Definitions

Nutrition Micro-nutrients Macro-nutrients Malnutrition Causes of Malnutrition Impact of Malnutrition
Vitamins
Major minerals
Proteins
Fat
Carbohydrates
Sugars
Starches
Stunted growth
Under-weight
Wasted malnutrition
Marasmus
Kwashiorkor
Malnutrition in adults Child malnutrition
Maternal malnutrition
Impact on adults

Nutrition

The process by which living organisms obtain food and use it for growth, metabolism, and repair. The stages of nutrition include ingestion, digestion, absorption, transport, assimilation and excretion. It is the foundation for health and development.

Adequate nutrition can mean a stronger immune system, improved capacity to learn, better health at all ages, and stronger and more productive people to break the cycle of poverty, a central cause of under nutrition.

Intake of good food requires adequate supply of micronutrients and macronutrients for the proper functioning of the body. Nutritional requirements depend on: age, sex, height, weight, degree of activity and rate of growth.

A diet is considered acceptable for an individual when it covers both micro- and macronutrient requirements (According to WHO standards).
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Micro-nutrients*

Micronutrients include vitamins and minerals. Micronutrient deficiencies is a major cause of death in the developing world.

Vitamins are needed by the body in small amounts to enable it to grow, develop and function. They work with other compounds to help produce energy, build tissues, remove waste and ensure that the body works efficiently.

Minerals are metals and other inorganic compounds that promote physiological processes and provide much of the structure for bones and teeth. Certain Vitamins and minerals work together and require the actions of other vitamins and minerals to be effective.

The Vitamins needed by humans are divided into water-soluble vitamins (B vitamins and vitamin C) and fat-soluble vitamins (A, D, E and K). Fat-soluble vitamins are absorbed by the intestine and carried to different parts of the body by the lymphatic system which forms part of our immune system. They are essential for maintaining the structure of our cells.
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Vitamins

Vitamin A
Needed for good vision, strong bones and healthy skin. It improves the body's ability to heal and it is an antioxidant.
Vitamin B1 (THIAMINE)
Promotes growth. Converts blood sugar into energy and is a nerve tonic.
Vitamin B2 (RIBOFLAVIN)

 Aids in cell respiration, growth and reproduction. Essential for the body to produce energy and it is an antioxidant.
Vitamin B3
(NIACIN)
Essential for sex hormones, increases energy, helps digestion and aids nervous system.
Vitamin B5 (PANTOTHENIC ACID)
Aids in healing wounds, fights infections, strengthens immune system and builds cells.
Vitamin B6 (PYRODOXAMINE)
Aids the nervous system. It is crucial for a healthy immune system and for the production of antibodies and white blood cells.
Vitamin B12
Forms red blood cells, increases energy, improves memory and concentration. Promotes growth in children and maintains nervous system.
Folic Acid (Vitamin B9)
Essential for red blood cells, protects against fetal abnormalities, helps in the metabolism of sugar, produces antibodies, crucial for the production of DNA and RNA and to the nervous system.
Vitamin C
Essential for good vision, healthy skin, bones, muscles, healing and protection from allergies and infections. It is an effective antioxidant.
Vitamin D
Essential for growth and healthy bones and teeth. Increases absorption of calcium from diet.
Vitamin E
Necessary for absorption of iron, metabolism of essential fatty acids, increases fertility, protects the circulatory system and cells and protects against fetal abnormalities. It is an effective antioxidant.
Vitamin K
Produces blood-clotting factors.

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Major Minerals

Calcium
Necessary for hormones and muscles and for blood pressure and blood clotting regulation. Aids nervous system and maintains strong bones and teeth. It helps to metabolize iron.
Iodine
Produces hormones for the thyroid gland. It is important for proper growth and development. Lack of iodine in the diet can cause goiter (swollen thyroid gland) and mental retardation.
Iron
Necessary for production of hemoglobin, protection of immune activity and to supply oxygen to cells.
Potassium
Necessary for water balance and protein synthesis, nerve and muscle function.
Magnesium
Repairs and maintains body cells. Required for transmission of nerve impulses, growth, repair and bone development.
Chromium
Stimulates insulin activity.

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Macro-nutrients*

Proteins

Proteins provide the nutrients for maintaining the structure of your body. Muscles, bones, skin, nails and hair are made of protein. Digestive juices break down the proteins into basic units called amino acids that are reused by the body to make the protein needed to maintain muscles, bones, blood and body organs. Protein is made up of differing combinations of 23 separate amino acids. The human body can produce most of the amino acids it needs but there are 9 known as essential amino acids, that must be obtained from the diet.

A lack of protein in the diet retards growth in children and causes a decrease in energy. Excess protein intake, on the other hand, puts a strain on the liver and kidneys and leads to an increased risk of cancer and coronary heart disease. Animal sources contain all 9 essential amino acids but can have side effects on cholesterol levels if taken in excess. All unrefined vegetable foods are full of protein. For example, rice is 8% protein, potatoes 10%, beans 26% and wheat 16%.
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Fat

Fat supplies energy and transports nutrients. There are two families of fatty acids considered essential for the body: the omega-3 and omega-6 fatty acids. Essential fatty acids are required by the body to function normally.
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Carbohydrates

Carbohydrates, which include cellulose, starches, sugars and many other compounds are the greatest source of energy. They are divided into starches and sugars.
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Sugars

The most common simple sugars are glucose, fructose and galactose. Sugar is found in many plants and fruits, the most important type being sucrose, which is obtained from sugar cane or sugar beet. Indian jaggery and raw sugar cane are the healthiest and best substitutes for white sugar.

