Malnutrition:

Good Nutrition: Normal nutrition implies a balance that avoids both deficiency and excessive intake of food. This balance ensures the body gets the necessary nutrients in the right amounts without going overboard.

Excess Nutrition: Excess nutrition can lead to problems like obesity, cardiovascular diseases, and metabolic disorders. Common causes include high intake of:

• Energy
• Fat
• Cholesterol
• Sugar
• Salt
• Vitamins A & D

Causes of Malnutrition:

• Primary Causes: Lack of food, poverty, ignorance, refusal to eat (due to reasons like idiosyncrasy, fad diets, alcoholism, or loneliness).
• Secondary Causes: Malabsorption (issues in nutrient absorption), defective metabolism, or increased nutrient excretion.

Effects of Malnutrition in the Body:

• Tissue Depletion: Results in biochemical lesions, which can be detected through blood and urine tests showing decreased nutrient levels and abnormal metabolites.
• Clinical Signs: These will vary based on the deficiency or excess but may manifest as growth retardation, intellectual deficits, or other physical health issues.

Under Nutrition:

Definition: Malnutrition includes both undernutrition and overnutrition. Undernutrition occurs when a diet is insufficient in providing all necessary nutrients, such as energy, proteins, and micronutrients. It often results from inadequate food intake or imbalance in the diet, which leads to deficiency diseases and poor health outcomes.

Direct Effects of Undernutrition:

• Nutritional deficiency diseases.
• Increased morbidity and mortality in children.
• Retarded physical and mental growth, leading to lowered productivity.
• Increased maternal mortality, stillbirths, and low birth weight.

Health Hazards from Overnutrition:

• Obesity
• Diabetes mellitus
• Hypertension
• Cardiovascular and renal diseases
• Liver and gall bladder disorders

Effects of Undernutrition in Different Age Groups:

• Young Children: Undernutrition in early childhood can lead to permanent stunting in physical growth. Intellectual development may also be impaired, and this often leads to long-term low mental performance. Nutritional deficiencies like protein-energy malnutrition (PEM), Vitamin A, and Vitamin B deficiencies are common among preschool children.
• Pregnant and Lactating Women: Undernutrition during pregnancy can affect both the mother and the child, leading to premature births, low birth weight, and higher maternal and neonatal mortality rates. Nutrient deficiencies such as anemia (iron and folic acid) are widespread.
• Men and Women:According to the National Nutrition Monitoring Bureau (NNMB), about half of the adult population in India faces Chronic Energy Deficiency (CED), which reduces work capacity and productivity. Iodine deficiency disorders (IDD) are also prevalent.

Protein-Energy Malnutrition (PEM):

Definition: PEM results from an inadequate intake of food and is not caused by protein deficiency alone. It involves both energy (calories) and protein deficiencies. It is primarily linked to poor living conditions, lack of healthcare, and socio-economic inequalities. It is most common in infants and young children, often in association with infections like respiratory infections and diarrhea.

Clinical Stages of PEM:

1. Kwashiorkor: Characterized by edema (fluid retention), which is a striking feature, often seen in children who have an adequate calorie intake but lack protein.
2. Marasmus: Characterized by severe growth retardation and wasting, where both fat and muscle mass are depleted.
3. Marasmic Kwashiorkor: A combined condition showing both edema and wasting.

Global Prevalence:
PEM remains a significant public health concern, especially in developing countries, and affects young children, often in underprivileged communities. The post-weaning stage is particularly critical, as children become more vulnerable to infections that exacerbate PEM.

Classification of Protein-Energy Malnutrition (PEM)

PEM can be classified under the following categories according to the FAO/WHO standards:

1. Growth Failure: This refers to children who fail to grow adequately due to insufficient protein and energy intake.
2. Micro-nutrient Malnutrition: This form occurs when a child’s diet lacks essential micronutrients (vitamins and minerals) needed for proper development and immunity.

Effects of PEM:

• Contributes to high child mortality and morbidity rates.
• Leads to stunted growth.
• Impacts learning abilities.
• Results in reduced work efficiency.

