattened dough. Many flatbreads are unleavened, although some are leavened, such as pizza and pita bread.
Flatbreads ran ...
) is made with fortified wheat flour. Other fortified products include fish sauce in Vietnam and iodized salt.
Micronutrient supplementation
According to the World Bank, treating malnutrition - mostly by fortifying foods with micronutrients - improves lives more quickly than other forms of aid, and at a lower cost. After reviewing a variety of development proposals, The Copenhagen Consensus, a group of economists who reviewed a variety of development proposals, ranked micronutrient supplementation as its number-one treatment strategy. In malnourished people with diarrhea,zinc supplementation
Zinc deficiency is defined either as insufficient zinc to meet the needs of the body, or as a serum zinc level below the normal range. However, since a decrease in the serum concentration is only detectable after long-term or severe depletion, s ...
is recommended following an initial four-hour rehydration period. Daily zinc supplementation can help reduce the severity and duration of the diarrhea. Additionally, continuing daily zinc supplementation for ten to fourteen days makes diarrhea less likely to recur in the next two to three months.The Treatment of Diarrhoea: A manual for physicians and other senior health workersWorld Health Organization, 2005. See especially Ch. 4 "Management of Acute Diarrhoea (Without Blood)" and Ch. 8 "Management of Diarrhoea With Severe Malnutrition." Malnourished children also need both potassium and magnesium.National Guidelines for the Management of Severely Malnourished Children in Bangladesh
, Institute of Public Health Nutrition, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, May 2008, page 18 (19 in PDF) and following pages. Within two to three hours of starting rehydration, children should be encouraged to take food, particularly foods rich in potassium like bananas, green coconut water, and unsweetened fresh fruit juice. Along with continued eating, many homemade products can also help restore normal electrolyte levels. For example, early during the course of a child's diarrhea, it can be beneficial to provide cereal water (salted or unsalted) or vegetable broth (salted or unsalted). If available, vitamin A, potassium, magnesium, and zinc supplements should be added, along with other vitamins and minerals. Giving base (as in Ringer's lactate) to treat acidosis without simultaneously supplementing potassium worsens low blood potassium.
Treating diarrhea
Preventing dehydration
Food and drink can help prevent dehydration in malnourished people with diarrhea. Eating (or breastfeeding, among infants) should resume as soon as possible. Sugary beverages like soft drinks, fruit juices, and sweetened teas are not recommended as they may worsen diarrhea. Malnourished people with diarrhea (especially children) should be encouraged to drink fluids; the best choices are fluids with modest amounts of sugar and salt, like vegetable broth or saltedrice water
Rice water is a suspension of starch obtained by draining boiled rice or by boiling rice until it completely dissolves into the water. It may be used as a weak gruel for invalids. It is especially effective in the treatment of diarrhea such as ...
. If clean water is available, they should be encouraged to drink that too. Malnourished people should be allowed to drink as much as they want, unless signs of swelling emerge.
Babies can be given small amounts of fluids via an eyedropper or a syringe without the needle. Children under two should receive a teaspoon of fluid every one to two minutes; older children and adults should take frequent sips of fluids directly from a cup. After the first two hours, fluids and foods should be alternated, rehydration should be continued at the same rate or more slowly, depending on how much fluid the child wants and whether they are having ongoing diarrhea. Alternating between rehydration and food at this point is After the first two hours of rehydration it is recommended that to alternate between rehydration and food.
If vomiting occurs, fluids can be paused for 5–10 minutes and then restarted more slowly. Vomiting rarely prevents rehydration, since fluids are still absorbed and vomiting is usually short-term.
Oral rehydration therapy
If prevention has failed and dehydration develops, the preferred treatment is rehydration through oral rehydration therapy (ORT). In severely undernourished children with diarrhea, rehydration should be done slowly, according to the World Health Organization. Oral rehydration solutions consist of clean water mixed with small amounts of sugars and salts. These solutions help restore normal electrolyte levels, provide a source of carbohydrates, and help with fluid replacement. Reduced- osmolarity ORS is the current standard of care for oral rehydration therapy, with reasonably wide availability. Introduced in 2003 by WHO and UNICEF, reduced-osmolarity solutions contain lower concentrations of sodium and glucose than original ORS preparations. Reduced-osmolarity ORS has the added benefit of reducing stool volume and vomiting while simultaneously preventing dehydration. Packets of reduced-osmolarity ORS include glucose, table salt,potassium chloride
Potassium chloride (KCl, or potassium salt) is a metal halide salt composed of potassium and chlorine. It is odorless and has a white or colorless vitreous crystal appearance. The solid dissolves readily in water, and its solutions have a salt ...
