Protein energy malnutrition in children

March 2013

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What is protein energy malnutrition?
Also known as protein-calorie malnutrition, this type of malnutrition results from the acute insufficiency of both dietary energy and proteins.

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Considering the time and origin its cause can be primarily due to lack of amino acids and energy nutrients in the diet or secondarily due to debilitating health conditions. In children losing up to 10% of body weight is considered as mild, whereas losing 10-20% is moderate and above 20% is severe malnutrition.

Causes of protein energy malnutrition in children

The primary malnutrition develops in children when their intake of proteins and energy sources is grossly insufficient to support their metabolic needs. This type of malnutrition is seen mostly in developing countries and also in regions ravaged by wars, famines and natural calamities.

The secondary type of malnutrition in children is prevalent even in developed countries. It is usually concurrent with major health problems like AIDS, chronic diarrhea, cancer, chronic kidney failure, chronic obstructive pulmonary disease (COPD), liver cirrhosis, Crohn disease and ulcerative colitis. In these debilitating illnesses, the body's ability to digest, absorb or use the nutrients is impaired. Severe malnutrition may occur in persons on long-term hemodialysis and in those affected by acute illness, severe burns, trauma, or sepsis.

When malnutrition syndrome reaches an advanced disease stage, depending upon the type of deficiency, it is variously named as Kwashiorkor or marasmus.

Kwashiorkor

1.protein-energy malnutrition
Kwashiorkor affected child

This is an advanced disease stage of malnutrition wherein there is acute protein deficiency. Symptoms of kwashiorkor include, protruding belly, liver enlargement and ascites, edema, dry and peeling skin, changes in skin pigment, loss of muscle mass, diarrhea, anemia, change in hair color and texture, apathy, irritability, dermatitis and severe infections. Delay in treatment can lead to permanent mental and physical disability, coma, shock and death. This condition is seen in children feeding on highly amino acid deficit diet after stoppage of breast feeding.

Marasmus

Unlike kwashiorkor, in marasmus there is severe protein and also calorie/energy deficiency. There is no edema. Marasmus is characterized by wasted muscles and tissues. Marasmus may appear in children who have very little to eat after stoppage of breast feeding. The symptoms include profound weakness, emaciation, baggy, wrinkled skin, lack of energy, extremely thin arms and legs, weakened immune system, low body temperature and mental and behavioral retardation.

2.protein-energy malnutrition
marasmus affected child

In children with marasmus if severe infections and complications occur, edema may be caused and the malnutrition syndrome is now termed as marasmic kwashiorkor.

Like children, elderly people are also dependent on others for getting the right type of nutrition and in addition their digestive and absorptive capacities are reduced. Like children, they are also at the high risk of developing the secondary malnutrition.

Diagnosis

Malnutrition can be recognized by correlating the symptoms with the visual observation and physical examination of body fat, eating habits, appetite, weight loss, edema and muscle strength. The history of general illnesses, diarrhea and gastrointestinal ailments can give an idea on the patients nutritional status. Blood and urine analysis will further help in the diagnosis.

Treatment

Immediate step in the treatment of malnutrition is correcting fluid and electrolyte imbalances. Antibiotics are given for treating infections. Gradually essential nutrients are replenished, first the carbohydrates and then the amino acids and micronutrients. Physiotherapy is given to make the patient gain the muscle strength. Once the affected children are free from complications energy dense dietary formulas are used to restore normal weight for the height. If the treatment is delayed, protein energy malnutrition can leave lasting effects on physical and mental health of children and they may not reach their full growth potential.

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What is malnutrition?

Image 1 source: http://phil.cdc.gov/
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Reference: Alderman H, Shekar M. Nutrition, food security, and health.In: Kliegman RM,Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 43.
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Protein energy malnutrition in children

Severe acute malnutrition

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Causes of severe acute malnutrition

Severe acute malnutrition is a life threatening situation and requires immediate treatment.

Undernourishment occurs primarily in situations of extreme poverty, famine, drought, floods, wars and other natural calamities. The loss and disappearance of wherewithal of livelihood devastates individuals, communities, populations and nations.
In such conditions primarily children and also adolescents and adults have the grave risk of acute malnutrition.

Acute malnutrition is also seen in situations of total dependency as seen in elderly people, prisoners and people with mental illness.
All their nutritional needs are to be cared for by others.
Acute malnutrition is also found among people suffering chronic infections and illness, malabsorption in intestines, liver and renal diseases, autoimmune and endocrine diseases, drug abuse, alcohol dependence and HIV/AIDS.

