{"id":6787,"date":"2024-04-24T12:48:06","date_gmt":"2024-04-24T07:18:06","guid":{"rendered":"https:\/\/www.diabetesasia.org\/magazine\/?p=6787"},"modified":"2024-11-19T12:59:49","modified_gmt":"2024-11-19T07:29:49","slug":"malnutrition-around-the-globe","status":"publish","type":"post","link":"https:\/\/www.diabetesasia.org\/magazine\/malnutrition-around-the-globe\/","title":{"rendered":"Malnutrition around the Globe"},"content":{"rendered":"

Malnutrition around the Globe <\/b><\/h2>\n

Malnutrition<\/b>\u00a0occurs when an organism gets too few or too many\u00a0nutrients<\/a>, resulting in health problems.<\/sup>\u00a0Specifically, it is “a\u00a0deficiency, excess, or imbalance of\u00a0energy<\/a>,\u00a0protein,\u00a0and\u00a0other nutrients” that adversely affects the body’s tissues and form.<\/span>\u00a0<\/sup>Malnutrition is not receiving the correct amount of nutrition.<\/p>\n

Malnutrition is a category of diseases that includes\u00a0undernutrition\u00a0and\u00a0overnutrition.<\/sup> Undernutrition is a lack of nutrients, resulting in\u00a0stunted growth,\u00a0wasting<\/a>, and underweight. A surplus of nutrients causes overnutrition, which can result in\u00a0obesity<\/a>. In some\u00a0developing countries, overnutrition in the form of obesity is beginning to appear within the same communities as undernutrition.<\/sup><\/p>\n

Most clinical studies use the term ‘malnutrition’ to refer to undernutrition. However, the use of ‘malnutrition’ instead of ‘undernutrition’ makes it impossible to distinguish between undernutrition and overnutrition, a less acknowledged form of malnutrition.<\/sup><\/sup>\u00a0Accordingly, a 2019 report by\u00a0The Lancet\u00a0Commission suggested expanding the definition of malnutrition to include “all its forms, including obesity, undernutrition, and other\u00a0dietary\u00a0risks.”<\/sup>\u00a0The\u00a0World Health Organization<\/a><\/sup>\u00a0and The Lancet Commission have also identified “[t]he double burden of malnutrition,” which occurs from “the coexistence of overnutrition (overweight and obesity) alongside undernutrition (stunted growth and wasting).”<\/sup><\/sup><\/p>\n

<\/div>\n

Prevalence<\/span><\/h2>\n
<\/a>
Number of people undernourished by region<\/figcaption><\/figure>\n

It is estimated that nearly one in three persons globally has at least one form of malnutrition: wasting, stunting, vitamin or mineral deficiency, overweight, obesity, or diet-related noncommunicable diseases.<\/sup>\u00a0Undernutrition is more common in\u00a0developing countries<\/a>. <\/sup>Stunting is more prevalent in urban slums than in rural areas.<\/sup> Studies on malnutrition have the population categorized into different groups, including infants, under-five children, children, adolescents, pregnant women, adults, and the elderly. Different growth references in different studies lead to variances in the undernutrition prevalence reported in other studies. Some of the growth references used in studies include the National Center for Health Statistics (NCHS) growth charts, WHO reference 2007, Centers for Disease Control and Prevention (CDC) growth charts, National Health and Nutrition Examination Survey (NHANES), WHO reference 1995, Obesity Task Force (IOTF) criteria and Indian Academy of Pediatrics (IAP) growth charts.<\/sup><\/p>\n

