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Undernutrition is an important determinant of maternal and child health, accounting for more than a third of child deaths and more than 10 percent of the total global disease burden according to 2008 studies.[28] Women__ Researchers from the Centre for World Food Studies in 2003 found that the gap between levels of undernutrition in men and women is generally small, but that the gap varies from region to region and from country to country.[20] These small-scale studies showed that female undernutrition prevalence rates exceeded male undernutrition prevalence rates in South/Southeast Asia and Latin America and were lower in Sub-Saharan Africa.[20] Datasets for Ethiopia and Zimbabwe reported undernutrition rates between 1.5 and 2 times higher in men than in women; however, in India and Pakistan, datasets rates of undernutrition were 1.5-2 times higher in women than in men. Intra-country variation also occurs, with frequent high gaps between regional undernutrition rates.[20] Gender inequality in nutrition in some countries such as India is present in all stages of life.[95] Within the household, there may be differences in levels of malnutrition between men and women, and these differences have been shown to vary significantly from one region to another, with problem areas showing relative deprivation of women.[20] Samples of 1000 women in India in 2008 demonstrated that malnutrition in women is associated with poverty, lack of development and awareness, and illiteracy.[95] The same study showed that gender discrimination in households can prevent a woman's access to sufficient food and healthcare.[95] How socialization affects the health of women in Bangladesh, Najma Rivzi explains in an article about a research program on this topic.[96] In some cases, such as in parts of Kenya in 2006, rates of malnutrition in pregnant women were even higher than rates in children.[97] Women have unique nutritional requirements, and in some cases need more nutrients than men; for example, women need twice as much calcium as men.[98] Studies on nutrition concerning gender bias within households look at patterns of food allocation, and one study from 2003 suggested that women often receive a lower share of food requirements than men.[20] Gender discrimination, gender roles, and social norms affecting women can lead to early marriage and childbearing, close birth spacing, and undernutrition, all of which contribute to malnourished mothers.[59] Frequent pregnancies with short intervals between them and long periods of breastfeeding add an additional nutritional burden.[20] During pregnancy and breastfeeding, women must ingest enough nutrients for themselves and their child, so they need significantly more protein and calories during these periods, as well as more vitamins and minerals (especially iron, iodine, calcium, folic acid, and vitamins A, C, and K).[98] In 2001 the FAO of the UN reported that iron deficiency afflicted 43 percent of women in developing countries and increased the risk of death during childbirth.[98] A 2008 review of interventions estimated that universal supplementation with calcium, iron, and folic acid during pregnancy could prevent 105,000 maternal deaths (23.6 percent of all maternal deaths).[11] Women in some societies are traditionally given less food than men since men are perceived to have heavier workloads.[98] Household chores and agricultural tasks can be arduous and require additional energy and nutrients; however, physical activity, which largely determines energy requirements, is difficult to estimate.[20] According to the FAO, women are often responsible for preparing food and have the chance to educate their children about beneficial food and health habits, giving mothers another chance to improve the nutrition of their children.[98] Children__ A malnourished Afghan child being treated by a medical team. The World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide,[29] about 1 million children.[99] Even mild degrees of malnutrition double the risk of mortality for respiratory and diarrheal disease mortality and malaria.[29] This risk is greatly increased in more severe cases of malnutrition.[29] There are three commonly used measures for detecting malnutrition in children: stunting (extremely low height for age), underweight (extremely low weight for age), and wasting (extremely low weight for height).[100] These measures of malnutrition are interrelated, but studies for the World Bank found that only 9 percent of children exhibit stunting, underweight, and wasting.[100] According to a 2008 review an estimated 178 million children under age 5 are stunted, most of whom live in sub-Saharan Africa.[11] A 2008 review of malnutrition found that about 55 million children are wasted, including 19 million who have severe wasting or severe acute malnutrition.[11] Measurements of a child’s growth provide the key information for the presence of malnutrition, but weight and height measurements alone can lead to failure to recognize kwashiorkor and an underestimation of the severity of malnutrition in children.