In children severe acute malnutrition occurs, not only due one or more of the above causes, but also due to long standing emotional and nutritional deprivation by carers due to poverty, family problems and poor understanding.
Successful management of acute malnutrition requires seeking total cooperation from the carers and also educating them so that the malnutrition does not relapse.

The definition of severe malnutrition and aid criteria of WHO/UNICEF for children

WHO reference criteria for malnutrition is, "Severe malnutrition is defined as a weight for length or height of less than 70% of the WHO reference, equivalent to a SD Score of less than -3, and/or nutritional oedema."
These WHO criteria are established upon level of stunting or wasting and the presence or absence of edema.

The weight of the child for her or his height, and the for her or his age are referred as Z-scores, reckoned as the observed value minus the average (median) value of the population under reference divided by the standard deviation of the population under reference,

where x stands for the raw score under standardization, μ stands for the mean value of the population and σ stands for the standard deviation of the population.
The values are of significance when they are from the actual population parameters and not from samples. WHO MUAC (mid-upper arm circumference) is also considered for identifying severe acute malnutrition (SAM) in children, the recommended value being 115 mm.

Defining malnutrition in adolescents and adults

The Body mass index (BMI) is the main factor for indicating level of undernourishment in adults.
Body mass index is calculated by dividing the body weight by the square of height as shown in the table below for International System of Units (SI units) and Imperial units.

International system of unit BMI =	mass(kg)
	_________
	(height(m)2

Imperial units

Nutritional status with respect to BMI

BMI	Nutritional status
below 16.0	Severe malnutrition
16.0-16.99	Moderate undernourishment
17.0-18.49	Mild undernourishment
18.5-24.99	Normal
25.0-29.99	Overweight
30.0 and above	Obesity

In adults, who cannot stand due to weakness or deformity, half arm span of the both the arms is measured and greater value is taken.
"Half arm span is the distance from the middle of the sternal notch to the tip of the middle finger; the arm should be held out horizontally to the side."
By good management programme, severe acute malnutrition can be managed successfully with minimum life loss, by immediate resuscitation, treatment of infection and reversal of abnormalities in metabolism.

Related topics of interest:
What is malnutrition
Causes of malnutrition
Nutrition disorders
Balanced nutrition
Balanced healthy diet

Current topic: Severe acute malnutrition

Malnutrition diseases - Nutrition disorders

Home › Nutritional deficiency › Malnutrition diseases - Nutrition disorders

Malnutrition diseases, which are nutrition disorders, occur as a result of our body not getting enough of or excess of nutrients.

Carbohydrate malnutrition diseases and nutrition disorders

Deficient malnutrition: Carbohydrates are easy and faster sources for energy production in the human body.

The shortage of carbohydrates in food causes nutrition problems like energy starvation, weakness and lethargy.

Excess nutrition: Consumption of excess carbohydrates above the body requirement for a long period of time causes obesity, type 2 diabetes and cardiovascular diseases.

protein nutrition disorders and malnutrition diseases

Deficient malnutrition: Protein deficiency in children causes malnutrition diseases like kwashiorkor.

kwashiorkor is marked by pedal edema, pot belly and wasted body muscles.

Excess nutrition: Prolonged consumption of excess of protein especially in the absence of fats causes nutrition problem called rabbit starvation in which there is discomfort and hunger that can be satiated only by the intake of fat and carbohydrates.

Obesity in a young man (enlarge)

Other symptoms of this protein excess nutrition include low blood pressure, low pulse rate, fatigue, diarrhea and headache.

Kwashiorkor in infant (enlarge)

Protein-energy malnutrition diseases and nutrition disorders

When there is both protein and energy deficiency arising due to malnutrition, a condition called marasmus arises in which there is emaciation and extensive muscle and tissue wasting.

Marasmus in a boy (enlarge) Catabolytis is an extreme biological process wherein the fat and muscle tissue are broken down to stay alive in the event of starvation.

Fat malnutrition and nutrition

Deficient malnutrition: deficiency of fats in nutrition causes low sex hormone levels and malabsorption of fat-soluble vitamins.

Fat deficiency coupled with high intake of proteins causes 'rabbit starvation' condition.

Excess nutrition: Fats when consumed in excess of requirement can result in cardiovascular problems and obesity.

Minerals nutrition disorders and malnutrition

Many malnutrition diseases are caused by the deficiency of minerals.

