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malnutrition
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{{redirect|Underfeeding|the concept in metalworking|Underfeeder}}{{short description|Medical condition that results from eating too little, too much, or the wrong nutrients}}{{Use mdy dates|date=December 2017}}







factoids
Malnutrition is a condition that results from eating a diet in which one or more nutrients are either not enough or are too much such that the diet causes health problems.BOOK, Facts for life, 2010, United Nations Children's Fund, New York, 978-92-806-4466-1, 61 and 75, 4th,weblink {{DorlandsDict|five/000062745|malnutrition}} It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough nutrients is called undernutrition or undernourishment while too much is called overnutrition.BOOK, Young, E.M., Food and development, 2012, Routledge, Abingdon, Oxon, 978-1-135-99941-4, 36–38,weblink Malnutrition is often used to specifically refer to undernutrition where an individual is not getting enough calories, protein, or micronutrients.BOOK, Essentials of International Health, 2011, Jones & Bartlett Publishers, 978-1-4496-6771-9, 194,weblink If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development. Extreme undernourishment, known as starvation, may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and abdomen. People also often get infections and are frequently cold. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking.Undernourishment is most often due to not enough high-quality food being available to eat. This is often related to high food prices and poverty. A lack of breastfeeding may contribute, as may a number of infectious diseases such as: gastroenteritis, pneumonia, malaria, and measles, which increase nutrient requirements. There are two main types of undernutrition: protein-energy malnutrition and dietary deficiencies. Protein-energy malnutrition has two severe forms: marasmus (a lack of protein and calories) and kwashiorkor (a lack of just protein). Common micronutrient deficiencies include: a lack of iron, iodine, and vitamin A. During pregnancy, due to the body's increased need, deficiencies may become more common.BOOK, Arora, Mala, Konje, Justin C., Recurrent pregnancy loss, 2007, Jaypee Bros. Medical Publishers, New Delhi, 978-81-8448-006-1, 2nd, In some developing countries, overnutrition in the form of obesity is beginning to present within the same communities as undernutrition.WEB, Progress For Children: A Report Card On Nutrition,weblink UNICEF, Other causes of malnutrition include anorexia nervosa and bariatric surgery.BOOK, Prentice, Andrew, Benjamin, Caballero, Lindsay, Allen, Encyclopedia of human nutrition, 2005, Elsevier/Academic Press, Amsterdam, 978-0-08-045428-3, 68, 2nd,weblink BOOK, Stoelting's anesthesia and co-existing disease, 2012, Saunders/Elsevier, Philadelphia, 978-1-4557-3812-0, 324, 6th,weblink Efforts to improve nutrition are some of the most effective forms of development aid. Breastfeeding can reduce rates of malnutrition and death in children, and efforts to promote the practice increase the rates of breastfeeding. In young children, providing food (in addition to breastmilk) between six months and two years of age improves outcomes. There is also good evidence supporting the supplementation of a number of micronutrients to women during pregnancy and among young children in the developing world. To get food to people who need it most, both delivering food and providing money so people can buy food within local markets are effective.WEB, World Food Programme, Cash and Vouchers for Food,weblink WFP.org, July 5, 2014, April 2012, Simply feeding students at school is insufficient. Management of severe malnutrition within the person's home with ready-to-use therapeutic foods is possible much of the time. In those who have severe malnutrition complicated by other health problems, treatment in a hospital setting is recommended. This often involves managing low blood sugar and body temperature, addressing dehydration, and gradual feeding.BOOK, Ann Ashworth, Guidelines