In children<\/span><\/h3>\n

The prevalence of undernutrition is highest among children under five.<\/sup>\u00a0In 2021, 148.1 million children under five years old were stunted, 45 million were wasted, and 37 million were overweight or obese.<\/sup>\u00a0The same year, an estimated 45% of deaths in children were linked to undernutrition.<\/sup><\/sup>\u00a0As of 2020, the prevalence of wasting among children under five in South Asia was reported to be 16% moderately or severely wasted.<\/sup>\u00a0As of 2022,\u00a0UNICEF<\/a> reported this prevalence as having slightly improved, but at 14.8%.<\/sup> India has one of the highest waste burdens in Asia, with over 20% wasted children.<\/sup> However, the burden of undernutrition among under-five children in African countries is much higher. A pooled analysis of the prevalence of chronic undernutrition among under-five children in East Africa was 33.3%. This prevalence of undernutrition among under-five children ranged from 21.9% in Kenya to 53% in Burundi.<\/sup> In Tanzania, the prevalence of stunting among children under five varied from 41% in lowland areas to 64.5% in highland areas. Undernutrition by underweight and wasting were 11.5% and 2.5% in the lowland and 22.% and 1.4% in the highland areas of Tanzania, respectively.<\/sup> In South Sudan, the prevalence of undernutrition explained by stunting, being underweight, and wasting in under-five children was 23.8%, 4.8%, and 2.3%, respectively.\u00a0In 28 countries, at least 30% of children were still affected by stunting in 2022.<\/sup><\/p>\n

Vitamin A deficiency<\/a> affects one-third of children under age 5 around the world,<\/sup>\u00a0leading to 670,000 deaths and 250,000\u2013500,000 cases of\u00a0blindness.<\/sup>\u00a0Vitamin A supplementation has been shown to reduce all-cause mortality by 12 to 24%.<\/sup><\/p>\n

In adults<\/span><\/h3>\n

As of June 2021, 1.9 billion adults were overweight or obese, and 462 million adults were underweight.<\/sup>\u00a0Globally, two billion people had\u00a0iodine deficiency<\/a>\u00a0in 2017.<\/sup> In 2020, 900 million women and children had anemia, often caused by iron deficiency.<\/sup>\u2009More than 3.1 billion people worldwide \u2013 42% \u2013 could not afford a healthy diet in 2021.<\/sup><\/p>\n

Certain groups have higher rates of undernutrition, including\u00a0elderly<\/a>\u00a0people and women (in particular while\u00a0pregnant<\/a><\/span>\u00a0or\u00a0breastfeeding\u00a0children<\/a> under five years of age). Undernutrition is an increasing health problem in people aged over 65 years, even in developed countries, especially among nursing home residents and acute care hospitals.<\/sup>\u00a0In the elderly, undernutrition is more commonly due to physical, psychological, and social factors, not a lack of food.<\/sup> Age-related reduced dietary intake due to chewing and swallowing problems, sensory decline, depression, imbalanced gut microbiome, poverty, and loneliness are major contributors to undernutrition in the elderly population. Malnutrition is also attributed to the wrong diet plans adopted by people who aim to reduce their weight without medical practitioners’ or nutritionists’ advice.<\/sup><\/p>\n

Increase in 2020<\/span><\/h3>\n
\"Projected<\/a><\/figure>\n

There has been a global increase in food insecurity and hunger between 2011 and 2020. According to the latest data,<\/a>\u00a0<\/strong>the number of undernourished people is approximately 735 million.\u00a0<\/strong>It<\/span>\u00a0is estimated that between 691 and 783 million people worldwide will face hunger in 2022. <\/sup>According to UNICEF, 2.4 billion people were moderately or severely food insecure in 2022, 391 million more than in 2019 (https:\/\/whfoods.com\/blog\/world-hunger-statistics\/)<\/p>\n

These increases are partially related to the ongoing\u00a0COVID-19 pandemic<\/a>, which continues to highlight the weaknesses of current food and health systems. It has contributed to food insecurity and increasing hunger worldwide; meanwhile, lower physical activity during lockdowns has contributed to increases in overweight and obesity.<\/sup> In 2020, experts estimated that the pandemic could have doubled the number of people at risk of suffering acute hunger by the end of the year. <\/sup>Similarly, experts estimated that the\u00a0prevalence\u00a0of moderate and severe wasting could increase by 14% due to COVID-19; coupled with reductions in nutrition and health services coverage, this could result in over 128,000 additional deaths among children under 5 in 2020 alone.<\/sup> Although COVID-19 is less severe in children than adults, undernutrition increases the risk of severe disease.<\/sup><\/p>\n

