Malnutrition: What you need to know

Malnutrition results from a poor diet or a lack of food. It happens when the intake of
nutrients or energy is too high, too low, or poorly balanced.
Undernutrition can lead to delayed growth or wasting, while a diet that provides too
much food, but not necessarily balanced, leads to obesity.

In many parts of the world, undernutrition results from a lack of food. In some cases,
however, undernourishment may stem from a health condition, such as an eating
disorder or a chronic illness that prevents the person from absorbing nutrients.

According to the World Health Organization (WHO), malnutrition is the gravest single
threat to global public health. Globally, it contributes to 45 percent of deaths of chil-
dren aged under 5 years.

This article will focus mainly on undernutrition.

What is malnutrition?

Older people can be at risk of nutrition if they are isolated and have mobility prob-
lems.

Malnutrition involves a dietary deficiency. People may eat too much of the wrong
type of food and have malnutrition, but this article will focus on undernutrition, when
a person lacks nutrients because they do not consume enough food.

Poor diet may lead to a lack of vitamins, minerals, and other essential substances.
Too little protein can lead to kwashiorkor, symptoms of which include a distended ab-
domen. A lack of vitamin C can result in scurvy.
 Scurvy is rare in industrialized nations, but it can affect older people, those who con-
sume excessive quantities of alcohol, and people who do not eat fresh fruits and
vegetables. Some infants and children who follow a limited diet for any reason may
be prone to scurvy.

According to the World Health Organization (WHO), 462 million people worldwide
are malnourished, and stunted development due to poor diet affects 159 million chil-
dren globally.

Malnutrition during childhood can lead not only to long-term health problems but also
to educational challenges and limited work opportunities in the future. Malnourished
children often have smaller babies when they grow up.

It can also slow recovery from wounds and illnesses, and it can complicate diseases
such as measles, pneumonia, malaria, and diarrhea. It can leave the body more sus-
ceptible to disease.

Symptoms

Signs and symptoms of undernutrition include:

 lack of appetite or interest in food or drink

 tiredness and irritability

 inability to concentrate

 always feeling cold

 loss of fat, muscle mass, and body tissue

 higher risk of getting sick and taking longer to heal

 longer healing time for wounds

 higher risk of complications after surgery

 depression

 reduced sex drive and problems with fertility

In more severe cases:

 breathing becomes difficult

 skin may become thin, dry, inelastic, pale, and cold

 the cheeks appear hollow and the eyes sunken, as fat disappears from the face

 hair becomes dry and sparse, falling out easily

Eventually, there may be respiratory failure and heart failure, and the person may
become unresponsive. Total starvation can be fatal within 8 to 12 weeks

Children may show a lack of growth, and they may be tired and irritable. Behavioral
and intellectual development may be slow, possibly resulting in learning difficulties.

Even with treatment, there can be long-term effects on mental function, and digestive
problems may persist. In some cases, these may be lifelong.

Adults with severe undernourishment that started during adulthood usually make a
full recovery with treatment.
Causes

Malnutrition can result from various environmental and medical conditions.

1) Low intake of food

This may be caused by symptoms of an illness, for example, dysphagia, when it is

difficult to swallow. Badly fitting dentures may contribute.

2) Mental health problems

Conditions such as depression, dementia, schizophrenia, anorexia nervosa, and bu-

limia can lead to malnutrition.

3) Social and mobility problems

Some people cannot leave the house to buy food or find it physically difficult to pre-
pare meals. Those who live alone and are isolated are more at risk. Some people do
not have enough money to spend on food, and others have limited cooking skills.

4) Digestive disorders and stomach conditions

If the body does not absorb nutrients efficiently, even a healthful diet may not pre-
vent malnutrition. People with Crohn's disease or ulcerative colitis may need to have
part of the small intestine removed to enable them to absorb nutrients.

Celiac disease is a genetic disorder that involves a gluten intolerance. It may result
in damage to the lining of the intestines and poor food absorption.

Persistent diarrhea, vomiting, or both can lead to a loss of vital nutrients.

 5) Alcoholism

Addiction to alcohol can lead to gastritis or damage to the pancreas. These can
make it hard to digest food, absorb certain vitamins, and produce hormones that reg-
ulate metabolism.

Alcohol contains calories, so the person may not feel hungry. They may not eat
enough proper food to supply the body with essential nutrients.

6) Lack of breastfeeding

Not breastfeeding, especially in the developing world, can lead to malnutrition in in-
fants and children.

