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Thursday, February 16, 2017

Nutrition / Diet Malnutrition: Causes, Symptoms

Malnutrition is the condition that results from eating a diet in which certain nutrients are lacking, in excess too high in intake, or in the wrong proportions. It is responsible for nearly 45 per cent of deaths in children under-five, and around 3.1 million deaths in children under five annually. UNICEF report on child malnutrition shows that India is home to 61 million stunted children under five and 38 per cent of all stunted children in the world.
Protein Calorie Malnutrition It refers to a form of malnutrition where there is inadequate protein intake. It is considered as the primary nutritional problem and also the 1st National Nutritional Disorder. The term protein-energy malnutrition applies to a group of related disorders that include marasmus, kwashiorkor and intermediate states of marasmus-kwashiorkor. Protein calorie Malnutrition is due to “food gap” between the intake and requirement. Status of Malnutrition in India The rural India has more cases of malnutrition among children less than 5 years of age as more cases of stunted, wasted and underweight children. High malnutrition of all types prevails in illiterate mothers and mother with less than 5 years education. The percentage of underweight girls under five years of age is higher than boys under five years of age, while in the cases of stunted growth and acute malnutrition, girls are in a better condition. Malnutrition among children is highest for underweight mothers. The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate and Kerala among the lowest. HunGaMa Report Findings Brazil’s Fome Zero Programme Brazil has made significant leaps in overcoming hunger by providing food security to the citizens. Brazil’s Fome Zero or Zero Hunger programme was initiated by the government in 2003. Based on the pillars of conditional cash transfer, school meals and strengthening family agriculture, Fome Zero has able to reduce poverty, provide food security reduce hunger. Brazil’s child mortality rate was reduced by 13 points and 20 million people came above the poverty line. Although India showed better economic growth than Brazil, Brazil surpassed it in reducing poverty and increasing food security for its citizen. The “HUNGaMA” report and the activities of the Citizen’s Alliance Against Malnutrition from 112 districts over nine States tells that 42 per cent of children are underweight and 58 per cent are stunted by the age of 24 months. Causes of Malnutrition Illness and disease resulting from maternal and child under nutrition, Changing diets and patterns of physical activity Obesity and overweight Lack of breastfeeding practices Deficiencies of vitamins and minerals such as vitamin A, zinc, iron and calcium. Challenges & Implications of Malnutrition Under nutrition reduces a nation’s economic advancement by at least eight per cent because of direct productivity losses, losses via poorer cognition and losses via reduced schooling. Lack of medical facilities and trained medical personnel Inadequate transport facility also caused a large number of infant deaths. Lack of protocols: Lack of standard protocols and less trained doctors on standard Emergency and Essential Maternal Obstetric and New-born Care lead to most of the infant’s deaths with lack of health facilities and quality of antenatal services. Lack of medicine: Lack of iron and folic acid supplies and Injection Iron Sucrose IV to control and treat severe anaemia among pregnant mothers are not in regular supplies at rural areas. Schemes to address the Malnutrition Problem in India National Food Security Bill: The bill, if passed will play major role in eradicating malnutrition in the country and overcoming calorie deprivation. Mid-day Meal Scheme: This programme is conducted with part subsidies from the Government and partly with donations from individuals and corporate. The meals served with the nutritional norms given by the government of India and aims to eradicate malnutrition among children in India. National Rural Health Mission: The National Rural Health Mission of India mission was created for the years 2005–2012, and its goal is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women, and children with the sub goal to Reduce infant mortality rate (IMR) and maternal mortality ratio (MMR) One full meal under Integrated Child Development Scheme: It is mainly for children and for pregnant and lactating mothers. Started in the year 1975, ICDS has been instrumental in improving the health of mothers and children under age 6 by providing health and nutrition education, health services, supplementary food, and pre-school education. ICDS Systems Strengthening and Nutrition Improvement Project: To overcome the malnutrition problem in eight selected states, a World Bank aided ‘ICDS System Strengthening and Nutrition Improvement Project (ISSNIP)’ worth Rs 2,89,300 lakh has been approved and made effective from November 2012. It makes efforts to promote healthy pregnancy, timely and exclusive breastfeeding, infant and young child feeding practices, as well as improvements in personal hygiene with a particular focus on children under three. Community mobilisation scheme of Acute Malnutrition: This Scheme aims to prove that a holistic, decentralized, community-based approach to malnutrition eradication with better health outcomes, be more inclusive for children under 5 and will be more cost-effective in the long-run than centralized approaches, especially for rural, marginalized tribal communities.