, and trisodium citrate
Trisodium citrate has the chemical formula of Na3C6H5O7. It is sometimes referred to simply as "sodium citrate", though sodium citrate can refer to any of the three sodium salts of citric acid. It possesses a saline, mildly tart flavor, and is a ...
. For general use, each packet should be mixed with a liter of water. However, for malnourished children, experts recommend adding a packet of ORS to two liters of water, along with an extra 50 grams of sucrose
Sucrose, a disaccharide, is a sugar composed of glucose and fructose subunits. It is produced naturally in plants and is the main constituent of white sugar. It has the molecular formula .
For human consumption, sucrose is extracted and refined ...
and some stock potassium solution.
People who have no access to commercially available ORS can make a homemade version using water, sugar, and table salt. Experts agree that homemade ORS preparations should include one liter
The litre (international spelling) or liter (American English spelling) (SI symbols L and l, other symbol used: ℓ) is a metric unit of volume. It is equal to 1 cubic decimetre (dm3), 1000 cubic centimetres (cm3) or 0.001 cubic metre (m3). ...
(34 oz.) of clean water and 6 teaspoons of sugar; however, they disagree about whether they should contain half a teaspoon of table salt or a full teaspoon. Most sources recommend using half a teaspoon of salt per liter of water.Family Practice NotebookOral Rehydration Solution, Scott Moses, MD, February 1, 2014. However, people with malnutrition have an excess of body sodium. To avoid worsening this symptom, ORS for people with severe undernutrition should contain half the usual amount of sodium and more potassium. Patients who do not drink may require fluids by nasogastric tube.
Intravenous
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
fluids are recommended only in those who have significant dehydration due to their potential complications, including congestive heart failure.
Low blood sugar
Hypoglycemia, whether known or suspected, can be treated with a mixture of sugar and water. If the patient is conscious, the initial dose of sugar and water can be given by mouth. Otherwise, they should receive glucose byintravenous
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
or nasogastric tube. If seizures occur (and continue after glucose is given), rectal diazepam may be helpful. Blood sugar levels should be re-checked on two hour intervals.
Hypothermia
Hypothermia (dangerously lowcore body temperature
Normal human body-temperature (normothermia, euthermia) is the typical temperature range found in humans. The normal human body temperature range is typically stated as .
Human body temperature varies. It depends on sex, age, time of day, exert ...
) can occur in malnutrition, particularly in children. Mild hypothermia causes confusion trembling, and clumsiness; more severe cases can be fatal. Keeping malnourished children warm can prevent or treat hypothermia. Covering the child (including their head) in blankets is one method. Another method is to warm the child through direct skin-to-skin contact with their mother or father, then covering both parent and child.
Warming methods are usually most important at night. Prolonged bathing or prolonged medical exams can further lower body temperature and are not recommended for malnourished children at high risk of hypothermia.
Epidemiology
The figures provided in this section on epidemiology all refer to ''undernutrition'' even if the term malnutrition is used which, by definition, could also apply to too much nutrition.
The Global Hunger Index (GHI) is a multidimensional statistical tool used to describe the state of countries' hunger situation. The GHI measures progress and failures in the global fight against hunger. The GHI is updated once a year. The data from the 2015 report shows that Hunger levels have dropped 27% since 2000. Fifty two countries remain at serious or alarming levels. In addition to the latest statistics on Hunger and Food Security, the GHI also features different special topics each year. The 2015 report include an article on conflict and food security.