for the inpatient treatment of severely malnourished children, 2003, World Health Organization, Geneva, 978-92-4-154609-6, Routine antibiotics are usually recommended due to the high risk of infection. Longer-term measures include: improving agricultural practices,JOURNAL, Jonathan A. Foley, Navin Ramankutty, Kate A. Brauman, Kate Brauman, Emily S. Cassidy, James S. Gerber, Matt Johnston, Nathaniel D. Mueller, Christine O’Connell, Deepak K. Ray, Paul C. West, Christian Balzer, Elena M. Bennett, Stephen R. Carpenter, Jason Hill, Chad Monfreda, Stephen Polasky, Johan Rockström, John Sheehan, Stefan Siebert, David Tilman, David P.M. Zaks, Solutions for a cultivated planet, Nature, 478, 7369, 337–42, October 2011, 21993620, 10.1038/nature10452, reducing poverty, improving sanitation, and the empowerment of women.There were 821 million undernourished people in the world in 2018 (10.8% of the total population).WEB,weblink The state of food security and nutrition in the world (2019), FAO, 15 July 2019, 15 July 2019,
This is a reduction of about 176 million people since 1990 when 23% were undernourished, but an increase of about 36 million since 2015, when 10.6% were undernourished.WEB, The State of Food Insecurity in the World 2018,weblink Food and Agricultural Organization of the United Nations, Jan 11, 2019, WEB, Global hunger declining, but still unacceptably high International hunger targets difficult to reach,weblink Food and Agriculture Organization of the United Nations, July 1, 2014, September 2010, In 2012, it was estimated that another billion people had a lack of vitamins and minerals.WEB, An update of 'The Neglected Crisis of Undernutrition: Evidence for Action',weblink www.gov.uk, Department for International Development, July 5, 2014, Oct 2012, In 2015, protein-energy malnutrition was estimated to have resulted in 323,000 deaths—down from 510,000 deaths in 1990.JOURNAL, GBD 2015 Mortality and Causes of Death, Collaborators, Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, October 8, 2016, 388, 10053, 1459–1544, 27733281, 10.1016/s0140-6736(16)31012-1, 5388903, JOURNAL, GBD 2013 Mortality and Causes of Death, Collaborators, Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013, Lancet, December 17, 2014, 25530442, 10.1016/S0140-6736(14)61682-2, 385, 9963, 117–71, 4340604, Other nutritional deficiencies, which include iodine deficiency and iron deficiency anemia, result in another 83,000 deaths. In 2010, malnutrition was the cause of 1.4% of all disability adjusted life years.JOURNAL, Murray, CJ, Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet, Dec 15, 2012, 380, 9859, 2197–223, 23245608, 10.1016/S0140-6736(12)61689-4, About a third of deaths in children are believed to be due to undernutrition, although the deaths are rarely labelled as such.WEB, Maternal, newborn, child and adolescent health,weblink WHO, July 4, 2014, In 2010, it was estimated to have contributed to about 1.5 million deaths in women and children,JOURNAL, Lim SS, Vos T, Flaxman AD, etal, A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet, 380, 9859, 2224–60, December 2012, 23245609, 10.1016/S0140-6736(12)61766-8, 4156511, though some estimate the number may be greater than 3 million. An additional 165 million children were estimated to have stunted growth from malnutrition in 2013.JOURNAL, Bhutta, ZA, Das, JK, Rizvi, A, Gaffey, MF, Walker, N, Horton, S, Webb, P, Lartey, A, Black, RE, Lancet Nutrition Interventions Review, Group, Maternal and Child Nutrition Study, Group, Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?, Lancet, Aug 3, 2013, 382, 9890, 452–77, 23746776, 10.1016/s0140-6736(13)60996-4, Undernutrition is more common in developing countries.BOOK, Liz Young, World Hunger Routledge Introductions to Development, 2002, 978-1-134-77494-4, 20,weblink 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.BOOK, editors, Ronnie A. Rosenthal, Michael E. Zenilman, Mark R. Katlic, Principles and practice of geriatric surgery, 2011, Springer, Berlin, 978-1-4419-6999-6, 78, 2nd,weblink
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Definitions