What Causes Malnutrition?

Malnutrition could arise from many factors. While sub-nutrition among the poor, mostly arises due to unavailability of proper nutritious food, the over nutrition could be an aftermath of sedentary lifestyle or health conditions, such as the improper functioning of the thyroid gland or PCOD.
Here is a glimpse into what you could term as the triggers of malnutrition:
1. Lack of a Balanced Diet: Malnutrition in children is caused due to the lack of a nutritious and balanced diet. In countries where poverty prevails, people don’t consume essential nutrients like proteins, carbohydrates, fats in their daily meal. Hence, malnutrition is mostly observed in children from poverty-stricken areas. People who have limited knowledge about nutrition are often seen following an unhealthy diet. This doesn’t contain the required nutrients, vitamins and minerals, and leads to malnutrition.
2. Indigestible and Harmful Diet: Indigestible and harmful diets can be among the major malnutrition causes. Children from rich families consume expensive food items that are indigestible and harmful. These food items can cause lack of hunger, leading to malnutrition. Loss of appetite can cause many diseases like cancer, liver or kidney disease, chronic infections, tumors, depressive illness, including malnutrition.
3. Lack of a Regulated Diet: Irregular intake of food can cause malnutrition. Breakfast, lunch, and dinner must always be taken at a proper time. Irregular timing of meals can cause indigestion and malnutrition.
4. Dirty Environment: A dirty environment at home or in the school is one of the basic causes of malnutrition. The home and school environment tend to become dirty when it lacks fresh and pure air, sunlight, playground, clean lanes. This hampers the required nutrition of children. Those children who are made to work in glass factories, leather industries, brick industries, etc. have to face a dirty, unhygienic and unhealthy environment. This can lead to malnourishment in children.

5. Lack of Sound Sleep and Rest: Low space and a suffocating bedroom can hamper the sleep of the child. Excess homework and watching television till late hours can also cause lack of sleep. This results in indigestion and causes malnutrition.
6. Negligence of Children: Children who are not paid attention at home and in the school can experience anxiety. This can also cause malnutrition.
7. Bodily Diseases: Children who are infected by diseases must have a balanced diet. When this is not done, it can hinder proper body functioning and lead to malnutrition.
8. Heavy Work: Continuous hard work can hinder the digestive process of children. This is mainly observed in children from low-income groups, who have to do heavy labor and lots of physical work.
9. Lack of Exercise and Games: Malnutrition can also be caused due to lack of exercise and games. This slows down the digestive process and causes malnutrition.
10. Lack of Food: This is commonly observed in the low-income group as well as homeless people. People with eating disorders such as anorexia nervosa can have problems in maintaining adequate nutrition levels.
11. Dysphagia: Some can suffer from difficulty in eating due to the painful condition of the teeth. This is observed in people with dysphagia who have difficulty in swallowing food. This can cause malnutrition. Malnutrition can also occur due to throat or mouth blockage.
12. Elderly Living Alone: Elderly or physically challenged people who live alone have difficulty in cooking healthy, balanced meals for themselves, and this can lead to malnutrition. Individuals with long-term illnesses lose their appetite and ability to absorb nutrients from the food they eat. This can also cause malnutrition.

13. Ignorance Of Pregnant Mothers: The root cause of malnutrition in children in India is impoverished pregnant mothers who are unable to provide suitable nutrition as they, themselves, are malnourished. This is primarily due to gender inequality. This causes their diets to be inadequate in both quantity and quality.
14. Poverty: Very often poverty is another major reason behind undernourished children. In the villages especially where the income level is restricted one is unable to provide suitable nutrition to their children.
15. Illiteracy And Ignorance: Many a times illiteracy and ignorance also result in malnutrition wherein the parents are unaware of the dietary requirements of their children. Either the children become obese, or they become too underweight and skinny.

