Malnutrition is the condition that occurs when a persons 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 describedkwashiorkor 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 worlds 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.
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PREVENTION

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