People affected
The United Nations estimated that there were 821 million undernourished people in the world in 2017. This is using the UN's definition of 'undernourishment', where it refers to insufficient consumption of raw calories, and so does not necessarily include people who lack micro nutrients. The undernourishment occurred despite the world's farmers producing enough food to feed around 12 billion people—almost double the current world population. Malnutrition, as of 2010, was the cause of 1.4% of alldisability adjusted life years
The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed in the 1990s as a way of comparing the overall health and life ex ...
.
Mortality
Mortality due to malnutrition accounted for 58 percent of the total mortality in 2006: "In the world, approximately 62 million people, all causes of death combined, die each year. 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.
According to the World Health Organization, malnutrition is the biggest contributor to child mortality
Child mortality is the mortality of children under the age of five. The child mortality rate, also under-five mortality rate, refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births.
It en ...
, present in half of all cases. 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. 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.
History
Hunger has been a perennial human problem. However, until the early 20th century, there was relatively little awareness of the qualitative aspects of malnutrition. Throughout history, various peoples have known the importance of eating certain foods to prevent symptoms now associated with malnutrition. Yet such knowledge appears to have been repeatedly lost and then re-discovered. For example, the ancient Egyptians reportedly knew the symptoms of scurvy. Much later, in the14th century
As a means of recording the passage of time, the 14th century was a century lasting from 1 January 1301 ( MCCCI), to 31 December 1400 ( MCD). It is estimated that the century witnessed the death of more than 45 million lives from political and n ...
, Crusaders sometimes used anti-scurvy measures - for example, ensuring that citrus fruits were planted on Mediterranean islands, for use on sea journeys. However, for several centuries, Europeans appear to have forgotten the importance of these measures. They rediscovered this knowledge in the 18th century
The 18th century lasted from January 1, 1701 ( MDCCI) to December 31, 1800 ( MDCCC). During the 18th century, elements of Enlightenment thinking culminated in the American, French, and Haitian Revolutions. During the century, slave trad ...
, and by the early 19th century, the Royal Navy was issuing frequent rations of lemon juice to every crewman on their ships. This massively reduced scurvy deaths among British sailors, which in turn gave the British a significant advantage in the Napoleonic Wars. Later on in the 19th century, the Royal Navy replaced lemons with limes (unaware at the time that lemons are far more effective at preventing scurvy).
According to historian Michael Worboys, malnutrition was essentially discovered, and the science of nutrition established, between World War I and World War II. Advances built on prior works like Casimir Funk's 1912 formulisation of the concept of vitamins. Scientific study of malnutrition increased in the 1920s and 1930s, and grew even more common after World War II.
Non-governmental organizations and United Nations agencies began to devote considerable energy to alleviating malnutrition around the world. The exact methods and priorities for doing this tended to fluctuate over the years, with varying levels of focus on different types of malnutrition like Kwashiorkor
Kwashiorkor ( , ) is a form of severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates. It is thought to be caused by sufficient calorie intake, but with insufficient protein consumption (or lack of goo ...
or Marasmus
Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the a ...
; varying levels of concern on protein deficiency compared to vitamins, minerals and lack of raw calories; and varying priorities given to the problem of malnutrition in general compared to other health and development concerns. The green Revolution of the 1950s and 1960s saw considerable improvement in capability to prevent malnutrition.
One of the first official global documents addressing Food security and global malnutrition was the 1948 Universal Declaration of Human Rights(UDHR). Within this document it stated that access to food was part of an adequate right to a standard of living. The Right to food was asserted in the International Covenant on Economic, Social and Cultural Rights, a treaty adopted by the United Nations General Assembly on December 16, 1966. The Right to food is a human right for people to feed themselves in dignity, be free from hunger, food insecurity, and malnutrition. As of 2018, the treaty has been signed by 166 countries, by signing states agreed to take steps to the maximum of their available resources to achieve the right to adequate food.
However, after the 1966 International Covenant the global concern for the access to sufficient food only became more present, leading to the first ever World Food Conference that was held in 1974 in Rome, Italy. The Universal Declaration on the Eradication of Hunger and Malnutrition was a UN resolution adopted November 16, 1974 by all 135 countries that attended the 1974 World Food Conference. This non-legally binding document set forth certain aspirations for countries to follow to sufficiently take action on the global food problem. Ultimately this document outline and provided guidance as to how the international community as one could work towards fighting and solving the growing global issue of malnutrition and hunger.