Iodine

Deficient malnutrition: Goiter, cretinism and hypothyroidism are the results of dietary Iodine deficiency.

Iron

Deficient malnutrition: Iron deficiency in nutrition causes anemia with symptoms of decreased hemoglobin in blood.

Excess nutrition disorders: Iron in excess causes iron overload and iron intoxication damaging intestinal lining and liver.

Sodium

Deficient malnutrition: Hyponatremia and electrolyte disturbance occurs in deficiency with fluid retention.

Excess nutrition: Hypernatremia and electrolyte disturbance occurs affecting oxygen transport.

Calcium

Deficient malnutrition: Hypocalcaemia occurs with electrolyte disturbance.

Excess nutrition: Hypocalcaemia occurs in excess consumption.

Potassium

Deficient malnutrition diseases: Hypokalemia with symptoms like elevated blood pressure is caused when there is malnutrition of this mineral.

Excess nutrition disorders: Hyperkalemia with symptoms like palpitation and muscle weakness is encountered in excess nutrition of potassium.

Magnesium

Deficient malnutrition diseases: Muscle weakness and hyperexcitability are symptoms of its deficiency. In severe deficiency death may occur from heart failure.

Excess nutrition: Hypermagnesemia occurs in persons with renal impairment with symptoms like nausea, vomiting and weakness.

Phosphorus

Deficiency malnutrition: Hypophosphatemia occurs.

Excess nutrition: Hyperphosphatemia occurs.

Zinc

Deficiency malnutrition diseases: Hair loss, diarrhea, wasting of body tissues and skin lesions occur due to Zinc deficiency.

Excess nutrition disorders: Zinc in excess causes zinc toxicity which suppresses copper and iron absorption.

Copper

Deficiency malnutrition diseases: Pancytopenia is caused with reduction in the number of white and red blood cells and platelets.

Excess nutrition: Copper toxicity shows symptoms like palsy and convulsions and in some cases result in death.

Vitamins malnutrition diseases and nutrition disorders

There is much negative impact in health with the deficiency of vitamins in the nutrition.

Vitamin A

Deficiency malnutrition: Deficiency of vitamin A causes low testosterone levels, night blindness and Xerophthalmia. In Xerophthalmia the eye fails to produce tears leading to dryness of cornea and conjunctiva.

Excess nutrition disorders: Hypervitaminosis A is the condition caused by excess of vitamin A. The malnutrition effects include angular cheilitis, hair loss, excessively dry skin, birth defects, nausea and vomiting, headache, blurred vision and reduced muscle coordination.

Vitamin B₁

Deficiency malnutrition: The deficiency of vitamin B1 in nutrition causes Beriberi leading to neurodegeneration, wasting and death.

Excess nutrition: Adverse effects are not recorded for higher doses.

Vitamin B₂

Deficiency malnutrition: Deficiency of riboflavin (vitamin B2) gives rise to a medical condition called Ariboflavinos. This characterised by sore throat, cracking of the lips and corners of the mouth, glossitis and seborrheic dermatitis.

Excess: No averse effects are reported for excess consumption of riboflavin.

Vitamin B₃

Deficiency malnutrition: Deficiency of niacin leads to Pellagra.

The affected person suffers from hypersensitivity to light, diarrhea, dementia and dermatitis.

Excess nutrition disorders: excess of niacin can cause birth defects, cardiac arrhythmias and dyspepsia.

Vitamin B₆

Deficiency malnutrition: Lack of vitamin B6 causes seizures, nerve damage, anemia, skin problems and mouth sores.

Excess nutrition: Overdose causes neurological problems like numbness, staggering and poor coordination.

Vitamin B₇

Deficiency malnutrition: Hair loss, dermatitis, conjunctivitis, depression and hallucination are some of the symptoms of deficiency.

Excess: No adverse effects are reported for excess consumption.

Vitamin B₉

Deficiency malnutrition: Neural tube defects in developing embryos and impaired DNA synthesis and repair are some of the effects of deficiency.

Excess disorders: No adverse reactions are found for overdose.

Vitamin B₁₂

Deficiency diseases: Pernicious anemia occurs when there is nutrition deficiency of this vitamin. Symptoms like sore tongue, weakness, paraesthesias, diarrhea and memory changes are seen. Excess disorders: No adverse effects have been reported in case of heavy doses of vitamin B12.

Vitamin C

Deficiency: Scurvy is the result of deficiency of vitamin C.