File:Kwashiorkor 6180.jpg|thumb|Child in the United States with signs of KwashiorkorKwashiorkorUnless 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.JOURNAL, Sathish Subramanian, Sayeeda Huq, Tanya Yatsunenko, Rashidul Haque, Mustafa Mahfuz, Mohammed A. Alam, June 19, 2014, Persistent gut microbiota immaturity in malnourished Bangladeshi children, Nature, 510,

Undernutrition and overnutrition

Malnutrition is caused by eating a diet in which nutrients are not enough or is too much such that it causes health problems.BOOK, Nikolaos Katsilambros, Clinical Nutrition in Practice, 2011, John Wiley & Sons, 978-1-4443-4777-7, 37,weblink It is a category of diseases that includes undernutrition and overnutrition.WEB, WHO, nutrition experts take action on malnutrition,weblink World Health Organization, February 10, 2012, 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.WEB, Progress For Children: A Report Card On Nutrition,weblink UNICEF, However, the term malnutrition is commonly used to refer to undernutrition only.BOOK, Nikolaos Katsilambros, Clinical Nutrition in Practice, 2011, John Wiley & Sons, 978-1-4443-4777-7, 39,weblink 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.

Protein-energy malnutrition

Undernutrition is sometimes used as a synonym of protein–energy malnutrition (PEM). While other include both micronutrient deficiencies and protein energy malnutrition in its definition. It differs from calorie restriction in that calorie restriction may not result in negative health effects. The term hypoalimentation means underfeeding.{{DorlandsDict|four/000051473|hypoalimentation}}The term "severe malnutrition" or "severe undernutrition" is often used to refer specifically to PEM.BOOK, Walker, W. Allan, Christopher, Duggan, John B., Watkins, Nutrition in pediatrics: basic science, clinical application, 2008, BC Decker, Hamilton, 978-1-55009-361-2, 127–41,weblink PEM is often associated with micronutrient deficiency. Two forms of PEM are kwashiorkor and marasmus, and they commonly coexist.

Kwashiorkor

Kwashiorkor is mainly caused by inadequate protein intake. The main symptoms are edema, wasting, liver enlargement, hypoalbuminaemia, steatosis, and possibly depigmentation of skin and hair. Kwashiorkor is further identified by swelling of the belly, which is deceiving of actual nutritional status. The term means ‘displaced child’ and is derived from a Ghana language of West Africa, means "the sickness the older one gets when the next baby is born," as this is when the older child is deprived of breast feeding and weaned to a diet composed largely of carbohydrates.JOURNAL, Listening to the Ga: Cicely Williams' Discovery of Kwashiorkor on the Gold Coast, Stanton J, 2001, Clio Medica: Studies in the History of Medicine and Health, 61, 149–71, 11603151,

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. Marasmus can result from a sustained diet of inadequate energy and protein, and the metabolism adapts to prolong survival. It is traditionally seen in famine, significant food restriction, or more severe cases of anorexia. Conditions are characterized by extreme wasting of the muscles and a gaunt expression.

Undernutrition, hunger

Undernutrition encompasses stunted growth (stunting), wasting, and deficiencies of essential vitamins and minerals (collectively referred to as micronutrients). The term hunger, which describes a feeling of discomfort from not eating, has been used to describe undernutrition, especially in reference to food insecurity.