Adoption of the right to food was included in the Additional Protocol to the American Convention on Human Rights in the area of Economic, Social, and Cultural Rights, this 1978 document was adopted by many countries in the Americas, the purpose of the document is, "to consolidate in this hemisphere, within the framework of democratic institutions, a system of personal liberty and social justice based on respect for the essential rights of man."
A later document in the timeline of global inititaves for malnutrition was the 1996 Rome Declaration on World Food Security, organized by the Food and Agriculture Organization. This document reaffirmed the right to have access to safe and nutritious food by everyone, also considering that everyone gets sufficient food, and set the goals for all nations to improve their commitment to food security by halving their amount of undernourished people by 2015. In 2004 the Food and Agriculture Organization adopted the Right to Food Guidelines
The Voluntary Guidelines to support the Progressive Realization of the Right to Adequate Food in the Context of National Food Security, also known as the Right to Food Guidelines, is a document adopted by the Food and Agriculture Organization of ...
, which offered states a framework of how to increase the right to food on a national basis.
Special populations
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.Children
Undernutrition adversely affects the cognitive development of children, contributing to poor earning capacity and poverty in adulthood. The development of childhood undernutrition coincides with the introduction of complementary weaning foods which are usually nutrient deficient. The World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide, about 1 million children. There is a strong association between undernutrition and child mortality. 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.Prüss-Üstün, A., Bos, R., Gore, F., Bartram, J. (2008)Safer water, better health – Costs, benefits and sustainability of interventions to protect and promote health
World Health Organization (WHO), Geneva, Switzerland Over 90% of the stunted children below five years of age live in sub-Saharan Africa and South Central Asia. Although access to adequate food and improving nutritional intake is an obvious solution to tackling undernutrition in children, the progress in reducing children undernutrition is disappointing.
Women
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. These small-scale studies showed that female undernutrition prevalence rates exceeded male undernutrition prevalence rates in South/Southeast Asia and Latin America and were lower in Sub-Saharan Africa. Datasets for Ethiopia and Zimbabwe reported undernutrition rates between 1.5 and 2 times higher in men than in women; however, in India and Pakistan, datasets rates of undernutrition were 1.5–2 times higher in women than in men. Intra-country variation also occurs, with frequent high gaps between regional undernutrition rates. Gender inequality in nutrition in some countries such as India is present in all stages of life.
Studies on nutrition concerning gender bias within households look at patterns of food allocation, and one study from 2003 suggested that women often receive a lower share of food requirements than men. Gender discrimination, gender roles, and social norms affecting women can lead to early marriage and childbearing, close birth spacing, and undernutrition, all of which contribute to malnourished mothers.
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. Samples of 1000 women in India in 2008 demonstrated that malnutrition in women is associated with poverty, lack of development and awareness, and illiteracy. The same study showed that gender discrimination in households can prevent a woman's access to sufficient food and healthcare. How socialization affects the health of women in Bangladesh, Najma Rivzi explains in an article about a research program on this topic. In some cases, such as in parts of Kenya in 2006, rates of malnutrition in pregnant women were even higher than rates in children.
Women in some societies are traditionally given less food than men since men are perceived to have heavier workloads. Household chores and agricultural tasks can in fact be very arduous and require additional energy and nutrients; however, physical activity, which largely determines energy requirements, is difficult to estimate.