Other major causes of hunger include manmade conflicts,\u00a0climate changes, and\u00a0economic<\/a>\u00a0downturns.<\/sup><\/p>\n

Type<\/span><\/h2>\n\n\n\n\n
External videos<\/th>\n<\/tr>\n
\"video\u00a0Daniel Quinn on Facts of World Hunger<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Undernutrition<\/span><\/h3>\n
<\/a>
Prevalence of undernourishment (2020\u20132022 average)<\/figcaption><\/figure>\n
<\/a>
Number of undernourished people (2020\u20132022 average)<\/figcaption><\/figure>\n
<\/a>
The prevalence of undernourishment (PoU) was still higher in 2022 than before the pandemic in 58% of countries, and the situation is worse in low-income countries (77%).<\/figcaption><\/figure>\n

Undernutrition can occur either due to protein-energy wasting or micronutrient<\/a> deficiencies.\u00a0<\/sup><\/sup><\/sup><\/sup><\/sup><\/sup><\/sup>It adversely affects physical and mental functioning and causes body composition and cell mass changes.<\/sup><\/sup>\u00a0Undernutrition is a major health problem, causing the highest\u00a0mortality rate<\/a>\u00a0in children, particularly in those under 5 years, and is responsible for long-lasting\u00a0physiologic<\/a>\u00a0effects.<\/sup>\u00a0It is a barrier to the complete physical and mental development of children.<\/sup><\/p>\n

Undernutrition can manifest as stunting, wasting, and underweight. If it occurs during pregnancy or before two years of age, it may result in permanent problems with physical and mental development. Extreme undernutrition can cause starvation, chronic hunger, severe acute malnutrition\u00a0(SAM), and\/or\u00a0Moderate Acute Malnutrition\u00a0(MAM).<\/p>\n

The\u00a0signs and symptoms\u00a0of\u00a0micronutrient deficiencies\u00a0depend on which micronutrient is lacking.<\/sup> However, undernourished people are often thin and short, with very poor energy levels. Swelling\u00a0in the legs\u00a0and abdomen\u00a0is also common.<\/sup><\/sup><\/sup> Undernourished people usually get infections<\/a>\u00a0and frequently feel cold.<\/sup><\/p>\n

Micronutrient undernutrition<\/span><\/h4>\n

Micronutrient undernutrition results from insufficient vitamin and mineral intake.<\/sup>\u00a0Worldwide, deficiencies in\u00a0iodine,\u00a0Vitamin A<\/a>, and\u00a0iron\u00a0are the most common. Children and pregnant women in\u00a0low-income countries\u00a0are at especially high risk for micronutrient deficiencies.<\/sup><\/sup><\/p>\n

Anemia is commonly\u00a0caused by iron deficiency\u00a0but can also result from other micronutrient deficiencies and diseases. This condition can have major health consequences<\/a>.<\/sup><\/p>\n

It is possible to have overnutrition simultaneously with micronutrient deficiencies; this condition is termed the\u00a0double burden of malnutrition<\/a><\/b>.<\/p>\n

Protein-energy malnutrition<\/span><\/h4>\n

‘Undernutrition’ sometimes refers specifically to\u00a0protein\u2013energy malnutrition<\/a>\u00a0(PEM).<\/sup><\/sup> This condition involves micronutrient deficiencies and an imbalance of protein intake and energy expenditure.<\/sup>\u00a0It differs from\u00a0calorie restriction<\/a> because it may not have negative health effects. Hypoalimentation (underfeeding) is one cause of undernutrition.[55]<\/a><\/sup><\/p>\n

