Malnutrition is the condition that occurs when a person’s body is not getting enough nutrients.

It occurs in children who are either undernourished or over nourished. Children who are over nourished may become over weight or obese and those who are under nourished are more likely to have severe long term consequences.

Two types of protein-energy malnutrition have been described—kwashiorkor and marasmus. Kwashiorkor occurs with fair or adequate calorie intake but inadequate protein intake, while marasmus occurs when the diet is inadequate in both calories and protein.

Kwashiorkor: protein deficiency

Marasmus: energy deficiency

Marasmic/ Kwashiorkor: combination of chronic energy deficiency and chronic or acute protein deficiency

Malnutrition remains of the worlds highest priority health issues not only because its effects are so widespread and long lasting, but also because it can be eradicated.

More than 35% of all preschool age children in developing countries are under weight.

The unicef report found that 146 million children under five years in the developing world are suffering from insufficient food intake, repeated infections diseases, muscle wasting and vitamin deficiencies.

GLOBAL BURDEN OF MALNUTRITION

Despite the fact that the world already produces enough food to feed everyone — 6 billion people — and could feed the double — 12 billion people.

There were 925 million undernourished people in the world in 2010, an increase of 80 million since 1990.

Nearly 17% of people in the developing world are undernourished.

1 out of 3 people in developing countries are affected by vitamin and mineral deficiencies and therefore more subject to infection, birth defects and impaired physical and psycho-intellectual development.

Under nutrition, an important part of the complex, affects millions of people, mainly in Africa, Asia and Latin America.

Directly or indirectly the concurrent vicious life cycle of malnutrition contributes to almost 35% of the estimated 7.6 million deaths under-5 deaths; consequently affecting the future health and socioeconomic development and productive potential of the society.

South Asia is the worst affected region with half of the world’s malnourished children are to be found in just 3 countries Bangladesh, India and Pakistan.

This is one side of picture. 2 out of 3 overweight and obese people now live in developed countries, the vast majority in emerging markets and transition economies.

By 2010, more obese people will live in developing countries than in the developed world.

Under-and over-nutrition problems and diet-related chronic diseases account for more than half of the world's diseases and hundreds of millions of dollars in public expenditure.

Scope of the Problem

Chronic food deficits affect about 792 million people in the world (FAO 2000), including 20% of the population in developing countries. Worldwide, malnutrition affects one in three people and each of its major forms dwarfs most other diseases globally (WHO, 2000). Malnutrition affects all age groups, but it is especially common among the poor and those with inadequate access to health education and to clean water and good sanitation. More than 70% of children with protein-energy malnutrition live in Asia, 26% live in Africa, and 4% in Latin America and the Caribbean (WHO 2000).

The World Health Organization (WHO) says that malnutrition is by far the largest contributor to child mortality globally, currently present in 45 percent of all cases.4

PREVENTION

NICE (National Institute for Health and Clinical Excellence), UK, has guidelines for malnutrition treatment.8

They state that the needs and preferences of the patient need to be taken into account. The patient, along with healthcare professionals, should be able to make informed decisions about care and treatment.

NICE guidelines say that individuals who are receiving nutritional support, as well as their caregivers (UK: carers):

Should be fully informed about their treatment Should be given tailored information Should be given the opportunity to discuss diagnosis, treatment options and relevant physical,

psychological and social issues. Should be given contact details of relevant support groups, charities and voluntary

organizations.

When a diagnosis of either malnutrition or malnutrition risk has been made, the healthcare professional (either a doctor or dietician) who is responsible for the patient will devise a targeted care plan.

The care plan - aims for treatment will be set out, which should include the treatment for any underlying conditions/illnesses which are contributory factors to the malnutrition.

Typically, treatment will include a feeding program with a specially planned diet, and possibly some additional nutritional supplements.

Severely malnourished patients, or individuals who cannot get sufficient nutrition by eating or drinking may need and should receive artificial nutritional support.

The patient will be closely monitored for progress. Their treatment will be regularly reviewed to make sure their nutritional needs are being met.

Diet - a good healthcare professional will discuss eating and drinking with the patient and provide advice regarding healthy food choices. The aim is to make sure the patient is receiving a healthy, nutritious diet.

The doctor or dietitian will work with the patient to make sure enough calories are being consumed from carbohydrates, proteins, fats and diary, as well as vitamins and minerals. If the patient cannot get their nutritional requirements from the food they eat, oral supplements may be needed. An additional 250kcal to 600kcal may be advised.

Artificial nutritional support - there are two main types of artificial nutritional support, mainly for patients with severe malnutrition:

Enteral nutrition (tube feeding) - a tube is placed in the nose, the stomach or small intestine. If it goes through the nose it is called a nasogastric tube or nasoenteral tube. If the tube goes through the skin into the stomach it is called a gastrostomy or percutaneous endoscopic gastrostomy (PEG) tube. One that goes into the small intestine is called a jejunostomy or percutaneous endoscopic jejunostomy (PEJ) tube.

Parenteral feeding - a sterile liquid is fed directly into the bloodstream (intravenously). Some patients may not be able to take nourishment directly into their stomach or small intestine.

Monitoring progress - the patient will be regularly monitored to check that he/she is receiving the right amount of calories and nutritional needs. This may be adjusted as the patient's requirements change. Patients receiving artificial nutritional support will be switched over to normal eating as soon as they are able to.