Symptoms include bleeding gums and mucous membranes and suppurating wounds.

Excess nutrition: Excess of vitamin C may lead to diarrhea and upset stomach.

Vitamin D

Deficiency malnutrition diseases: Deficiency of vitamin D causes rickets in children and osteomalacia in adults.

Excess nutrition disorders: Excess of vitamin D leads to hypervitaminosis D with vomiting, dehydration and constipation.

Vitamin E

Deficiency malnutrition: Vitamin E deficiency causes poor nerve conduction and neurological problems.

Excess nutrition disorders: Hypervitaminosis E is the result excess of vitamin E, leading to excessive bleeding.

Vitamin K

Deficiency malnutrition: Vitamin K is required for blood coagulation and the deficiency leads to hemorrhage.

Excess disorders: There are no adverse effects of excess consumption of vitamin K.

Diseases and conditions causing malnutrition and nutrition disorders

• AIDS
• Achalasia (esophageal motility disorders)
• Alzheimer diseases ( Senile Dementia)
• Autoimmune enteropathy (intestinal wall is attacked by one's own immune system)
• Blind loop syndrome disorders(medical condition of obstructed intestine)
• Boyd-Stearns syndrome (metabolic disorders)
• Brinton diseases (thickening and hardening of stomach wall)
• Cystic Fibrosis (common hereditary diseases)
• Chronic heart diseases
• Celiac diseases
• Chronic renal diseases
• Chronic lung diseases
• Chronic diarrhea
• Congenital microvillous atrophy (chronic, intractable diarrhea in new-born infants)
• Congenital sucrose-isomaltose malabsorption (congental deficiency or absence of the enzymes sucrase and isomaltase)
• Chylomicron Retention Diseases (disorders of fat absorption)
• Dementia (a serious loss of cognitive ability)
• Eating disorders (psychiatric diseases of eating)
• Galactosemia (rare genetic metabolic disorders)
• pernicious anemia
• Pancreatic insufficiency
• Patau syndrome disorders(a chromosomal abnormality)
• Short bowel syndrome (complete dysfunction of a large segment of bowel)
• Third degree burns
• Tuberculosis
• Renal failure diseases
• Sepsis
• Ulcerative colitis
• Whooping Cough
• Surgery
• Trauma
• Pregnancy
• Dyspepsia

Consumption of nutrients in balanced manner is the only way to avoid nutrition disorders and malnutrition diseases.

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Causes of malnutrition - Poverty - Hunger

Home › Nutritional deficiency › Malnutrition - Causes - Poverty - Hunger

Poverty and hunger causes malnutrition

Proper balanced nutrition is required for the function of life process.

Poverty and the resultant hunger causes malnutrition in populations, as food become beyond their reach due to high prices. Even in United States, a Symbol of Affluence, after the economic meltdown there are many households with low-income who do not always have sufficient healthy food to eat and suffer poverty and hunger.
Most of the hunger and lack of food occurs not due to lack of availability of food, but due to poverty making people ill-afford it.
As protein rich food is usually priced high, it causes people in poverty, to knowingly opt for malnutrition by going in for cheaper calorie rich food to satisfy their hunger.
Poverty and hunger have devastating effect on children.

Worldwide, poverty, hunger and malnutrition are the causes for more than 50% of the childhood deaths.

Malnutrition for a prolonged period of time affects physical and mental development of poverty and hunger affected children for the rest of their lives.

This causes reduction in capabilities and starts a poverty and hunger cycle as they become less suitable in the competitive job market; their children again become victims of poverty and hunger.

Lack of balance in food habits causes malnutrition

Poverty or no poverty, malnutrition can also be due to unbalanced consumption of nutrients.

The deficiency of proteins and/or micro nutrients creeps into the health of many people due to malnutrition.

Initially this goes unnoticed and manifests and causes devastating effects after a long period of time.

Deficiency of vitamins and minerals due to their undernourishment or malnutrition causes people to get affected by deficiency diseases like anemia, loss of vision, rickets and osteomalacia, scurvy and beriberi without suffering either poverty or pangs of hunger.

This malnutrition arises due to their food habits and lack of knowledge about nutritional requirements.

Excess and over consumption of food causes malnutrition

Malnutrition arises not only due to poverty and hunger but also due to excess consumption of nutrients.

The excess consumption of calories is usually accompanied by protein and micro nutrient deficiency and causes malnutrition.