Two forms of PEM are\u00a0kwashiorkor<\/a>\u00a0and\u00a0marasmus<\/a>; both commonly coexist.<\/sup><\/p>\n

<\/a>
Child in the\u00a0United States\u00a0with signs of\u00a0kwashiorkor, a dietary protein deficiency<\/figcaption><\/figure>\n

Kwashiorkor<\/i> is primarily caused by inadequate protein intake.\u00a0<\/sup>Its symptoms include\u00a0edema<\/a>, wasting,\u00a0liver enlargement,\u00a0hypoalbuminaemia, and\u00a0steatosis<\/a>; the condition may also cause\u00a0depigmentation\u00a0of\u00a0skin<\/a>\u00a0and\u00a0hair<\/a>.<\/sup> The disorder is further identified by a characteristic swelling of the belly and extremities, which disguises the patient’s undernourished condition.<\/sup> ‘Kwashiorkor’ means ‘displaced child’ derived from the\u00a0Ga language\u00a0of coastal\u00a0Ghana\u00a0in\u00a0West Africa. It means “the sickness the baby gets when the next baby is born,” as it often occurs when the older child is deprived of breastfeeding and\u00a0weaned\u00a0to a diet composed largely of carbohydrates.<\/sup><\/p>\n

Marasmus<\/i> (meaning ‘to waste away’) can result from a sustained diet deficient in protein and energy. This causes their\u00a0metabolism<\/a> to adapt to prolong survival.<\/sup>\u00a0The primary symptoms are severe wasting, leaving little or no\u00a0edema<\/a>; minimal\u00a0subcutaneous fat; and abnormal\u00a0serum albumin<\/a>\u00a0levels.<\/sup> It is traditionally seen in\u00a0famine, significant food restriction, or severe\u00a0anorexia.<\/sup>\u00a0Conditions are characterized by extreme wasting of the muscles and a gaunt expression.<\/sup><\/p>\n

Overnutrition<\/span><\/h3>\n

Excessive consumption of energy-dense foods and drinks and limited physical activity causes overnutrition.<\/sup> It causes obesity, which is defined as a\u00a0body mass index<\/a> (BMI) of 25 or more, and can lead to obesity (a BMI of 30 or more).\u00a0<\/sup><\/sup>Obesity has become a major health issue worldwide.<\/sup>\u00a0Overnutrition is linked to\u00a0chronic non-communicable diseases\u00a0like\u00a0diabetes<\/a>,<\/span> certain\u00a0cancers<\/a>, and\u00a0cardiovascular diseases. Hence, identifying and addressing the immediate risk factors has become a major health priority.<\/sup> The recent evidence on the impact of diet-induced obesity in fathers and mothers around the time of conception is identified to program the health outcomes of multiple generations negatively.<\/sup><\/p>\n

According to UNICEF, at least 1 in every 10 children under five is overweight in 33 countries.<\/sup><\/p>\n

Classifying malnutrition<\/span><\/h2>\n

<\/span>Definition by Gomez & Galvan<\/span><\/h3>\n

In 1956, G\u00f3mez and Galvan studied factors associated with death in a group of malnourished children in a hospital in Mexico City,\u00a0Mexico<\/a>. They defined three categories of malnutrition: first, second, and third-degree.<\/sup>\u00a0The degree of malnutrition is calculated based on a child’s body size compared to the\u00a0median<\/a>\u00a0weight for their age.<\/sup>\u00a0The risk of death increases with increasing degrees of malnutrition.<\/sup><\/p>\n

An adaptation of Gomez’s original classification is still used today. While it provides a way to compare malnutrition within and between populations, this classification system 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 born prematurely<\/a>\u00a0may be considered short for their age even if they have good nutrition.<\/sup><\/p>\n\n\n\n\n\n\n\n\n
Degree of PEM<\/th>\n% of desired body weight for age and sex<\/th>\n<\/tr>\n
Normal<\/td>\n90\u2013100%<\/td>\n<\/tr>\n
Mild: Grade I (1st degree)<\/td>\n75\u201389%<\/td>\n<\/tr>\n
Moderate: Grade II (2nd degree)<\/td>\n60\u201374%<\/td>\n<\/tr>\n
Severe: Grade III (3rd degree)<\/td>\n<60%<\/td>\n<\/tr>\n
SOURCE: “Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition”<\/sup><\/small><\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n