Other causes of malnutrition are:

  • Drug or alcohol abuse
  • Digestive illnesses such as ulcerative colitis or Crohn’s disease
  • Diarrhea, nausea or vomiting.
  • Some medications
  • Serious injury, burns or major surgical procedures.
  • Pregnant women with deficits in the normal diet.
  • Lack of knowledge
  • Premature babies
  • Heart defects from birth, cystic fibrosis, cancers, and other long-term diseases
  • Malnutrition is observed in neglected children or orphans.

Effects Of Malnutrition

The effects of malnutrition vary from person to person. However, there are some generic symptoms, which would enable a
doctor to identify that the person is suffering from malnutrition.
Here are the signs of undernutrition:

  • Extreme loss of adipose tissue
  • Difficulty in breathing, with the person suffering from frequent respiratory failures
  • Difficulty to recuperate after a surgical procedure
  • Depression
  • Extremely low body temperatures
  • A dip in the white blood cell count
  • Frequent infections and delayed recovery
  • Delayed wound healing
  • Low libido
  • Irregular menstrual cycles
  • Extreme levels of fatigue and tiredness
  • Irritability and anxiety
  • Extremely dry skin and scalp
  • Alopecia
The person may even develop organ failure, in extreme cases. In children, lack of proper nourishment could trigger:
  • Slow behavioral growth
  • Mental retardation
  • Persistent digestive disorders
  • Irritability
  • Lack of interest in playing and studies
The other end of the spectrum is even more frightening. An obese person is under the massive risk of malnutrition as he tends to binge on only fattening foods. Let us take a look at what to look for in such people:
  • Binge eating
  • High BMI
  • High waist to hip ratio
  • Diabetes
  • Hypertension
  • Stress, anxiety, and irritability
  • Depression
  • Low or nil libido
  • Irregular periods
  • Polycystic ovarian disease
  • Dry skin
  • Premature graying of hair

How To Treat Malnutrition

You need to identify the root cause as well as the gravity of malnutrition to treat the condition. If the root cause is a medical disorder, then that needs to be addressed and cured in the first place. Once the underlying cause is cleared out, the next course of action would be to put the concerned person on an adequately planned nutritious diet to ease out the leftover signs of malnutrition.
A typical malnutrition treatment program will come with an exclusive diet plan along with a set of nutritional supplements, depending on the severity of the case. In extreme cases, patients are put on tube feeding, so that they receive the right amount of nutrients. The person is then kept under strict monitoring to ensure that the recovery is on the track.
In cases of over-nutrition, the person is asked to cut down the supplements or food items that have triggered this condition. In case of obesity, the treatment will be decided based on the total body weight and BMI, in general. While there are no exact ways to find out the right weight for your height, there are assorted ways that people usually rely on. You can let the doctor follow his rules and abide by the same so that you overcome the condition.

How To Prevent Malnutrition

The sole way to keep away malnutrition –which means both ends of this broad spectrum – is to make sure that your meals are always balanced. And for this, you have to include the following major food groups in your diet:
  • Proteins
  • Carbohydrates
  • Vegetables
  • Fruits
  • Healthy fats
  • Milk and other dairy sources [If you are a vegan, you must include equivalent sources of nutrients in your diet]
  • Make sure you drink at least 1.5 liters of water daily

Improvements Required For Curbing Causes Of Child Malnutrition In India

There are several steps that are being taken to cut down the percentage of the child malnutrition in India. The most primary step is to educate an expecting mother about the various methods of enhancing the nutrition of their infants. The most basic way of stopping child malnutrition would be breastfeeding for a basic period of first six months after childbirth. Expecting mothers should be provided with vitamin and mineral supplements to nourish the bones of the unborn child. Children should have regular health check-ups and should be supplied with adequate nutritional supplements.
There are various NGOs and other government bodies that are working with diligence to curb and eradicate malnutrition in children of India yet Indian children comprise a large part of the malnourished children present in the world. There has to be a collective effort from the society to eradicate malnutrition.

If your risk of malnutrition rises from a health condition, then your dietary requirements are definitely going to be quite complex. You can hire a personal dietician who could help you create a personalized diet plan to overcome the condition and deal with it in a better way.
As we just saw, malnutrition is not just about food. It is about lifestyle, your attitude, and much more. If you want to deal with this condition, you ought to change your view and relation with food. Make sure exercise is a part and parcel of your life along with a healthy diet.

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