Malnutrition is a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals. Malnutrition is often used to specifically refer to undernutrition where an individual is not getting enough calories, protein, or micronutrients. If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development. In some developing countries, overnutrition in the form of obesity is beginning to present within the same communities as undernutrition. Other causes of malnutrition include anorexia nervosa and bariatric surgery.
Efforts to improve nutrition are some of the most effective forms of development aid. Simply feeding students at school is insufficient. Routine antibiotics are usually recommended due to the high risk of infection. reducing poverty, improving sanitation, and the empowerment of women. This is a reduction of 216 million people since 1990 when 23% were undernourished. In 2012 it was estimated that another billion people had a lack of vitamins and minerals. In 2015, protein-energy malnutrition was estimated to have resulted in 323,000 deaths—down from 510,000 deaths in 1990. Other nutritional deficiencies, which include iodine deficiency and iron deficiency anemia, result in another 83,000 deaths. About a third of deaths in children are believed to be due to undernutrition, although the deaths are rarely labelled as such. In 2010, it was estimated to have contributed to about 1.5 million deaths in women and children, though some estimate the number may be greater than 3 million. Undernutrition is more common in developing countries. Certain groups have higher rates of undernutrition, including women—in particular while pregnant or breastfeeding—children under five years of age, and the elderly. In the elderly, undernutrition becomes more common due to physical, psychological, and social factors.
Unless specifically mentioned otherwise, the term malnutrition refers to undernutrition for the remainder of this article. Malnutrition can be divided into two different types, SAM and MAM. SAM refers to children with severe acute malnutrition. MAM refers to moderate acute malnutrition.
===Undernutrition and overnutrition=== Malnutrition is caused by eating a diet in which nutrients are not enough or are too much such that it causes health problems. It is a category of diseases that includes undernutrition and overnutrition. Overnutrition can result in obesity and being overweight. In some developing countries, overnutrition in the form of obesity is beginning to present within the same communities as undernutrition.
However, the term malnutrition is commonly used to refer to undernutrition only. This applies particularly to the context of development cooperation. Therefore, "malnutrition" in documents by the World Health Organization, UNICEF, Save the Children or other international non-governmental organizations (NGOs) usually is equated to undernutrition.
Undernutrition is sometimes used as a synonym of protein–energy malnutrition (PEM).
The term "severe malnutrition" or "severe undernutrition" is often used to refer specifically to PEM. PEM is often associated with micronutrient deficiency.
====Marasmus==== Marasmus (‘to waste away’) is caused by an inadequate intake of protein and energy. The main symptoms are severe wasting, leaving little or no edema, minimal subcutaneous fat, severe muscle wasting, and non-normal serum albumin levels. The degrees were based on weight below a specified percentage of median weight for age.
===Definition by Waterlow=== John Conrad Waterlow established a new classification for malnutrition. One advantage of the Waterlow classification over the Gomez classification is that weight for height can be examined even if ages are not known. |}
These classifications of malnutrition are commonly used with some modifications by WHO. Protein and energy malnutrition and deficiencies of specific micronutrients (including iron, zinc, and vitamins) increase susceptibility to infection. Malnutrition affects HIV transmission by increasing the risk of transmission from mother to child and also increasing replication of the virus. Iron deficiency anemia in children under two years of age likely affects brain function acutely and probably also chronically. Folate deficiency has been linked to neural tube defects.
Malnutrition in the form of iodine deficiency is "the most common preventable cause of mental impairment worldwide." "Even moderate deficiency, especially in pregnant women and infants, lowers intelligence by 10 to 15 I.Q. points, shaving incalculable potential off a nation's development. The most visible and severe effects — disabling goiters, cretinism and dwarfism — affect a tiny minority, usually in mountain villages. But 16 percent of the world's people have at least mild goiter, a swollen thyroid gland in the neck."
===Diseases=== Malnutrition can be a consequence of health issues such as gastroenteritis or chronic illness, especially the HIV/AIDS pandemic. Diarrhea and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss. Parasite infections, in particular intestinal worm infections (helminthiasis), can also lead to malnutrition. Malnutrition may also occur due to increased energy expenditure (secondary malnutrition).