Definition by Gomez

In 1956, Gómez and Galvan studied factors associated with death in a group of malnourished (undernourished) children in a hospital in Mexico City, Mexico and defined categories of malnutrition: first, second, and third degree.JOURNAL, Stevenson, R.D., Conaway, M.R., Weight and Mortality Rates: "Gomez Classification" for Children With Cerebral Palsy?, Pediatrics, August 2011, 128, 2, e436–e437, 10.1542/peds.2011-1472, 21768321, The degrees were based on weight below a specified percentage of median weight for age. The risk of death increases with increasing degree 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, the classification 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.JOURNAL, Gueri, M., J.M. Gurney, P. Jutsum, The gomez classification. Time for a change?, Bulletin of the World Health Organization, 1980, 58, 5, 773–77,weblink 6975186, 2395976, {| class="wikitable" border="1"! Degree of PEM! % of desired body weight for age and sex| Normal| 90–100%| Mild: Grade I (1st degree)| 75–89%| Moderate: Grade II (2nd degree)| 60–74%| Severe: Grade III (3rd degree)|95%| >90%| Mild: Grade I| 87.5–95%| 80–90%| Moderate: Grade II| 80–87.5%| 70–80%| Severe: Grade IIIoral rehydration solution (ORS). The oral rehydration solution is both slightly sweet and slightly salty and the one recommended in those with severe undernutrition should have half the usual sodium and greater potassium. Fluids by nasogastric tube may be use in those who do not drink. Intravenous fluids are recommended only in those who have Shock (circulatory)>significant dehydration due to their potential complications. These complications include congestive heart failure. Over time, ORS developed into Oral rehydration therapy, or oral rehydration therapy, which focused on increasing fluids by supplying salts, carbohydrates, and water. This switch from type of fluid to amount of fluid was crucial in order to prevent dehydration from diarrhea.VICTORALAST2=BRYCEDATE=JAN 2000URL=HTTP://WWW.SCIELOSP.ORG/SCIELO.PHP?PID=S0042-96862000001000010&SCRIPT=SCI_ARTTEXT&TLNG=EVOLUME=78PAGES=1246–55PMID=11100619ACCESS-DATE=, 2019-08-20, 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.BOOK,weblink The Treatment of diarrhoea : a manual for physicians and other senior health workers, 2005, World Health Organization, 978-92-4-159318-2, 4, Geneva, 8–16, 4. Management of acute diarrhoea without blood, Broad spectrum antibiotics are recommended in all severely undernourished children with diarrhea requiring admission to hospital.To prevent dehydration readily available fluids, preferably with a modest amount of sugars and salt such as vegetable broth or salted rice water, may be used. The drinking of additional clean water is also recommended. Once dehydration develops oral rehydration solutions are preferred. As much of these drinks as the person wants can be given, unless there are signs of swelling. If vomiting occurs, fluids can be paused for 5–10 minutes and then restarting more slowly. Vomiting rarely prevents rehydration as fluid are still absorbed and the vomiting rarely last long. A severely malnourished child with what appears to be dehydration but who has not had diarrhea should be treated as if they have an infection.For babies a dropper or syringe without the needle can be used to put small amounts of fluid into the mouth; for children under 2, a teaspoon every one to two minutes; and for older children and adults, frequent sips directly from a cup. After the first two hours, rehydration should be continued at the same or slower rate, determined by how much fluid the child wants and any ongoing diarrheal loses. After the first two hours of rehydration it is recommended that to alternate between rehydration and food.In 2003, WHO and UNICEF recommended a reduced-osmolarity ORS which still treats dehydration but also reduced stool volume and vomiting. Reduced-osmolarity ORS is the current standard ORS with reasonably wide availability.WHO Drug Information Vol. 16, No. 2, 2002.Low-osmolarity oral rehydration solution (ORS), Rehydrate Project, updated: April 23, 2014. 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.The Treatment of Diarrhoea: A manual for physicians and other senior health workers, WHO, 2005. Specifically, 45 milliliters of potassium chloride solution from a stock solution containing 100g KCl per liter, along with one packet of ORS, two liters of water, and 50 grams of sucrose. And please remember, sucrose has approximately twice the molecular weight of glucose, with one mole of glucose weighing 180 g and one mole of sucrose weighing 342 g.Malnourished children have an excess of body sodium. Recommendations for home remedies agree with one liter of water (34 oz.) and 6 teaspoons sugar and disagree regarding whether it is then one teaspoon of salt added or only 1/2, with perhaps most sources recommending 1/2 teaspoon of added salt to one liter water."Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1". World Health Organization, 2005, Annex 12 – Preparation of Home Made Oral Rehydration Solution, p. 51 (57 in PDF): "Ingredients: Half a teaspoon of salt (2.5 grams), six level teaspoons of sugar (30 grams) and one litre of safe drinking water"."Dehydration, treatments and drugs." Mayo Clinic January 7, 2011. "In an emergency situation where a pre-formulated solution is unavailable, you can make your own oral rehydration solution by mixing half teaspoon salt, six level teaspoons of sugar and one litre (about 1 quart) of safe drinking water."Family Practice Notebook, Oral Rehydration Solution, Scott Moses, MD, February 1, 2014.

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.National Guidelines for the Management of Severely Malnourished Children in Bangladesh recommends, for initial hypoglycemia, a 50 milliliter bolus of 10% glucose or sucrose. This can also be achieved by added 1 rounded teaspoon of sugar to 10.5 teaspoons of water (which is 3.5 tablespoons of water). 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.

Hypothermia

Hypothermia can occur. To prevent or treat this, the child can be kept warm with covering including of the head or by direct skin-to-skin contact with the mother or father and then covering both parent and child. Prolonged bathing or prolonged medical exams should be avoided. Warming methods are usually most important at night.