Definition by Waterlow<\/span><\/h3>\n

In the 1970s,\u00a0John Conrad Waterlow<\/a>\u00a0established a new classification system for malnutrition.<\/sup> Instead of just weight-for-age measurements, Waterlow’s system combines weight-for-height (indicating acute episodes of malnutrition) with height-for-age to show the stunting resulting from chronic malnutrition.<\/sup>\u00a0One advantage of the Waterlow classification is that weight for height can be calculated even if a child’s age is unknown.<\/sup><\/p>\n\n\n\n\n\n\n\n\n
Degree of PEM<\/th>\nStunting (%) Height for age<\/th>\nWasting (%) Weight for height<\/th>\n<\/tr>\n
Normal: Grade 0<\/td>\n>95%<\/td>\n>90%<\/td>\n<\/tr>\n
Mild: Grade I<\/td>\n87.5\u201395%<\/td>\n80\u201390%<\/td>\n<\/tr>\n
Moderate: Grade II<\/td>\n80\u201387.5%<\/td>\n70\u201380%<\/td>\n<\/tr>\n
Severe: Grade III<\/td>\n<80%<\/td>\n<70%<\/td>\n<\/tr>\n
SOURCE: “Classification and definition of protein-calorie malnutrition.” by Waterlow, 1972<\/sup><\/small><\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n

The World Health Organization frequently uses these classifications of malnutrition, with some modifications.<\/sup><\/p>\n

Effects<\/span><\/h2>\n
See also:\u00a0Stunted Growth<\/a>\u00a0and\u00a0Wasting<\/a><\/div>\n
<\/a>
Child of a\u00a0sharecropper<\/a>\u00a0with undernutrition and\u00a0rickets, 1935<\/figcaption><\/figure>\n

Undernutrition weakens every part of the\u00a0immune system<\/a>.<\/sup> Protein and energy undernutrition increases susceptibility to infection, as do deficiencies of specific micronutrients (including iron, zinc, and vitamins).<\/sup>\u00a0In communities or areas that lack access to\u00a0safe drinking water, these additional health risks present a critical problem.<\/p>\n

Undernutrition plays a major role in the onset of active\u00a0tuberculosis<\/a>.<\/sup>\u00a0It also raises the risk of\u00a0HIV<\/a> transmission from mother to child and increases\u00a0replication\u00a0of\u00a0the virus<\/a>.<\/sup> Undernutrition can cause vitamin deficiency-related\u00a0diseases\u00a0like\u00a0scurvy\u00a0and\u00a0rickets<\/a>. As undernutrition worsens, those affected have less energy and experience impairment in brain functions. This can make it difficult (or impossible) for them to perform the tasks needed to acquire food, earn an\u00a0income, or gain an\u00a0education.<\/p>\n

Undernutrition can also cause acute problems, like\u00a0hypoglycemia\u00a0(low\u00a0blood sugar<\/a>). This condition can cause lethargy, limpness,\u00a0seizures<\/a>, and\u00a0loss of consciousness. Children are particularly at risk and can become hypoglycemic after 4 to 6 hours without food. Dehydration can also occur in malnourished people and can be life-threatening, especially in babies and small children.<\/p>\n

Signs\/symptoms<\/span><\/h3>\n

Undernourished people can show many different signs of dehydration. These can include sunken eyes, a very dry mouth, decreased urine output and\/or dark urine, increased heart rate with decreasing blood pressure, and altered mental status<\/a>.<\/p>\n

Type 1 Diabetes Mellitus early Detection<\/a><\/p><\/blockquote>\n