==== Undernutrition ==== A lack of adequate breastfeeding leads to malnutrition in infants and children, associated with the deaths of an estimated one million children annually. Illegal advertising of breast milk substitutes continues three decades after its 1981 prohibition under the WHO International Code of Marketing Breast Milk Substitutes.
Maternal malnutrition can also factor into an unhealthy or worse the death of a baby. Over 800,000 neonatal death 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 corn 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.
==== 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, and lowers life expectancy. As much as food shortages may be a contributing factor to malnutrition in countries with lack of technology, the FAO (Food and Agriculture Organization) has estimated that eighty percent of malnourished children living in the developing world live in countries that produce food surpluses. The economist Amartya Sen observed that, in recent decades, famine has always been a problem of food distribution and/or poverty, as there has been sufficient food to feed the whole population of the world. He states that malnutrition and famine were more related to problems of food distribution and purchasing power.
It is argued that commodity speculators are increasing the cost of food. As the real estate bubble 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.
The use of biofuels 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 and banana leaves, rather than crops themselves be used as fuel.
===Agricultural productivity=== Local food shortages can be caused by a lack of arable land, adverse weather, lower farming skills such as crop rotation, or by a lack of technology or resources needed for the higher yields found in modern agriculture, such as fertilizers, pesticides, irrigation, machinery and storage facilities. As a result of widespread poverty, farmers cannot afford or governments cannot provide the resources necessary to improve local yields. The World Bank and some wealthy donor countries also press nations that depend on aid to cut or eliminate subsidized agricultural inputs such as fertilizer, in the name of free market policies even as the United States and Europe extensively subsidized their own farmers. Many, if not most, farmers cannot afford fertilizer at market prices, leading to low agricultural production and wages and high, unaffordable food prices.
===Future threats=== There are a number of potential disruptions to global food supply that could cause widespread malnutrition.
Climate change is of importance to food security, with 95 percent of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics. According to the latest IPCC reports, temperature increases in these regions are "very likely." Even small changes in temperatures can lead to increased frequency of extreme weather conditions. Similar figures were present in other nations. An increase in extreme weather such as drought in regions such as Sub-Saharan Africa 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, also decreasing food security in these regions.
Colony collapse disorder is a phenomenon where bees die in large numbers. Since many agricultural crops worldwide are pollinated by bees, this represents a threat to the supply of food.
An epidemic of wheat stem rust caused by race Ug99 is currently spreading across Africa and into Asia and, it is feared, could wipe out more than 80 percent of the world’s wheat crops.
The effort to bring modern agricultural techniques found in the West, such as nitrogen fertilizers and pesticides, to Asia, called the Green Revolution, resulted in decreases in malnutrition similar to those seen earlier in Western nations. This was possible because of existing infrastructure and institutions that are in short supply in Africa, such as a system of roads or public seed companies that made seeds available. Investments in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces food prices. For example, in the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced against World Bank strictures, farmers produced record-breaking corn harvests as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter. Proponents for investing in agriculture include Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa’s farmers.
New technology in agricultural production also has great potential to combat undernutrition. By improving agricultural yields, farmers could reduce poverty by increasing income as well as open up area for diversification of crops for household use. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.
===Breastfeeding=== As of 2016 is estimated that about 821,000 deaths of children less than five years old could be prevented globally per year through more widespread breastfeeding.
===Fortified foods=== Manufacturers are trying to fortify everyday foods with micronutrients that can be sold to consumers such as wheat flour for Beladi bread in Egypt or fish sauce in Vietnam and the iodization of salt.
For example, flour has been fortified with iron, zinc, folic acid and other B vitamins such as thiamine, riboflavin, niacin and vitamin B12. Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth. However, there are many who believe that the world has more than enough resources to sustain its population. Instead, these theorists point to unequal distribution of resources and under- or unutilized arable land as the cause for malnutrition problems. For example, Amartya Sen advocates 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."
==Global initiatives== In April 2012, the Food Assistance Convention was signed, the world's first legally binding international agreement on food aid. The May 2012 Copenhagen Consensus recommended that efforts to combat hunger and malnutrition should be the first priority for politicians and private sector philanthropists looking to maximize the effectiveness of aid spending. They put this ahead of other priorities, like the fight against malaria and AIDS.