Major sources of sugar in the diet are sugar added to food and drinks, especially soft drinks and sweets. Sugar is also added to a wide range of processed foods. Sugar provides calories, but no other nutrients. If you fill up on sugary foods, you are more likely to be at risk of tooth decay and vitamin and mineral deficiencies.
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Starches

Starches are converted into sugars in the body and are found principally in plant foods: pulses, tubers (like potatoes), grains and some roots (like carrots). They are also known as "complex carbohydrates." Starch is the plant's energy store. Highly refined starches like white flour, white rice or corn flour have as little nutritional value as sugars. Unrefined starches such as beans, potatoes, wholegrain or brown flours are a good source of protein and contain a wide range of minerals and vitamins. Millet, for example, is an excellent source of iron.

Any carbohydrate can give the body energy. However, different types of carbohydrate affect energy levels in different ways. Sugar carbohydrates tend to give a sudden burst of energy followed by a drop, whereas complex carbohydrates provide sustained energy over a longer period of time and prevent drastic swings in blood sugar level. Excellent sources of complex carbohydrates include fruits, vegetables, pulses (lentils, beans, barley, etc.), whole grains like brown rice, oat, teff, wheat berries and seeds. It is recommended to get at least 60% of daily calorie intake from complex carbohydrates, preferably unrefined.
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(*) Mother and child organization

Malnutrition

The result of the body not receiving adequate amounts of some of, or all, the essential nutrients: micronutrients (vitamin and minerals) and macronutrients (fat, protein and carbohydrates), or when excreting them more rapidly than they can be replaced. It is a broad term which refers to both undernutrition (subnutrition) and overnutrition (i.e. obesity).

Malnutrition is a general term that indicates a lack of some or all nutritional elements necessary for human health.

There are three basic types of malnutrition.

  1. Protein-energy malnutrition--the lack of enough protein and food that provides energy (measured in calories). This is the type of malnutrition that is referred to when world hunger is discussed.
  2. The second type of malnutrition, is micronutrient (vitamin and mineral) deficiency.
  3. Over-consumption, taking in many more calories than required, is often accompanied by a deficiency in vitamins and minerals. These people, typically overweight or obese, are a fast-growing segment of the world's population. Ironically they often live as the middle and upper class in those countries where hunger is prevalent, such as in India and China. The health care costs, missed productivity and environmental costs associated with this group are huge. The WHO estimates this group to be 1.2 billion people worldwide. The common thread that affects all of these groups, 4.4 billion people, is malnutrition. According to the World Health Organization (WHO), malnutrition is the gravest single threat to global public health.

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Anthropometric Definitions of Malnutrition (*)

Stunted Growth

Stunted growth refers to low height-for-age; when a child is short for his/her age but not necessarily thin. Also known as chronic malnutrition, this carries long-term developmental risks.
Malnutrition causes permanent irreversible Brain stunting. 30-40 million youth under the age of two are effected.
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Under-weight

Under-weight refers to low weight-for-age; when a child can be either thin or short for his/her age. This reflects a combination of chronic malnutrition.

Stunted and under-weight children are most likely to suffer from impaired development and are more vulnerable to disease and illness.
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Wasted malnutrition

Wasted refers to low weight-for-height; when a child is thin for his/her height but not necessarily short. It carries an immediate increased risk of morbidity and mortality. Wasted children have a 5-20 times higher risk of dying from common diseases like diarrhea or pneumonia than normally nourished children. Beyond the age of 24-36 months, the effects of chronic malnutrition are irreversible.

The long-term consequences of chronic malnutrition are far-reaching. A recent multi-country study showed that for every 10% increase in stunting, the proportion of children reaching the final grade of school dropped by almost 8%. The same study showed that each year of schooling increases wages earned by almost 10% (Grantham-McGregor, S. et al, 2007, 'Child Development in Developing Countries: Developing Potential in the First 5 Years for Children in Developing Countries', The Lancet, Vol. 369, No. 9555: 60-70).
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Marasmus

When children do not get enough energy-giving food, their bodies become thin and they feel weak. Children with marasmus look old and wrinkled. Their skin is dry and their faces are thin, with sunken cheeks and large eyes. Their abdomens look swollen. They present sagging skin on legs and buttocks. Children with marasmus cry a lot, are very irritable and have increased greedy appetite. They are liable to all kinds of disease.
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Kwashiorkor

When children do not get enough variety of the right kind of food, for example when they eat only cereal-based porridge, their bodies (especially their stomachs and legs) swell so they may look fat. Micronutrient deficiency, particularly anti-oxidant nutrients, might be a probable cause. Sores develop on their skin and at the corner of their mouths. Their skin becomes pale and starts to peel off. Kwashiorkor children are most likely to lose their appetite and an interest in their surroundings.

