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Malnutrition: the story on HearLore | HearLore
Malnutrition
In 1990, the world produced enough food to feed 12 billion people, yet 821 million people were still undernourished. This paradox defines the modern crisis of malnutrition, a condition where the body receives too little or too many nutrients, resulting in severe health problems. Malnutrition is not merely a lack of food; it is a complex category of diseases that includes undernutrition, overnutrition, and imbalances of energy, protein, and other nutrients. While clinical studies often use the term malnutrition to refer specifically to undernutrition, this narrow definition obscures the reality that obesity and toxic levels of micronutrients are also forms of malnutrition. The World Health Organization and The Lancet Commission have identified the double burden of malnutrition, where overnutrition in the form of obesity coexists with undernutrition in the same communities. In 2017, nearly one in three persons globally had at least one form of malnutrition, ranging from wasting and stunting to vitamin deficiencies and diet-related noncommunicable diseases. Undernutrition remains more common in developing countries, yet stunting is increasingly prevalent in urban slums compared to rural areas. The statistics reveal a staggering reality: in 2021, 148.1 million children under five years old were stunted, 45 million were wasted, and 37 million were overweight or obese. The same year, an estimated 45% of deaths in children were linked to undernutrition, making it the single biggest contributor to child mortality worldwide.
The Double Burden
The coexistence of undernutrition and overnutrition within the same communities challenges the traditional understanding of hunger. In some developing countries, obesity is beginning to appear alongside undernutrition, creating a double burden that complicates public health strategies. This phenomenon occurs as economic development and rapid urbanization shift dietary patterns, leading to increased consumption of energy-dense foods and limited physical activity. In the United States, more than half of all adults are now overweight, a condition that increases susceptibility to disease and reduces life expectancy. Yet, in countries like Ghana and China, overnutrition has emerged in areas where hunger and poverty persist. The World Health Organization notes that 1.9 billion adults were overweight or obese as of June 2021, while 462 million adults were underweight. Globally, two billion people had iodine deficiency in 2017, and 900 million women and children had anemia, often caused by iron deficiency. More than 3.1 billion people in the world, representing 42% of the global population, were unable to afford a healthy diet in 2021. This dual crisis highlights the failure of current food systems to provide equitable access to nutritious food. The double burden of malnutrition is not just a medical issue but a social and economic one, driven by income inequality, lack of opportunities, and the influence of commodity speculators on food prices. The situation is particularly dire in low-income countries, where 77% of nations face higher prevalence of undernourishment than before the pandemic.
Common questions
What is the definition of malnutrition according to the World Health Organization and The Lancet Commission?
Malnutrition is a complex category of diseases that includes undernutrition, overnutrition, and imbalances of energy, protein, and other nutrients. The World Health Organization and The Lancet Commission identify the double burden of malnutrition where overnutrition in the form of obesity coexists with undernutrition in the same communities.
How many children were stunted or wasted in 2021 according to global statistics?
In 2021, 148.1 million children under five years old were stunted and 45 million were wasted. The same year, 37 million children were overweight or obese, and an estimated 45% of deaths in children were linked to undernutrition.
What are the specific health risks associated with undernutrition and malnutrition?
Undernutrition weakens the immune system, making individuals more susceptible to infections like tuberculosis and increasing the risk of HIV transmission. It can also cause vitamin-deficiency-related diseases like scurvy and rickets, as well as acute problems such as hypoglycemia and dehydration.
How did the Green Revolution impact food production in Malawi between 2005 and 2007?
Corn production in Malawi leaped to 3.4 million in 2007 compared to 1.2 million in 2005 after the government implemented subsidies for fertilizer and seed. This change made Malawi a major food exporter and lowered food prices while raising wages for farmworkers.
What are the projected numbers of chronically undernourished people in 2030 according to UNICEF?
According to UNICEF's projections, almost 600 million people will be chronically undernourished in 2030. Global warming and extreme weather events like drought are expected to have major impacts on agricultural production and food security in the tropics and subtropics.