The main global policy to reduce hunger and poverty are the Sustainable Development Goals. In particular Goal 2: Zero hunger sets globally agreed targets to end hunger, achieve food security and improved nutrition and promote sustainable agriculture. The partnership Compact2025, led by IFPRI with the involvement of UN organisations, NGOs and private foundations develops and disseminates evidence-based advice to politicians and other decision-makers aimed at ending hunger and undernutrition in the coming 10 years, by 2025.
The EndingHunger campaign is an online communication campaign aimed at raising awareness of the hunger problem. It has many worked through viral videos depicting celebrities voicing their anger about the large number of hungry people in the world. Another initiative focused on improving the hunger situation by improving nutrition is the Scaling up Nutrition movement (SUN). Started in 2010 this movement of people from governments, civil society, the United Nations, donors, businesses and researchers, publishes a yearly progress report on the changes in their 55 partner countries.
In response to child malnutrition, the Bangladeshi government recommends ten steps for treating severe malnutrition. They are to prevent or treat dehydration, low blood sugar, low body temperature, infection, correct electrolyte imbalances and micronutrient deficiencies, start feeding cautiously, achieve catch-up growth, provide psychological support, and prepare for discharge and follow-up after recovery.
Among those patients who are hospitalized, nutritional support improves protein, calorie intake and weight.
===Food=== The evidence for benefit of supplementary feeding is poor. This is due to the small amount of research done on this treatment.
Specially formulated foods do however appear useful in those from the developing world with moderate acute malnutrition. In young children with severe acute malnutrition it is unclear if ready-to-use therapeutic food differs from a normal diet. They may have some benefits in humanitarian emergencies as they can be eaten directly from the packet, do not require refrigeration or mixing with clean water, and can be stored for years. This can result regardless of route of feeding and can present itself a couple of days after eating with heart failure, dysrhythmias and confusion that can result in death.
===Micronutrients=== Treating malnutrition, mostly through fortifying foods with micronutrients (vitamins and minerals), improves lives at a lower cost and shorter time than other forms of aid, according to the World Bank. The Copenhagen Consensus, which look at a variety of development proposals, ranked micronutrient supplements as number one.
In those with diarrhea, once an initial four-hour rehydration period is completed, zinc supplementation is recommended. Daily zinc increases the chances of reducing the severity and duration of the diarrhea, and continuing with daily zinc for ten to fourteen days makes diarrhea less likely recur in the next two to three months.
In addition, malnourished children need both potassium and magnesium.
Breast feeding and eating should resume as soon as possible. Drinks such as soft drinks, fruit juices, or sweetened teas are not recommended as they contain too much sugar and may worsen diarrhea. Broad spectrum antibiotics are recommended in all severely undernourished children with diarrhea requiring admission to hospital. For general use, one packet of ORS (glucose sugar, salt, potassium chloride, and trisodium citrate) is added to one liter of water; however, for malnourished children it is recommended that one packet of ORS be added to two liters of water along with an extra 50 grams of sucrose sugar and some stock potassium solution.
Malnourished children have an excess of body sodium.
===Low blood sugar=== Hypoglycemia, whether known or suspected, can be treated with a mixture of sugar and water. If the child is conscious, the initial dose of sugar and water can be given by mouth. If the child is unconscious, give glucose by intravenous or nasogastric tube. If seizures occur after despite glucose, rectal diazepam is recommended. Blood sugar levels should be re-checked on two hour intervals. The UN's World Food Program, the biggest non-governmental distributor of food, announced that it will begin distributing cash and vouchers instead of food in some areas, which Josette Sheeran, the WFP's executive director, described as a "revolution" in food aid. The aid agency Concern Worldwide is piloting a method through a mobile phone operator, Safaricom, which runs a money transfer program that allows cash to be sent from one part of the country to another. U.S. law, which requires buying food at home rather than where the hungry live, is inefficient because approximately half of what is spent goes for transport.
Ethiopia has been pioneering a program that has now become part of the World Bank's prescribed method for coping with a food crisis and had been seen by aid organizations as a model of how to best help hungry nations. Through the country's main food assistance program, the Productive Safety Net Program, Ethiopia has been giving rural residents who are 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. Ethiopia been pioneering a program, and Brazil has established a recycling program for organic waste that benefits farmers, 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. As a result, the country's waste is reduced and the urban poor get a steady supply of nutritious food.
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.
===People affected=== There were 793 million undernourished people in the world in 2015.