Epidemiology

(File:Percentage population undernourished world map.PNG|thumb|upright=1.3|Percentage of population affected by undernutrition by country in 2012)File:Nutritional deficiencies world map - DALY - WHO2004.svg|thumb|upright=1.3|(Disability-adjusted life year]] for nutritional deficiencies per 100,000 inhabitants in 2004. Nutritional deficiencies included: protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and iron deficiency anaemia.WEB,weblink Mortality and Burden of Disease Estimates for WHO Member States in 2002, xls, World Health Organization, 2002, {{Col-begin}}{{Col-break}}{{legend|#b3b3b3|no data}}{{legend|#ffff65|2200}}{{col-end}})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.NEWS,weblink Global hunger worsening, warns UN, BBC (Europe), 14 October 2009, 22 August 2010, 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.K. von Grebmer, J. Bernstein, A. de Waal, N. Prasai, S. Yin, Y. Yohannes: 2015 Global Hunger Index – Armed Conflict and the Challenge of Hunger. Bonn, Washington DC, Dublin: Welthungerhilfe, IFPRI, and Concern Worldwide. October 2015.

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.Jean Ziegler. "Promotion And Protection Of All Human Rights, Civil, Political, Economic, Social And Cultural Rights, Including The Right To Development: Report of the Special Rapporteur on the right to food, Jean Ziegler". Human Rights Council of the United Nations, January 10, 2008."According to the Food and Agriculture Organization of the United Nations (FAO), the world already produces enough food to feed every child, woman and man and could feed 12 billion people, or double the current world population."Malnutrition, as of 2010, was the cause of 1.4% of all disability adjusted life years.{| class="wikitable"|+Number of undernourished globally!Year!!2005!!2006!!2007!!2008!!2009!!2010!!2011!!2012!!2013!!2014!!2015!!2016!Number in millions|804!Percentage|10.8%{| class="wikitable"|+Number of undernourished in the developing world!Year!!1969–71!!1979–81!!1990–92!!1995–97!!2001–03!!2003–05!!2005–07||2010–12!Number in millionsWEB, The State of Food Insecurity in the World 2006,weblink Food and Agricultural Organization of the United Nations, April 6, 2019, WEB, The State of Food Insecurity in the World 2008,weblink Food and Agricultural Organization of the United Nations, April 6, 2019, WEB, The State of Food Insecurity in the World 2015,weblink Food and Agricultural Organization of the United Nations, April 6, 2019, |805!Percentage|14%

Mortality

(File:Nutritional deficiencies world map-Deaths per million persons-WHO2012.svg|thumb|left|upright=1.3|Deaths from nutritional deficiencies per million persons in 2012 {{legend|#ffff20|0-4}}{{legend|#ffe820|5-8}}{{legend|#ffd820|9-13}}{{legend|#ffc020|14-23}}{{legend|#ffa020|24-34}}{{legend|#ff9a20|35-56}}{{legend|#f08015|57-91}}{{legend|#e06815|92-220}}{{legend|#d85010|221-365}}{{legend|#d02010|366-1,207}})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 malnourishedweblink {{webarchive |url=https://web.archive.org/web/20120523015344weblink |date=May 23, 2012 }} In 2006, more than 36 million died of hunger or diseases due to deficiencies in micronutrients".BOOK, Jean, Ziegler, Jean Ziegler, L'Empire de la honte, Fayard, 2007, 978-2-253-12115-2, 130, In 2010 protein-energy malnutrition resulted in 600,000 deaths down from 883,000 deaths in 1990.JOURNAL, Lozano R, Naghavi M, Foreman K, etal, Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet, 380, 9859, 2095–128, December 2012, 23245604, 10.1016/S0140-6736(12)61728-0, 10536/DRO/DU:30050819, 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, present in half of all cases.NEWS, Malnutrition The Starvelings, The Economist, January 24, 2008,weblink Six million children die of hunger every year.NEWS,weblink CNN, U.N. chief: Hunger kills 17,000 kids daily, November 17, 2009, 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{{when|date=September 2016}} 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