Malnutrition weakens every part of the immune system, making individuals more susceptible to infections and diseases. Undernutrition plays a major role in the onset of active tuberculosis and raises the risk of HIV transmission from mother to child. It also increases the replication of the virus, creating a deadly cycle of illness and malnutrition. In communities lacking access to safe drinking water, these additional health risks present a critical problem. Undernutrition can cause vitamin-deficiency-related diseases like scurvy and rickets, and as it worsens, those affected have less energy and experience impairment in brain functions. Acute problems such as hypoglycemia, or low blood sugar, can cause lethargy, limpness, seizures, and loss 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. Signs of dehydration include sunken eyes, a very dry mouth, decreased urine output, increased heart rate with decreasing blood pressure, and altered mental status. The physical manifestations of malnutrition are diverse and severe. A child with kwashiorkor may exhibit edema, wasting, liver enlargement, and depigmentation of skin and hair, while a child with marasmus may show severe wasting, leaving little or no edema and minimal subcutaneous fat. The cognitive impacts are equally devastating. Protein-calorie malnutrition can cause cognitive impairments, especially in people who were malnourished during the critical period from the final third of gestation to the first 2 years of life. Iodine deficiency is the most common preventable cause of mental impairment worldwide, lowering intelligence by 10 to 15 IQ points and shaving incalculable potential off a nation's development.
The Social Determinants
Social conditions have a significant influence on the health of people, and the social determinants of undernutrition mainly include poor education, poverty, disease burden, and lack of women's empowerment. Undernutrition most commonly results from a lack of access to high-quality, nutritious food. High food prices are a major factor preventing low-income households from getting nutritious food. The household income is a socio-economic variable that influences the access to nutritious food and the probability of under and overnutrition in a community. For example, in Bangladesh, low socioeconomic status was associated with chronic malnutrition since it inhibited the purchase of nutritious foods like milk, meat, poultry, and fruits. The probability of overnutrition is significantly higher in higher-income families than in disadvantaged families. Food shortages may also contribute to malnutrition in countries which lack technology. However, in the developing world, 80% of malnourished children live in countries that produce food surpluses, according to estimates from the Food and Agriculture Organization. The economist Amartya Sen observes that, in recent decades, famine has always been a problem of food distribution, purchasing power, and/or poverty, since there has always been enough food for everyone in the world. Sociopolitical causes of malnutrition include government policies that fail to provide health-related services and differences in income levels, access to land, or levels of education. Community plays a crucial role in addressing the social causes of malnutrition. Communities with high social support and knowledge sharing about social protection programs can enable better public service demands. The use of biofuels as a replacement for traditional fuels raises the price of food, and the Green Revolution pioneers Norman Borlaug and Keith Rosenberg cited the lack of infrastructure as an obstacle to feeding Africa.
The Green Revolution
In the 1950s and 1960s, the Green Revolution aimed to bring modern Western agricultural techniques, such as nitrogen fertilizers and pesticides, to Asia. Investments in agriculture, such as funding for fertilizers and seeds, increased food harvests and thus food production. Consequently, food prices and malnutrition decreased, as they had earlier in Western nations. The Green Revolution was possible in Asia because of existing infrastructure and institutions, such as a system of roads and public seed companies that made seeds available. These resources were in short supply in Africa, decreasing the Green Revolution's impact on the continent. For example, almost five million of the 13 million people in Malawi used to need emergency food aid. However, in the early 2000s, the Malawian government changed its agricultural policies and implemented subsidies for fertilizer and seed introduced against World Bank strictures. By 2007, farmers were producing record-breaking corn harvests. Corn production leaped to 3.4 million in 2007 compared to 1.2 million in 2005, making Malawi a major food exporter. Consequently, food prices lowered and wages for farmworkers rose. Such investments in agriculture are still needed in other African countries like the Democratic Republic of the Congo, where the prevalence of malnutrition is among the highest in the world. Proponents for investing in agriculture include Jeffrey Sachs, who argues that wealthy countries should invest in fertilizer and seed for Africa's farmers. New technology in agricultural production has great potential to combat undernutrition. It makes farming easier, thus improving agricultural yields. By increasing farmers' incomes, this could reduce poverty and open up areas which farmers could use to diversify crops for household use. The World Bank claims to be part of the solution to malnutrition, asserting that countries can best break the cycle of poverty and malnutrition by building export-led economies, which give them the financial means to buy foodstuffs on the world market.