Kwashiorkor children present with what is called pitting oedema in both feet and lower limbs. Oedema can also expand to the whole body.

Marasmus and kwashiorkor symptoms can be combined. A child suffering from these conditions is at risk of dying.
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Causes of Malnutrition

  • Ignorance - Lack of knowledge about the kinds and amounts of food needed for good nutrition is one of the main causes of inadequate food intake and consequent under nutrition and overnutrition
  • Poverty - Poor economic conditions which reduce the purchasing power of an individual constitute one of the major reasons for inadequate food intake among the poorer sections of the society.
  • Disease, particularly HIV/AIDS, diarrhea, respiratory tract or ear infections, measles, hookworms and other gut parasites
  • Inadequate breastfeeding: infrequent or too short
  • Food availability and household purchasing power
  • Food quality
  • Increasing poverty tends to be associated with lower dietary diversity, poor consumption pattern, resulting in a lack of energy and micronutrients leading to anorexia (lack of appetite)
  • Early mixed feeding during breastfeeding with an inadequate introduction of complementary foods
  • Patriarchal cultural problems, women engage in planting and harvesting as well as child care with little access to family income
  • Educational status and literacy rates in women
  • Access to portable water and sanitation
  • High infectious excreta-related disease such as cholera
  • Dysfunctional public health system
  • Dieting by exclusion of essential nutrients and skipping of meals often leads to under-nutrition
  • War and conflicts
  • Climate and natural disasters
  • Food prices
  • Drugs and alcohol

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Malnutrition in Adults

It is often thought that undernutrition among seniors is rare. But many seniors are thin and/or anemic. Seniors are at risk of undernutrition if they:

  • Have poor appetites - often resulting from illness or depression (e.g. due to loss of status in the family or death of a relative)
  • Have eating difficulties because of lost teeth, sore gums, etc.
  • Are poor, sick, mentally confused or disabled especially if there is no one to shop, cultivate or cook for them.
  • Have heavy workloads and/or are caring for young or ill relatives.

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Impact of Malnutrition

Pregnant and lactating women, and young children less than three years old, are most vulnerable to malnutrition.

Scientific evidence has shown that beyond the age of 2-3 years, the effects of chronic malnutrition are irreversible. This means that to break the intergenerational transmission of poverty and malnutrition, children at risk must be reached during their first two years of life.

Child malnutrition

Child malnutrition is the single biggest contributor of under-five mortality due to greater susceptibility to infections and slow recovery from illness.

Children who do not reach their optimum height or consistently experience bouts of weight loss during childhood are affected in the long term in numerous ways. They do not reach their optimum size as adults (and may have less physical capacity for work), their brains are affected (resulting in lower IQs) and they are at greater risk of infection (which kills many young children).

Child malnutrition impacts education. The degree of cognitive impairment is directly related to the severity of stunting and iron deficiency, anemia. Studies show that stunted children in the first two years of life have lower cognitive test scores, delayed enrollment, higher absenteeism and more class repetition compared with non stunted children. Vitamin A deficiency reduces immunity and increases the incidence and gravity of infectious diseases, resulting in increased school absenteeism.

Child malnutrition impacts economic productivity. The mental impairment caused by iodine deficiency is permanent and directly linked to productivity loss. The loss from stunting is calculated as 1.38% reduced productivity for every 1% decrease in height while 1% reduced productivity is estimated for every 1% drop in iron status (Haddad and Bouis, 1990).

Maternal malnutrition

Maternal malnutrition increases the risk of poor pregnancy outcomes, including obstructed labor, premature or low-birth-weight babies and postpartum hemorrhage. Severe anemia during pregnancy is linked to increased mortality at labor.

Low birth weight is a significant contributor to infant mortality. Moreover, low birth-weight babies who survive are likely to suffer growth retardation and illness throughout their childhood, adolescence and into adulthood. Growth-retarded adult women are likely to carry on the vicious cycle of malnutrition by giving birth to low birth-weight babies.
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Impact on Adults

Malnutrition impedes productivity and creates a host of associated health problems for adults, making their lives even more difficult.

The health symptoms may not be immediately visible to either the individuals themselves or to health workers, or they can take years to manifest. The result is lost productivity, and a great increase in health care costs which negatively affects other government attempts to improve the quality of life - aside from the enormous social cost.

For example, many older people, in all countries, suffer from serious protein and micronutrient deficiencies. As people age, traditional foods may be difficult to chew, swallow or digest, or may seem bland, and eating loses its appeal. They may also simply forget to eat. And many aboriginal groups worldwide now suffer from a host of diseases previously unknown to them, such as diabetes and certain cancers. This is largely due to a shift from more traditional diets, which included fresh meat, vegetables, fruits, legumes and nuts, to some of the highly processed foods of modern society, which are often very nutrient-deficient. Another example would be most people from the former Eastern Bloc and Soviet Union countries who consume sufficient or excess calories, but who have protein, vitamin and mineral deficiencies. The worldwide size of this group is estimated at 2 billion people.
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