{{see also|Hunger#The fight against hunger}}While hunger has been a perennial human problem, there was relatively little awareness of the qualitative aspects of malnutrition until the early 20th century. Throughout history, various peoples have known the importance of eating certain foods to prevent the outbreak of symptoms now associated with malnutrition. Yet such knowledge appears to have been repeatedly lost and then re-discovered. For example, the symptoms of scurvy were reportedly known to the ancient Egyptians. Anti-scurvy measures were sometimes undertook by 14th century Crusaders, who would ensure that citrus fruits were planted on Mediterranean islands, for use on sea journeys. Knowledge of the importance of such measures appears to have been forgotten by Europeans for several centuries, to be rediscovered in the 18th century.In the early 19th century the British navy ensured their ship's crews were given frequent rations of lemon juice, massively reducing deaths from scurvy and giving the British a significant advantage in the Napoleonic wars. Later in the 19th century, the British navy replaced lemons with limes, not aware at the time that limes were much less effective than lemons at preventing scurvy.WEB,weblink Hunger, Science, and Politics: FAO, WHO, and Unicef Nutrition Policies, 1945-1978, University College London, 1996, Joshua Ruxin, 12 January 2019, Josh Ruxin, BOOK, James Vernon, Hunger: A Modern History, 81–140, passim, 2007, 978-0-674-02678-0, Harvard University Press, registration,weblink According to historian Michael Worboys, it was between the wars that malnutrition was essentially discovered, and the science of nutrition established. This built on work such as Casimir Funk's 1912 formulisation of the concept of vitamins. There was increased scientific study of malnutrition in the 1920s and 1930s, and this became even more pronounced after world war 2. Charities and United Nations agencies would 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 or Marasmus; 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.JOURNAL, David Grigg, The historiography of hunger: changing views on the world food problem 1945–1980, Transactions of the Institute of British Geographers, 1981, 6, 3, NS, 279–292, Before 1945 very little academic or political notice was taken of the problem of world hunger, since 1945 there has been a vast literature on the subject., 10.2307/622288, 622288, 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.WEB,weblink Universal Declaration of Human Rights, www.un.org, en, 2018-02-24, 2015-10-06, 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.WEB,weblink What is the Right to Food? {{!, Right to food|website=www.righttofood.org|language=en-US|access-date=2018-02-24}} 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.WEB,weblink Universal Declaration on the Eradication of Hunger and Malnutrition, en, 2018-02-24, 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."WEB,weblink American Convention on Human Rights, www.hrcr.org, 2018-03-17, 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 nutritous 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 halfing their amount of undernourished people by 2015.WEB,weblink Rome Declaration and Plan of Action, www.fao.org, 2018-03-17, In 2004 the Food and Agriculture Organization adopted the Right to Food Guidelines, 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.JOURNAL, Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., De Onis, M., Ezzati, M., Mathers, C., Rivera, J., Maternal and child undernutrition: Global and regional exposures and health consequences, The Lancet, 371, 9608, 243–60, 2008, 18207566, 10.1016/S0140-6736(07)61690-0, Maternal Child Undernutrition Study Group,weblink

Children

File:Niger childhood malnutrition 16oct06.jpg|thumb|right|Malnourished children in NigerNigerThe World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide, about 1 million children.JOURNAL, Manary, Mark J., Indi Trehan, Hayley S. Goldbach, Lacey N. LaGrone, Guthrie J. Meuli, Richard J. Wang, Kenneth M. Maleta, Antibiotics as Part of the Management of Severe Acute Malnutrition, The New England Journal of Medicine, January 31, 2013, 368, 5, 425–35, 10.1056/NEJMoa1202851, The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates., 23363496, 3654668, 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, SwitzerlandAs underweight children are more vulnerable to almost all infectious diseases, the indirect disease burden of malnutrition is estimated to be an order of magnitude higher than the disease burden of the direct effects of malnutrition. The combination of direct and indirect deaths from malnutrition caused by unsafe water, sanitation and hygiene (WASH) practices is estimated to lead to 860,000 deaths per year in children under five years of age.

Women

File:Lange-MigrantMother02.jpg|thumb|Migrant Mother by Dorothea LangeDorothea Lange(File:Starved girl.jpg|thumb|183x183px|Starved girl)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.JOURNAL, Nubé, M., Van Den Boom, G.J.M., Gender and adult undernutrition in developing countries, Annals of Human Biology, 30, 5, 520–37, 2003, 12959894, 10.1080/0301446031000119601, Gender inequality in nutrition in some countries such as India is present in all stages of life.JOURNAL, Dewan, Manju, Malnutrition in Women, Stud. Home Comm. Sci., 2008, 2, 1, 7–10,weblink March 3, 2014, 10.1080/09737189.2008.11885247, 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.WEB, Najma Rizvi, dandc.eu, Enduring misery, March 2013,weblink In some cases, such as in parts of Kenya in 2006, rates of malnutrition in pregnant women were even higher than rates in children.WEB, Carter, Rachel Bonham, Survey Reveals High Malnutrition Rates Among Pregnant Women in Kenya,weblink UNICEF, March 3, 2014, 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.WEB, Gender and Nutrition 2001,weblink Food and Agriculture of the United Nations, August 22, 2016, July 2001,