PEM has long-lasting effects on human development and national productivity.

Prevalence of Protein-Energy Malnutrition:

• PEM remains the most widespread nutritional disorder among children in developing countries.
• According to NNMB surveys, significant progress has been made in reducing the prevalence of severe (Grade III) malnutrition, from 15% in 1975-79 to 5% in 2006-07. However, the proportion of moderate (Grade II) malnutrition has increased.
• Clinical forms of PEM have reduced to less than 1%, and hospital admissions related to PEM have also decreased significantly.

Aetiology (Causes of PEM):

1. Age:
   • Preschool children are most vulnerable due to higher nutritional requirements.
   • Infections are more frequent in this age group, which further exacerbates the condition.
   • Marasmus (severe malnutrition) often develops before one year, and Kwashiorkor usually occurs after 18 months.
2. Diet-Related Factors:
   • Inadequate feeding practices, such as using diluted milk formulas and prolonged breastfeeding, can lead to deficiencies.
   • Delay in introducing supplementary feeds and reliance on adult diets that the child cannot adequately consume are also contributing factors.
   • Diets deficient in protein and energy are a major cause of PEM.
3. Role of Free Radicals and Aflatoxins:
   • Free radicals produced during infections, combined with aflatoxin poisoning (due to contaminated food), can further damage the body, especially when protein intake is insufficient. This results in conditions like Kwashiorkor.
4. Infections:
   • Unsanitary living conditions contribute to frequent infections such as diarrhea, which can precipitate or exacerbate PEM.
   • Measles, diarrhea, and respiratory infections are common infections that often lead to PEM. Infections not only impair appetite but also result in malabsorption of nutrients, worsening malnutrition.
5. Socio-Economic Factors:
   • Poverty is a major driver of PEM.
   • Poor economic conditions, inadequate feeding practices due to ignorance, large family sizes, and cultural taboos contribute to higher PEM rates.
   • Inadequate maternal care and work pressure on mothers also worsen the situation.

Measures to Combat Protein-Energy Malnutrition:

Treatment:

1. Dehydration: For mild to moderate dehydration, oral rehydration solutions (ORS) are used. Severe dehydration requires intravenous fluids to restore fluid balance.
2. Infections: Antibiotic therapy for infections like diarrhea and measles. Deworming for intestinal infections like giardiasis and ascariasis.
3. Hypothermia: Marasmic children are at risk of low body temperature and need to be kept warm with proper clothing or blankets. Glucose-saline injections or blood transfusions are needed in severe cases.
4. Anemia: Severe anemia requires blood transfusion if hemoglobin levels fall below 5 g/dL.

Dietary Management:

• Begin with a liquid formula that gradually increases in calories and protein.
• Vegetable oil can be added to increase energy content.
• Use milk-based formulas or cereal foods for older children.
• For convalescing children, provide a balanced diet that includes oil, sugar, banana, and a cereal-pulse mixture to meet energy requirements.

Health Promotion and Specific Protection:

• Promote breastfeeding, nutrition education, and family planning.
• Provide supplementary foods to improve dietary intake.
• Regular immunizations, growth monitoring, and periodic surveillance are crucial for early diagnosis and treatment of PEM.

Overnutrition & Obesity:

Obesity is a growing concern, particularly due to lifestyle changes. Obesity is a major risk factor for chronic diseases such as heart disease, diabetes, and certain cancers. While obesity is preventable through lifestyle modifications, it is becoming more common due to both genetic and environmental factors.

Causes of Obesity:

1. Genetic Factors: A genetic predisposition to obesity is significant, especially when both parents are obese.
2. Eating Habits: Overconsumption of high-calorie, processed foods, and poor eating habits can contribute to weight gain.
3. Physical Inactivity: Sedentary lifestyles and lack of exercise are major contributors to obesity.
4. Stress and Endocrine Factors: Stress and hormonal imbalances (e.g., hypothyroidism) can lead to weight gain.
5. Cultural and Societal Factors: Societal practices and environmental cues can influence food choices, leading to overeating and increased obesity risks.