Physiology
Women have unique nutritional requirements, and in some cases need more nutrients than men; for example, women need twice as much calcium as men.Pregnancy and breastfeeding
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). In 2001 the FAO of the UN reported that iron deficiency affected 43 percent of women in developing countries and increased the risk of death during childbirth. A 2008 review of interventions estimated that universal supplementation with calcium, iron, and folic acid during pregnancy could prevent 105,000 maternal deaths (23.6 percent of all maternal deaths). Malnutrition has been found to affect three quarters of UK women aged 16–49 indicated by them having less folic acid than the WHO recommended levels. Frequent pregnancies with short intervals between them and long periods of breastfeeding add an additional nutritional burden.Educating children
" Action for healthy kids" has created several methods to teach children about nutrition. They introduce 2 different topics, self-awareness which teaches children about taking care of their own health and social awareness, which is how culinary arts vary from culture to culture. As well as its importance when it comes to nutrition. They include eBooks, tips, cooking clubs. including facts about vegetables and fruits. Team Nutrition has created " MyPlate eBooks" this includes 8 different eBooks to download for free. These eBooks contain drawings to color, audio narration, and a large number of characters to make nutrition lessons entertaining for children. According to the FAO, women are often responsible for preparing food and have the chance to educate their children about beneficial food and health habits, giving mothers another chance to improve the nutrition of their children.Elderly
Malnutrition and being underweight are more common in the elderly than in adults of other ages. If elderly people are healthy and active, the aging process alone does not usually cause malnutrition. However, 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. Sadness or depression can play a role, causing changes in appetite, digestion, energy level, weight, and well-being. 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. Poor dental health, ill-fitting dentures, or chewing and swallowing problems can make eating difficult. As a result of these factors, malnutrition is seen to develop more easily in the elderly.
Rates of malnutrition tend to increase with age with less than 10 percent of the "young" elderly (up to age 75) malnourished, while 30 to 65 percent of the elderly in home care, long-term care facilities, or acute hospitals are malnourished. Many elderly people require assistance in eating, which may contribute to malnutrition. However, the mortality rate due to undernourishment may be reduced. Because of this, one of the main requirements of elderly care is to provide an adequate diet and all essential nutrients. Providing the different nutrients such as protein and energy keeps even small but consistent weight gain. Hospital admissions for malnutrition in the United Kingdom have been related to insufficient social care, where vulnerable people at home or in care homes are not helped to eat.
In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission. Malnutrition and weight loss can contribute to sarcopenia
Sarcopenia is a type of muscle loss (muscle atrophy) that occurs with aging and/or immobility. It is characterized by the degenerative loss of skeletal muscle mass, quality, and strength. The rate of muscle loss is dependent on exercise level, c ...
with loss of lean body mass and muscle function. Abdominal obesity or weight loss coupled with sarcopenia lead to immobility, skeletal disorders, insulin resistance, hypertension, atherosclerosis, and metabolic disorders. A paper from the ''Journal of the American Dietetic Association'' noted that routine nutrition screenings represent one way to detect and therefore decrease the prevalence of malnutrition in the elderly.
See also
*Action Against Hunger
Action Against Hunger (french: Action Contre La Faim - ACF) is a global humanitarian organization which originated in France and is committed to ending world hunger. The organization helps malnourished children and provides communities with acce ...
* ''A Place at the Table
''A Place at the Table'' is a 2012 film produced by Lori Silverbush and Kristi Jacobson, with appearances by Jeff Bridges, Raj Patel, and chef Tom Colicchio. The film, concerning hunger in the United States, was released theatrically in the Unite ...
''
* Agrobiodiversity
* Child health and nutrition in Africa Child health and nutrition in Africa is concerned with the health care of children through adolescents in the various countries of Africa. The right to health and a nutritious and sufficient diet are internationally recognized fundamental human righ ...
* Childhood obesity
Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of ...
* Community Therapeutic Care
Community Therapeutic Care is a new approach to dealing with acute malnutrition.
Community-based Therapeutic Care (CTC) was developed to improve the coverage and impact of selective feeding programs for the treatment of acute malnutrition. Its c ...
* Deficiency (medicine)
In medicine, a deficiency is a lack or shortage of a functional entity, by less than normal or necessary supply or function.TheFreeDictionary > deficiency Citing:
*Dorland's Medical Dictionary for Health Consumers. © 2007
* Miller-Keane Encycloped ...
* Eating disorder
An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating d ...
* Economic issues
A social issue is a problem that affects many people within a society. It is a group of common problems in present-day society and ones that many people strive to solve. It is often the consequence of factors extending beyond an individual's cont ...
* Famine scales Famine scales are the ways in which degrees of food security are measured, from situations in which an entire population has adequate food to full-scale famine. The word "famine" has highly emotive and political connotations and there has been exte ...