Risk factors

In some parts of the world, widespread and long-term malnutrition can result from a
lack of food.

In the wealthier nations, those most at risk of malnutrition are:

 older people, especially those who are hospitalized or in long-term institutional care

 individuals who are socially isolated

 people on low incomes

 those who have difficulty absorping nutrients

 people with chronic eating disorders, such as bulimia or anorexia nervosa

 people who are recovering from a serious illness or condition

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Diagnosis

Prompt diagnosis and treatment can prevent the development and complications of
malnutrition.

There are several ways to identify adults who are malnourished or at risk of malnutri-
tion, for example, the Malnutrition Universal Screening Tool (MUST) tool.

MUST has been designed to identify adults, and especially older people, with mal-
nourishment or a high risk of malnutrition.

It is a 5-step plan that can help health care providers diagnose and treat these condi-
tions.

Here are the steps:

 Step 1: Measure height and weight, calculate body mass index (BMI), and provide
a score.

 Step 2: Note the percentage of unplanned weight loss and provide a score. For ex-
ample, an unplanned loss of 5 to 10 percent of weight would give a score of 1, but a
10-percent loss would score 2.

 Step 3: Identify any mental or physical health condition and score. For example, if a
person has been acutely ill and taken no food for over 5 days, the score will be 3.
 Step 4: Add scores from steps 1, 2 and 3 to obtain an overall risk score.

 Step 5: Use local guidelines to develop a care plan.

If the person is at low risk of malnutrition, their overall score will be 0. A score of 1
denotes a medium risk and 2 or more indicates a high risk.

MUST is only used to identify malnutrition or the risk of malnutrition in adults. It will
not identify specific nutritional imbalances or deficiences.

Treatment

Following the MUST screening, the following may happen:

Low risk: Recommendations include ongoing screening at the hospital and at home.

Medium risk: The person may undergo observation, their dietary intake will be docu-
mented for 3 days, and they will receive ongoing screening.

High risk: The person will need treatment from a nutritionist and possibly other spe-
cialists, and they will undergo ongoing care.

For all risk categories, help and advice on food choices and dietary habits should be
offered.

Treatment types

The type of treatment will depend on the severity of the malnutrition, and the pres-
ence of any underlying conditions or complications.
The healthcare provider will prepare a targeted care plan, with specific aims for treat-
ment. There will normally be a feeding program with a specially planned diet, and
possibly some additional nutritional supplements.People with severe malnourishment
or absorption problems may need artificial nutritional support, either through a tube
or intravenously.

The patient will be closely monitored for progress, and their treatment will be regu-
larly reviewed to ensure their nutritional needs are being met.

Diet

A dietitian will discuss healthful food choices and dietary patterns with the patient, to
encourage them to consume a healthy, nutritious diet with the right number of calo-
ries. Those who are undernourished may need additional calories to start with.

Monitoring progress

Regular monitoring can help ensure an appropriate intake of calories and nutrients.
This may be adjusted as the patient's requirements change. Patients receiving artifi-
cial nutritional support will start eating normally as soon as they can.

Prevention

To prevent malnutrition, people need to consume a range of nutrients from a variety

of food types. There should be a balanced intake of carbohydrates, fats, protein, vita-
mins, and minerals, as well as plenty of fluids, and especially water.

People with ulcerative colitis, Crohn's disease, celiac disease, alcoholism, and other
health issues will receive appropriate treatment for their condition.
 Malnutrition of Filipino Children