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 afflicted 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).JOURNAL, Bhutta, Z.A., Ahmed, T., Black, R.E., Cousens, S., Dewey, K., Giugliani, E., Haider, B.A., Kirkwood, B., Morris, S.S., Sachdev, H.P.S., Shekar, M., What works? Interventions for maternal and child undernutrition and survival, The Lancet, 371, 9610, 417–40, 2008, 18206226, 10.1016/S0140-6736(07)61693-6, Maternal Child Undernutrition Study Group, 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.NEWS,weblink Folic acid to be added to UK flour in effort to reduce birth defects, The Guardian, Denis Campbell, 14 October 2014, 15 October 2018, Frequent pregnancies with short intervals between them and long periods of breastfeeding add an additional nutritional burden.

Educating 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

File:Sea buckthorn seed oil gel.JPEG|thumb|right|Essential nutrients are one of the main requirements of elderly careelderly careMalnutrition and being underweight are more common in the elderly than in adults of other ages.JOURNAL, Kvamme, Jan–Magnus, Olsen, Jan Abel, Florholmen, Jon, Jacobsen, Bjarne K., Risk of malnutrition and health-related quality of life in community-living elderly men and women: The Tromsø study, Quality of Life Research, 2011, 20, 4, 575–82, 10.1007/s11136-010-9788-0, 21076942, 3075394, If elderly people are healthy and active, the aging process alone does not usually cause malnutrition.JOURNAL, Wellman, N.S, Weddle, D.O, Kranz, S, Brain, C.T, Elder Insecurities: Poverty, Hunger, and Malnutrition, Journal of the American Dietetic Association, October 1997, 97, 10, S120–22, 10.1016/S0002-8223(97)00744-X, 9336570, 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.JOURNAL, Bulent Saka, Omer Kaya, Gulistan Bahat Ozturk, Nilgun Erten, M. Akif Karan, Malnutrition in the elderly and its relationship with other geriatric syndromes, Clinical Nutrition, 2010, 29, 6, 745–48, 10.1016/j.clnu.2010.04.006, 20627486, 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.JOURNAL, Volkert, Dorothee, Malnutrition in the elderly – prevalence, causes and corrective strategies, Clinical Nutrition, 2002, 21, 110–12, 10.1016/S0261-5614(02)80014-0, 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.JOURNAL, Volkert, D., Malnutrition in the elderly – prevalence, causes and corrective strategies, Clinical Nutrition, 21, 110–12, 2002, 10.1016/S0261-5614(02)80014-0, Many elderly people require assistance in eating, which may contribute to malnutrition. However, the mortality rate due to undernourishment may be reduced.JOURNAL, Milne, AC, Potter, J, Vivanti, A, Avenell, A, Protein and energy supplementation in elderly people at risk from malnutrition, The Cochrane Database of Systematic Reviews, 15 April 2009, 2, CD003288, 10.1002/14651858.CD003288.pub3, 19370584, Because of this, one of the main requirements of elderly care is to provide an adequate diet and all essential nutrients.JOURNAL, Mamhidir, Anna-Greta, Kihlgren, Mona, Soerlie, Venke, Malnutrition in elder care: qualitative analysis of ethical perceptions of politicians and civil servants, BMC Medical Ethics, 2010, 11, 11, 10.1186/1472-6939-11-11, 20553607, 2927875, 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.NEWS, Care crisis triggers rise in malnutrition, charities claim,weblink 1 October 2019, Home care Insight, 19 August 2019, In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission.JOURNAL, Bolin, T., Bare, M., Caplan, G., Daniells, S., Holyday, M., Malabsorption may contribute to malnutrition in the elderly, Nutrition, 26, 7–8, 852–53, 2010, 20097534, 10.1016/j.nut.2009.11.016, Malnutrition and weight loss can contribute to sarcopenia 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

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References

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External links

{{Medical resources| DiseasesDB = EE|46}}| ICD9 = 263.9| ICDO =| OMIM =| MedlinePlus = 000404| eMedicineSubj = ped| eMedicineTopic = 1360| MeshID = D044342}}{{Wiktionary|malnutrition|undernutrition}}{{commons category}} {{Nutritional pathology}}{{Diseases of Poverty}}{{Authority control}}

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