Occupying the upper and middle class of the society in many developing countries (which are afflicted by poverty), these segments of population following the human inclination for sweet and fatty food, load themselves with red meat products and nutritionally empty and calorie rich fast foods; Ironically they also suffer malnutrition of micro nutrients and are afflicted with obesity and related health problems though are free from poverty.

This coupled with reduced physical activity causes a large section of them to suffer from heart diseases.

Health disorder causes malnutrition

The risk of malnutrition increases in chronic illness. Especially diseases of gastrointestinal tract, liver and kidney have an immediate impact on the nutritional status of the affected person.

Diseases of chronic nature like, coeliac disease, cancer and AIDS interfere with the absorption and utilization of certain nutrients leading to a state of chronic deficiency and malnutrition.

Some of the predisposing factors which lead to of malnutrition are, lactose intolerance, burns, fractures, trauma, pancreatitis, chronic nausea and vomiting, impaired intake, dysphagia, anorexia, cystic fibrosis and malabsorption.

Addiction to drugs or alcohol causes malnutrition

People who have developed dependency to alcohol or drugs may neglect their diet requirements due to reduced sense of hunger.

These habits affect their work and financial status pushing them into poverty and hunger.

Further dependency for a long period can affect their body organs like liver leading to inefficient absorption and utilization of nutrients leading to malnutrition.

Wars and conflicts are causes of malnutrition

Wars, conflicts and civil-wars ruin nations of their productivity and drag the inhabitants into poverty and hunger.

Conflict causes the supply mechanism gets derailed and the surplus food production regions of the nation get stagnation of the produce and suffering its loss due to lack of storage facilities slip into financial problems and hunger.

The deficit regions suffer non-availability of food.

Another aspect of the war is that it makes people to flee from their homes in the war zone; as refugees they become totally helpless and fully dependent on doles from relief agencies to stave off hunger.

Natural disaster causes malnutrition

When natural disasters like, earthquakes, hurricanes, floods and tsunamis strike, many a breadwinner is lost in the calamity, pushing the survivors of his family into poverty and hunger.

The survivors lose their land, property and wherewithal of their livelihood and get thrown into a life of poverty and hunger.

Poor sanitation and unsafe water causes malnutrition

Poor sanitation and hygiene leads to communicable diseases like hepatitis and gastroenteritis to prevail in groups of population.

These affliction can affect the liver and gastrointestinal tract due to which absorption and utilization of nutrients is affected and leads to malnutrition.

Unsafe water carries  many waterborne diseases in the children in poverty ridden countries.

Gender bias and neglect of child nutrition causes malnutrition

In the third world countries, especially in South Asia, there is lack of care of women and children.

Pregnant women are not properly cared for their increased nutritional needs and causes malnutrition in them; this may happen both in poverty and hunger or in affluence. This in turn makes children born to them suffer malnutrition.

The newborn gets milk poor in quality from a week mother and the infant's growth is affected.

The switch towards formula feed and cow milk starves the infant of vital antibodies from the mother, making the infant susceptible to infections and diseases.

Old age related causes of malnutrition

Every fourth elderly American is affected by malnutrition.

Elderly people in all developed and underdeveloped countries suffer from protein and micronutrient malnutrition, for which the causes are many.

Energy needs of the elderly decreases without change in the requirements of other nutrients.

The food balance has to change with slight reduction in carbohydrates without change in the balance of other nutrients.

The shift from the traditional natural food sources of their younger days to modern processed food of present days decreases their nutritional balance and causes malnutrition.

The nutritional status of elderly people is negatively impacted by the mental and physiological changes due to aging and hunger.

With decreased sense of smell and taste, food appears bland to them and causes reduction in their appetite and hunger.

Problem of dental and oral health, difficulty in chewing food and difficulty in digestion leads to reduced intake of food and malnutrition.

The progressive loss of hearing and vision in elderly makes them less mobile and reduces their physical activity.

Their immunity decreases with malnutrition, causes them to suffer many old age diseases.

This depletes their finances and makes them to suffer from poverty and hunger.

Another aspect of malnutrition is food distribution.

It is estimated by FAO (food and agriculture Organization) that 80% of the children suffering lack of food and hunger are from developing countries which have food surplus. It is due to poverty or supplies not reaching them.

The shift towards primary and commodity market for safer investments causes the food prices to sky-rocket sinking vulnerable populations into poverty, hunger and malnutrition.

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What is malnutrition?

Home › What is malnutrition?

