Manglapus Giana L.

BSN 2-C

MALNUTRITION
Malnutrition is directly responsible for 300,000 deaths per year in children younger than 5 years
in developing countries and contributes indirectly to more than half the deaths in childhood
worldwide. The World Health Organization (WHO) says that malnutrition is by far the largest contributor to child
mortality globally, currently present in 45 percent of all cases.

What is malnutrition?

Malnutrition is a broad term commonly used as an alternative to undernutrition but technically it also refers to
overnutrition. People are malnourished if their diet does not provide adequate calories and protein for growth
and maintenance or they are unable to fully utilize the food they eat due to illness (undernutrition). They are
also malnourished if they consume too many calories (overnutrition).

Underweight births and inter-uterine growth restrictions are responsible for about 2.2 million child deaths
annually in the world. Deficiencies in vitamin A or zinc cause 1 million deaths each year.
WHO adds that malnutrition during childhood usually results in worse health and lower educational
achievements during adulthood. Malnourished children tend to become adults who have smaller babies.
While malnutrition used to be seen as something which complicated such diseases as measles, pneumonia
and diarrhea, it often works the other way round - malnutrition can cause diseases to occur.
Globally, as well as in developed, industrialized countries, the following groups of people are at highest risk of
malnutrition (subnutrition):

Elderly people, especially those who are hospitalized or in long-term institutional care
Individuals who are socially isolated
People on low incomes (poor people)
People with chronic eating disorders, such as bulimia or anorexia nervosa
People convalescing after a serious illness or condition.
Pathophysiology

Signs and symptoms of malnutrition (subnutrition) include:

Loss of fat (adipose tissue)
Breathing difficulties, a higher risk of respiratory failure
Depression
Higher risk of complications after surgery
Higher risk of hypothermia - abnormally low body temperature
 The total number of some types of white blood cells falls; consequently, the immune system is
weakened, increasing the risk of infections.
Higher susceptibility to feeling cold
Longer healing times for wounds
Longer recover times from infections
Longer recovery from illnesses
Lower sex drive
Problems with fertility
Reduced muscle mass
Reduced tissue mass
Tiredness, fatigue, or apathy
Irritability.

In more severe cases:

Skin may become thin, dry, inelastic, pale, and cold

Eventually, as fat in the face is lost, the cheeks look hollow and the eyes sunken

Hair becomes dry and sparse, falling out easily

Sometimes, severe malnutrition may lead to unresponsiveness (stupor)

If calorie deficiency continues for long enough, there may be heart, liver and respiratory failure

Total starvation is said to be fatal within 8 to 12 weeks (no calorie consumption at all).

Signs and symptoms

History

Clinical signs and symptoms of protein-energy malnutrition (PEM) include the following:

Poor weight gain

Slowing of linear growth
Behavioral changes: Irritability, apathy, decreased social responsiveness, anxiety, and attention
deficits

The most common and clinically significant micronutrient deficiencies and their consequences include the
following:

Iron: Fatigue, anemia, decreased cognitive function, headache, glossitis, and nail changes
Iodine: Goiter, developmental delay, and mental retardation
Vitamin D: Poor growth, rickets, and hypocalcemia
Vitamin A: Night blindness, xerophthalmia, poor growth, and hair changes
Folate - Glossitis, anemia (megaloblastic), and neural tube defects (in fetuses of women without
folate supplementation)
Zinc: Anemia, dwarfism, hepatosplenomegaly, hyperpigmentation and hypogonadism,
acrodermatitis enteropathica, diminished immune response, and poor wound healing

Physical examination

Physical findings that are associated with PEM include the following [1] :
 Decreased subcutaneous tissue: Areas that are most affected are the legs, arms, buttocks, and
face
Edema: Areas that are most affected are the distal extremities and anasarca (generalized edema)
Oral changes: Cheilosis, angular stomatitis, and papillar atrophy
Abdominal findings: Abdominal distention secondary to poor abdominal musculature and
hepatomegaly secondary to fatty infiltration
Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of
trauma
Nail changes: Fissured or ridged nails
Hair changes: Thin, sparse, brittle hair that is easily pulled out and that turns a dull brown or
reddish color

Children

Children who are severely malnourished typically experience slow behavioral development, even mental
retardation may occur. Even when treated, undernutrition may have long-term effects in children, with
impairments in mental function and digestive problems persisting - in some cases for the rest of their lives.

Causes of malnutrition
In many developing countries long-term (chronic) malnutrition is widespread - simply because people do not
have enough food to eat.

In more wealthy industrialized nations malnutrition is usually caused by:

1) Poor diet
If a person does not eat enough food, or if what they eat does not provide them with the nutrients they require
for good health, they suffer from malnutrition. Poor diet may be caused by one of several different factors. If the
patient develops dysphagia (swallowing difficulties) because of an illness, or when recovering from an illness,
they may not be able to consume enough of the right nutrients.
2) Mental health problems
Some patients with mental health conditions, such as depression, may develop eating habits which lead to
malnutrition. Patients with anorexia nervosa or bulimia may develop malnutrition because they are ingesting
too little food.
3) Mobility problems
People with mobility problems may suffer from malnutrition simply because they either cannot get out enough
to buy foods, or find preparing them too arduous.

In the poorer nations malnutrition is commonly caused by:

1) Food shortages
In the poorer developing nations food shortages are mainly caused by a lack of technology needed for higher
yields found in modern agriculture, such as nitrogen fertilizers, pesticides and irrigation. Food shortages are a
significant cause of malnutrition in many parts of the world.
2) Food prices and food distribution
It is ironic that approximately 80% of malnourished children live in developing nations that actually produce
food surpluses (Food and Agriculture Organization). Some leading economists say that famine is closely linked
to high food prices and problems with food distribution.
3) Lack of breastfeeding
Experts say that lack of breastfeeding, especially in the developing world, leads to malnutrition in infants and
children. In some parts of the world mothers still believe that bottle feeding is better for the child.
Another reason for lack of breastfeeding, mainly in the developing world, is that mothers abandon it because
they do not know how to get their baby to latch on properly, or suffer pain and discomfort.

Management
Children with chronic malnutrition may require caloric intakes of more than 120-150 kcal/kg/day to achieve
appropriate weight gain. Most children with mild malnutrition respond to increased oral caloric intake and
supplementation with vitamin, iron, and folate supplements. The requirement for increased protein is met
typically by increasing the food intake.
In moderate to severe cases of malnutrition, enteral supplementation via tube feedings may be necessary.

Prevention
The prevention of malnutrition in children starts with
an emphasis on prenatal nutrition and good prenatal
care. Promotion of breastfeeding is particularly
crucial in developing countries where safe
alternatives to human milk are unavailable. Health
care providers should also counsel parents on the
appropriate introduction of nutritious supplemental
foods.

References:

H.R. Shashidhar, MD (Mar 10, 2016). Medscape: Malnutrition retrieved from

http://emedicine.medscape.com/article/985140-overview#a6