The Treatment Revolution
Improving nutrition is a key part of the United Nations' Sustainable Development Goal 2, Zero Hunger, which aims to reduce malnutrition, undernutrition, and stunted child growth. Efforts such as infant and young child feeding practices to improve nutrition are some of the common forms of development aid. Interventions often promote breastfeeding to reduce rates of malnutrition and death in children. Some of these interventions have been successful. For example, interventions with commodities such as ready-to-use therapeutic foods, ready-to-use supplementary foods, micronutrient intervention, and vitamin supplementation were identified to significantly improve nutrition, reduce stunting, and prevent diseases in communities with severe acute malnutrition. In young children, outcomes improve when children between six months and two years of age receive complementary food in addition to breast milk. There is also good evidence that supports giving supplemental micronutrients to pregnant women and young children in the developing world. The United Nations has reported on the importance of nutritional counseling and support, for example in the care of HIV-infected persons, especially in resource-constrained settings where malnutrition and food insecurity are endemic. UNICEF provides nutritional counseling services for malnourished children in Afghanistan. Sending food and money is a common form of development aid, aimed at feeding hungry people. Some strategies help people buy food within local markets. Simply feeding students at school is insufficient. Longer-term measures include improving agricultural practices, reducing poverty, and improving sanitation. Identifying malnourishment is crucial. In 2000, the United States Centers for Disease Control and Prevention established the International Micronutrient Malnutrition Prevention and Control program. It tested children for malnutrition by conducting a three-dimensional scan using an iPad or a tablet. Its objective was to help doctors provide more efficient treatments. The Screening Tool for the Assessment of Malnutrition in Paediatrics is another method for the identification and evaluation of malnutrition in young children. Regularly measuring and charting children's growth and including activities to promote health, an intervention called growth monitoring and promotion, is often considered by policy makers and is recommended by the World Health Organization.
The Future of Food
In the future, a variety of factors could potentially disrupt global food supply and cause widespread malnutrition. According to UNICEF's projections, it is projected that almost 600 million people will be chronically undernourished in 2030. Global warming is of importance to food security. Almost all malnourished people, 95%, live in the tropics and subtropics, where the climate is relatively stable. According to the Intergovernmental Panel on Climate Change report in 2007, temperature increases in these regions are very likely. Even small changes in temperatures can make extreme weather conditions occur more frequently. Extreme weather events, like drought, have a major impact on agricultural production and hence nutrition. For example, the 1998, 2001 Central Asian drought killed about 80% of livestock in Iran and caused a 50% reduction in wheat and barley crops there. Other central Asian nations experienced similar losses. An increase in extreme weather such as drought in regions such as Sub-Saharan Africa would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productivity of many crop species and decreases food security in these regions. Another threat is colony collapse disorder, a phenomenon where bees die in large numbers. Since many agricultural crops worldwide are pollinated by bees, colony collapse disorder represents a threat to the global food supply. Restricting population size is a proposed solution to malnutrition. Thomas Malthus argues that population growth can be controlled by natural disasters and by voluntary limits through moral restraint. Robert Chapman suggests that government policies are a necessary ingredient for curtailing global population growth. The United Nations recognizes that poverty and malnutrition, as well as the environment, are interdependent and complementary with population growth. According to the World Health Organization, family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts. However, more than 200 million women worldwide lack adequate access to family planning services.