* Fome Zero
Fome Zero (, ''Zero Hunger'') is a program of the Government of Brazil introduced by President Luiz Inácio Lula da Silva in 2003, with the goal to eradicate hunger and extreme poverty in the country.
Contents of the program
The program is co- ...
(Zero Hunger)
* Food Donation Connection
Food Donation Connection (FDC), LLC is a privately owned American company that serves as the liaison between restaurants/food service companies interested in donating surplus food, and local social service agencies that distribute food to people ...
* Homelessness
Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and adequate housing. People can be categorized as homeless if they are:
* living on the streets, also kn ...
* Hunger in the United Kingdom
Chronic hunger has affected a sizable proportion of the UK's population throughout its history. Following improved economic conditions that followed World War II, hunger became a less pressing issue. Yet since the lasting global inflation in t ...
* Hunger in the United States
Hunger in the United States of America affects millions of Americans, including some who are middle class, or who are in households where all adults are in work. The United States produces far more food than it needs for domestic consumption—h ...
* Hunger marches
Hunger marches are a form of social protest that arose in the United Kingdom during the early 20th century. Often the marches involved groups of men and women walking from areas with high unemployment, to London where they would protest outside pa ...
* The Hunger Project
The Hunger Project (THP), founded in 1977 with the stated goal of ending world hunger in 25 years, is an organization committed to the sustainable end of world hunger. It has ongoing programs in Africa, Asia, and Latin America, where it implemen ...
* Income inequality
* Integrated Food Security Phase Classification
* Malnutrition in India
* Malnutrition in South Africa
* Malnutrition in Peru Malnutrition is a condition that affects bodily capacities of an individual, including growth, pregnancy, lactation, resistance to illness, and cognitive and physical development. Malnutrition is commonly used in reference to undernourishment, or a ...
* Malnutrition in Zimbabwe
Overview
Zimbabwe, a country in southern Africa, is suffering widespread malnutrition and diseases, such as HIV/ AIDS, tuberculosis, and malaria. "One in four human beings is malnourished" in Africa, but Zimbabwe is near the deep end with almost 1 ...
* NutritionDay
"nutritionDay worldwide" is a large scale, worldwide action project designed to reduce disease-related malnutrition among hospitalised patients and nursing home residents. The aim of this project is to increase awareness and knowledge regarding ...
* Nutrition and Education International
* Muselmann
Muselmann (German plural Muselmänner) was a slang term used amongst prisoners of German Nazi concentration camps during the Holocaust (World War II) to refer to those suffering from a combination of starvation (known also as "hunger disease") ...
* National Security Study Memorandum 200
National Security Study Memorandum 200: Implications of Worldwide Population Growth for U.S. Security and Overseas Interests (NSSM200), also known as the "Kissinger Report", was a national security directive completed on December 10, 1974 by the ...
(1974)
* Oxfam
Oxfam is a British-founded confederation of 21 independent charitable organizations focusing on the alleviation of global poverty, founded in 1942 and led by Oxfam International.
History
Founded at 17 Broad Street, Oxford, as the Oxford Co ...
* Poverty trap
* Project Open Hand
* Social programs
* Starvation response
Starvation response in animals (including humans) is a set of adaptive biochemical and physiological changes, triggered by lack of food or extreme weight loss, in which the body seeks to conserve energy by reducing the amount of calories it burns ...
* Sustainable fishery
A conventional idea of a sustainable fishery is that it is one that is harvested at a sustainable rate, where the fish population does not decline over time because of fishing practices. Sustainability in fisheries combines theoretical discipl ...
* United Nations Millennium Declaration
* Vitamin deficiency
Vitamin deficiency is the condition of a long-term lack of a vitamin. When caused by not enough vitamin intake it is classified as a ''primary deficiency'', whereas when due to an underlying disorder such as malabsorption it is called a ''seconda ...
References
External links
*Action Against Hunger , ACF-USA
Action Against Hunger , ACF-UK
Hunger Relief International , HRI
Hunger Relief research on IssueLab
The Global Food Security and Nutrition Forum (FSN Forum)
Ten Things you can do to Fight World Hunger
''The Nation'', May 13, 2009
United Nation 2007 report
World Food Programme , WFP
UN
WFP
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