The provision of nutrients for the health and growth of a living organism is called nourishment or nutrition. Imbalanced, excessive or insufficient intake of nutrients is malnutrition.

What is malnutrition and nutrition?

All living beings, including humans rely on external inputs as nutrition for their life process, health, growth and survival.

Major requirements for metabolism and life processes are carbohydrates, proteins, fats, vitamins, minerals and water.

These nutrition requirements, depending upon the quantity required for human health, are also categorized as macro nutrients and micronutrients.

Macronutrients: Macronutrients are required in greater quantities for health and life process. They include carbohydrates, proteins, fats, fiber and water.

Micronutrients: Micronutrients are required in smaller quantities for health and function of life processes.

Minerals and vitamins are the micronutrient nutrition requirements for health, the lack of which leads to malnutrition.

Though oxygen in the air is the very basis of health and life process in humans, it is not listed as nutrient due its abundant availability in nature.

The nutrition requirements of the higher animals are mostly similar regarding macronutrients and micronutrients.

However there are differences in the requirements of some of the essential nutrients.

The nutrition requirements can again be categorized as essential nutrients and nonessential nutrients.

Many organisms synthesize certain nutrient requirements in biological processes in their body in sufficient quantities.

Hence outsourcing these nutrients from diet is not essential for that particular organism for that specific nutrient (eg.vitamin C in the case of goat).

Essential nutrients: Essential amino acids, essential fatty acids, vitamins and dietary minerals are some of the nutrients which are essential for the human nutrition, health and life process. The lack of these in food causes malnutrition.

These essential nutrients are to obtained from diet as either they are not synthesized by the human body or cannot be synthesized in sufficient quantities (eg. vitamin C).

MyPyramid (enlarge)

Malnutrition and health

The imbalanced, excessive or insufficient consumption of nutrients is referred as malnutrition.

Malnutrition due to insufficient availability: Malnutrition due to insufficiency in nutrition can be due to many reasons. Most important being poverty, high food prices, famine due to drought or blight of major food crop, chronic illness, antinutrients in the food, regional non availability, lack of breastfeeding in early infancy etc..

Starvation (enlarge) Malnutrition due to unbalanced consumption of nutrients: Though food as such is available in sufficient quantities, it may be having excess of one or more nutrients when compared to others, affecting health.

Inversely the food may be lacking sufficient quantities of certain nutrients. This is termed as unbalanced nutrition.

Dependence of single source of food is a classic example of this.

Malnutrition due to excessive consumption of nutrients: With affluence or plenty of cheap food supply, food may be consumed in excess of body's nutrition requirement. Lifestyles encouraging consumption of non-nutritious food, sugar and fat loaded foods affect health and leads to malnutrition.

Overeating is also a type of malnutrition. This can lead to health problems like obesity, type 2 diabetes, heart diseases etc.

What are the dangers of malnutrition?

It is estimated that nearly 60% mortality in the world is due to hunger or hunger induced malnutrition related deficiencies and diseases.

Malnutrition decreases the immunity and increases risk of diseases like tuberculosis.

Deficiency in the availability of certain critical nutrients like vitamins and minerals lead to poor health and deficiency diseases like, pellagra, scurvy, beriberi, rickets, goiters, cretinism, anemia and mental impairments.

Food habits encouraging the use of 'junk food' have increased the risks of cancer, type 2 diabetes, poor immunity and heart diseases.

What is to be done to fight malnutrition?

The whole world is producing more food than the nutrition requirement of the world population. Malnutrition can be overcome by food aid to under-developed countries, supply of fortified food to populations in risk nutrition and publicity and campaign efforts at all levels for promoting balanced nutrition for good health.

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Nutrition and malnutrition

Lack of proper nutrition is a challenge for health care
Malnutrition is a situation wherein a person is suffering from excess of certain nutrients or deficit of certain nutrients.
The imbalance of the nutrients either on the higher side or on the lower side can be temporarily or permanently harmful.
In the poor third world malnutrition is usually by starvation or by not getting sufficient nutritive food.
In developed world malnutrition is usually by consumption of excessive fat food and junk food.
This may be coupled with deficiency of some essential trace elements and vitamins due to lack of balanced food.
This could be the major cause for heart ailments.
In infants and their subsequent growth into adulthood the malnutrition of the mother before and during pregnancy has a great effect.
For example if the mother suffers from deficiency of folic acid during pregnancy the neural tube formation and the subsequent development of nervous system is affected in the fetus.

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