Malnutrition

The nutritional requirements of the human body reflect the nutritional

intake necessary to maintain optimal body function and to meet the body's
daily energy needs. Malnutrition (literally, "bad nutrition") is defined as
"inadequate nutrition," and while most people interpret this as undernutrition,
falling short of daily nutritional requirements, it can also mean overnutrition,
meaning intake in excess of what the body uses. However, undernutrition
affects more than one-third of the world's children, and nearly 30 percent of
people of all ages in the developing world, making this the most damaging form
of malnutrition worldwide.

The etiology of malnutrition includes factors such as poor food

availability and preparation, recurrent infections, and lack of nutritional
education. Each of these factors is also impacted by political instability and
war, lack of sanitation, poor food distribution, economic downturns, erratic
health care provision, and by factors at the community/regional level.

People at Risk

Certain people are more susceptible to malnutrition than others. For

example, individuals in rapid periods of growth, such as infants, adolescents,

In developing nations, more than half of all deaths among children under
five years old are due to malnutrition. Malnourished children who survive may
experience stunted growth, illness, and lifelong malnourishment and pregnant
women, have higher nutritional needs than others, and are therefore more
susceptible to the effects of poor nutrition. Those living in deprived
socioeconomic circumstances or that lack adequate sanitation, education, or
the means to procure food are also at risk. Most importantly, individuals at risk
for systemic infections (particularly gastrointestinal) and those who suffer with
a chronic disease are at greatly increased risk because they require additional
energy to support their immune system and often have decreased absorption
of nutrients.

In fact, the relationship between malnutrition and infection is cyclical—

infection predisposes one to malnutrition, and malnutrition, which impairs all
immune defenses, predisposes one to infection. The World Health Organization
(WHO) identifies malnutrition as "the single most important risk factor for
disease" (WHO). Some research has identified malnourished children as being
more likely to suffer episodes of infectious disease, as well as episodes of
longer duration and greater severity, than other children. In particular,
hookworm, malaria, and chronic diarrhea have been linked with malnutrition.
These conditions are more prevalent in the developing world than in the
industrialized world, though malnutrition exists worldwide, particularly in
areas of poverty and among patients with chronic disease or who are
hospitalized and on enteric feeding.

Necessary Nutrients

The WHO's Department of Nutrition for Health and Development is

responsible for formulating dietary and nutritional guidelines for international
use. Adequate total nutrition includes the following nutrients: protein, energy
(calories), vitamin A and carotene, vitamin D, vitamin E, vitamin K, thiamine,
riboflavin, niacin, vitamin B6, pantothenic acid, biotin, folate, vitamin C,
antioxidants, calcium, iron, zinc, selenium, magnesium, and iodine. Most
important are protein and the caloric/energy requirement needed to utilize
protein. If these elements are inadequate, the result is a protein-energy
malnutrition (PEM), or protein-calorie malnutrition (PCM), which affects one in
every four children worldwide, with the highest concentration in Asia. Chronic
deficiencies of protein and calories result in a condition called marasmus,
while a diet high in carbohydrates but low in protein causes a condition called
kwashiorkor.

Malnutrition and Growth

Malnutrition from any cause retards normal growth. Growth assessments

are therefore the best way to monitor a person's nutritional status. While there
are a variety of methods used to measure growth, the most common are known
as anthropometric indices, which compare an individual's age, height, and
weight, each of which is measured against the others. The values are expressed
as percentages, or percentiles, of the normal distribution of these
measurements. So, for example, a child with a given height and age might rank
in the 90th percentile for height based on all children of that particular age,
meaning that 90 percent of children that age are shorter than this particular
child. Through anthropometric studies, researchers have found that particular
measurements correlate with specific growth trends, based on how the body
normally changes over time. Abnormal height-forage (stunting) usually
measures long-term growth faltering. Low weight-for-height (wasting)
correlates with an acute growth disturbance.

Malnutrition can have severe long-term consequences. Children who

suffer from malnutrition are more likely to have slowed growth, delayed
development, difficulty in school, and high rates of illness, and they may
remain malnourished into adulthood.
 Limited growth patterns are distributed unevenly across the globe.
Eighty percent of children affected by stunting or wasting live in Asia, with 15
percent in Africa and 5 percent in Latin America. Low weight-for-age
(underweight) is usually used as an overall measurement of growth status. More
than 35 percent of all preschool-age children in developing countries are
underweight. There are differences, however, across regions. "The risk of being
underweight is 1.5 times higher in Asia than in Africa, and 2.3 times higher in
Africa than Latin America" (Onis, p. 10). In some ways, these indices also
enable an indirect understanding of the societal factors in these regions that
contribute to malnutrition as mentioned above.

The Universal Declaration of Human Rights, established by the United Nations

(UN) in 1948, identifies nutrition as a fundamental human right.

An acutely malnourished Liberian boy is weighed at a therapeutic feeding

center. Such centers, operated by international relief organizations, provide
intensive care and a specialized diet to rehabilitate severely malnourished
children.
Malnutrition remains one of the world's highest priority health issues, not
only because its effects are so widespread and long lasting, but also because it
can be eradicated. Given the multifactorial causes of malnutrition,
interventions must be focused on both acute and broad goals. Current efforts
are targeted at high-risk groups, particularly infants and pregnant women, for
it is "in these populations and during these ages those nutritional interventions
have the greatest potential for benefit" (Schroeder, p. 46). Even the simple
supplementation of vitamin A or beta-carotene supplements during pregnancy
can decrease maternal mortality by 40 percent. Interventions include direct
food supplementation, food access, agricultural enrichment, nutritional
education, and improved infrastructure related to hygiene, sanitation, and
health care delivery. Each of these programs "must be tailored to the particular
problems, cultural conditions, and resource constraints of the local context"
(Schroeder, p. 417). Strategies for reducing the prevalence of malnutrition
must effectively address its many causes.

Fats That
Raise Sources Examples
Cholesterol

Dietary foods from meats, egg yolks,

cholesterol animals dairy products,
organ meats (heart,
etc.), fish and
 poultry

Saturated fats foods from whole milk, cream,

animals ice cream, whole-
milk cheeses,
butter, lard and
meats

certain plant oils palm, palm kernel

and coconut oils,
cocoa butter

Trans fats partially cookies, crackers,

hydrogenated cakes, French fries,
vegetable oils fried onion rings,
donuts