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Malnutrition has long been associated with poverty, poor diet and inadequate access to health care, and it remains a key global health issue that both stems from and contributes to ill-health, with 50 % of childhood deaths due to underlying undernutrition.
Malnutrition results from 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 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.
Despite record food output globally, hunger is still with us. Most scholars argue that key policy actions are urgently needed to tackle this scourge and must focus on improving diet quality for all
Today’s world is characterized by the coexistence of agricultural bounty and widespread hunger and malnutrition.
Recent years have seen a reversal of a decades old trend of falling hunger, alongside the re-emergence of famine.
National and global evidence shows that ensuring an adequate food supply is still an important contribution to eradicating hunger. However, generating more food in the form of staple grains or tubers is not enough. Good nutrition and an end to hunger both require everyone to have an appropriate diet. How can that be achieved?
According to the World Health Organization (WHO), malnutrition is the gravest single threat to global public health. Globally, it contributes to 45% of deaths of children aged under 5 years.
Characterizing the problem:
A recent report for the World Committee on Food Security argued that “malnutrition in all its forms—not only hunger, but also micronutrient deficiencies, as well as overweight and obesity—is…a critical challenge not only in the developing but also in the developed countries. Resolving malnutrition requires a better understanding of the determinants and processes that influence diets
What is malnutrition?
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.
Malnutrition ranges from extreme hunger and undernutrition to obesity.
Furthermore, malnutrition is found in all countries, irrespective of their economic development, where people lack high quality diets.
Thus, solutions to hunger and to all forms of malnutrition need to focus on ensuring an adequate supply of food, but equally, on the quality of diets.
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 abdomen. A lack of vitamin C can result in scurvy.
Scurvy is rare in industrialized nations, but it can affect older people, those who consume 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 children globally.
However, despite such progress the world still has unacceptably high numbers of undernourished people. Of the roughly 800 million undernourished, 780 million are in low income countries, especially in sub-Saharan Africa and South Asia.
The continents of Africa and Asia have the greatest number of people living in extreme poverty, and it is here that extreme hunger and poverty together present the greatest risk of famine.
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 susceptible to disease.
Signs and symptoms of under-nutrition 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
- 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.
Effective actions to tackle hunger and malnutrition
In 2016, the world hit a new record by producing over 2.5 billion metric tons of cereal grains—up from 1.8 billion tons 20 years earlier. But hunger persists because an increased supply of food alone is neither the solution to hunger nor an answer to malnutrition.
Countries that have made recent progress in reducing hunger and improving nutrition have a core set of common characteristics.
Firstly, they tend to be politically stable countries that have pursued relatively equitable growth policies (not only increasing wealth for some but reducing poverty overall). Secondly, they employ targeted safety nets for the poor and invest in accessible services (education, clean water, healthcare).
Thirdly, they assume responsibility for responding to shocks (economic, environmental, or due to conflict) in timely ways that mitigate human suffering.
Successful actions typically include a mix of targeted so-called nutrition specific programming (aimed at preventing or resolving defined nutrition and health problems in individuals) and nutrition sensitive interventions for the whole population that deal with the underlying causes.
In health, national policies to support accessible high-quality services are critical to ensuring antenatal and postnatal care, particularly combined with targeted nutrition, exclusive breast feeding, and infant feeding messaging.
Measures directed at underweight mothers are important for good birth outcomes, as well as varied forms of micronutrient supplementation.
In other words, the quality of services, scale of coverage, and the singling out of nutritionally vulnerable demographic groups are all keys to success.
The sustainable development goals require all countries and their citizens to act together to end hunger and all forms of malnutrition by 2030.
Setting targets is a good first step, but actions need to follow quickly. Urgent attention to achieve such goals is seriously overdue.
Policy action must be designed to reduce malnutrition in all its forms, and be adequately funded. Measures must be evidence based, implemented at scale, and include both broad based and targeted actions aimed at the most nutritionally vulnerable people.
The evidence to support such actions is growing, but it is already plentiful and compelling; there is no need for delay.
The rapidly escalating threats posed by malnutrition represent a planetary challenge on a par with poverty and climate change. An appropriate response at the required scale ought to be the top priority for all decision makers globally.