An American humanitarian, Dr. Norman Borlaug (2011), once said, “You

can’t build a peaceful world on empty stomachs and human misery.” Be-
yond question, the world, particularly the Philippines, is facing a serious
problem of malnutrition especially with children. Malnutrition is defined as
the condition when certain nutrients, such as calories, protein, vitamins,
and minerals, are lacking from a person’s diet. This ill health may lead to
negative effects on the different functions of the human body. According to
the 2011 national nutrition survey results conducted by the Food and Nutri-
tion Research Institute, 15.9% or two out of ten children from 0 to 45
months old were born weighing less than 5.5 lbs. The results from the sur-
vey also showed that 20.2% of children in the 0 to 45 months old category
were considered underweight. Moreover, the Department of Education
warned the public about the fact that as many as 1.8 million children from
the Philippines suffer from severe malnourishment. Further studies also
showed that there is a greater risk of malnutrition in poor households and
disaster prone areas. Without a doubt, malnutrition of Filipino children is an
effect of existing multifaceted problems that can be fought with the im-
proved efforts of the government and the people.
Malnourishment among young Filipino children is primarily caused by natu-
ral catastrophes, lack of education and poverty. Natural disasters bring
massive effects on the physical and economic access to food, availability
and stability of supplies, and nutrition. Unforeseen catastrophes quickly re-
sult into a food and nutrition crisis, meaning, risk of hunger and malnutrition
increases. In the country, numerous Filipino agricultural workers face liveli-
hood crisis caused by extreme weather. Crop losses and lower livestock
and poultry production escalates malnutrition contingencies. In like manner,
lack of knowledge and poor literacy can lead to unhealthy food choices
which can dreadfully affect children’s well-being. Inadequacy of education
especially among mother disadvantages children by negligence of healthy
practices such as breastfeeding and sufficient nutrient intake. A deficient
nutritional status of a child is induced by an insufficient knowledge as to
which nutrients are vital for growth. It follows that education and malnutri-
tion are firmly related.
 Another root of malnutrition is poverty. It is the major cause of malnutrition
in the Philippines. In the first quarter 2015 survey of Social Weather Sta-
tions (SWS), it showed that around 7.9 million Filipino families are food-
poor. This means that financial struggles hinder families from access to
food. According to Umil (2015), “Families living in urban poor communities
provide and feed their families with the meagre income they earn”. With ex-
pensive prices of basic commodities, families tend to rely on unhealthy op-
tions such as instant noodles and canned goods. If consumed regularly,
these poor food choices deny the children from getting the appropriate nu-
trition that their body needs and bring further health complications.
As serious as its condition today, malnutrition of Filipino children can be
eradicated through three feasible solutions. First is to augment agricultural
programs for farmers so that they would be secured in occurrences of natu-
ral calamities. In a study conducted by the Southeast Asian Regional Cen-
ter for Graduate Study and Research in Agriculture (SEARCA), the govern-
ment’s crop insurance program proved to be a necessary key to farmers’
consistent agricultural production despite severe weather conditions. In ad-
dition, improving the Philippine Crop Insurance Corporation (PCIC) would
be an important help for the farmers. PCIC, which is owned and controlled
by the government, provides insurance protection to farmers against losses
caused by natural disasters. Augmentation of these government programs
would be beneficial for reducing malnutrition. Second answer to malnutri-
tion is proper education. Access to appropriate and formal education, espe-
cially for mothers and children, should help diminish malnutrition related
mortality and morbidity (World Bank, 2006). In Somalia, mothers who got
the privilege of education at supplementary feeding centers helped the
country’s rate of Global Acute Malnutrition (GAM) to improve. The GAM
rate has dropped from an alarming 45% to around 16%. On the other hand,
studies conducted in Kenya proved the importance of maternal education
as a key agent of nutritional status among children. These cases show the
possibility of education being a central solution against malnutrition in the
Philippines. Lastly, malnutrition of children can be solved through improved
efforts by the government and the people. Coming up with broad economic
policies would help reduce poverty and bring the country into economic
progress which the families can benefit from. However, these policies
would only be successful if it is sustainable enough with right budget alloca-
tions.
Anti-poverty programs should be well-implemented while proving the needs
of the families. Livelihood and income opportunities from the government
would also aid in the fight against poverty. Nevertheless, government en-
deavors are not enough; commitment from the public is necessary as well.
Involvement from the people and public awareness play major roles to en-
sure that children get the right nutrition they deserve.
Ending the problem of malnutrition of Filipino children would take a lot of
effort and a long period of time. It will not settle on its own nor will it vanish
from the Earth by itself. The suffering Filipino children need help from the
people around them, especially the government. Responsively, some non-
governmental organizations, like Save the Children, execute projects that
would help solve the current malnutrition situation in the country. However,
these projects are not enough to eliminate a problem as serious as malnu-
trition. With that idea in mind, the best solution may be focusing on the lack
of knowledge by providing proper education not only for the children but
also for the parents. This would give a long-term answer to malnutrition as
they would benefit from education throughout their entire lives. Education
would give someone the knowledge on what kinds of food to eat that are
most nutritious. The child of an educated mother is more likely to survive up
to the age of 5 than an uneducated mother in most cases. Also, education
has been the key for the successful malnutrition reduction in Somalia and
other countries in East Africa (Nicol, 2013; Kasirye, 2010). The same can
certainly be done in the Philippines as well. In spite of that, it would be aus-
picious if people would support government programs, learn to utilize natu-
ral resources, and if parents would hold on to their responsibilities for the
welfare of their children.