[29] The 2008 Copenhagen Consensus estimated that undernutrition causes 35 percent of the disease burden in children younger than 5 years old, and that the nutrition of children 5 years and younger depends strongly on the nutrition level of their mothers during pregnancy and breastfeeding.[21] Infants born to young mothers who are not fully developed are found to have low birth weights.[95] The level of maternal nutrition during pregnancy can affect newborn body size and composition.[101] Iodine-deficiency in mothers usually causes brain damage in their offspring, and some cases cause extreme physical and mental retardation. This affects the children’s ability to achieve their full potential. In 2011 UNICEF reported that thirty percent of households in the developing world were not consuming iodized salt, which accounted for 41 million infants and newborns in whom iodine deficiency could still be prevented.[102] Maternal body size is strongly associated with the size of newborn children.[101] Undernourished girls tend to grow into short adults and are more likely to have small children.[101] Short stature of the mother and poor maternal nutrition stores increase the risk of intrauterine growth retardation (IUGR).[101] However, environmental factors can weaken the effect of IUGR on cognitive performance.[101] Studies in Bangladesh in 2009 found that the mother’s literacy, low household income, higher number of siblings, less access to mass media, less supplementation of diets, unhygienic water and sanitation are associated with chronic and severe malnutrition in children.[59] Prenatal malnutrition and early life growth patterns can alter metabolism and physiological patterns and have lifelong effects on the risk of cardiovascular disease.[101] Children who are undernourished are more likely to be short in adulthood, have lower educational achievement and economic status, and give birth to smaller infants.[101] Children often face malnutrition during the age of rapid development, which can have long-lasting impacts on health.[29] A Somali boy receiving treatment for malnourishment at a health facility. Children suffering from severe acute malnutrition are very thin, but they often also have swollen hands and feet, making the internal problems more evident to health workers.[4] Undernutrition in children causes direct structural damage to the brain and impairs infant motor development and exploratory behavior.[101] Children who are undernourished before age two and gain weight quickly later in childhood and in adolescence are at high risk of chronic diseases related to nutrition.[101] Inadequate food intake, infections, psychosocial deprivation, the environment, and perhaps genetics contribute.[29] Children with severe malnutrition are very susceptible to infection.[29] However, children with chronic diseases like HIV have a higher risk of malnutrition, since their bodies cannot absorb nutrients as well.[4] Diseases such as measles are a major cause of malnutrition in children; thus immunizations present a way to relieve the burden.[4] Studies have found a strong association between undernutrition and child mortality.[11] Once malnutrition is treated, adequate growth is an indication of health and recovery.[29] Even after recovering from severe malnutrition, children often remain stunted for the rest of their lives.[29] A study in Bangladesh in 2009 reported that rates of malnutrition were higher in female children than male children.[59] Other studies show that, at the national level, differences between undernutrition prevalence rates between young boys and girls are generally small.[20] Girls often have a lower nutritional status in South and Southeastern Asia compared to boys.[20] In other developing regions, the nutritional status of girls is slightly higher.[20] In almost all countries, the poorest quintile of children has the highest rate of malnutrition.[100] However, inequalities in malnutrition between children of poor and rich families vary from country to country, with studies finding large gaps in Peru and very small gaps in Egypt.[100] In 2000, rates of child malnutrition were much higher in low income countries (36 percent) compared to middle income countries (12 percent) and the United States (1 percent).[100] Measures have been taken to reduce child malnutrition. Studies for the World Bank found that, from 1970–2000, the number of malnourished children decreased by 20 percent in developing countries.[100] Iodine supplement trials in pregnant women have been shown to reduce offspring deaths during infancy and early childhood by 29 percent.[4] However, universal salt iodization has largely replaced this intervention.[4] The Progresa program in Mexico combined conditional cash transfers with nutritional education and micronutrient-fortified food supplements; this resulted in a 10 percent reduction the prevalence of stunting in children 12–36 months old.[11] Milk fortified with zinc and iron reduced the incidence of diarrhea by 18 percent in a study in India. Breastfeeding can reduce rates of malnutrition and dehydration caused by diarrhea, but mothers are sometimes wrongly advised to not breastfeed their children.[4] Breastfeeding has been shown to reduce mortality in infants and young children.[11] Since only 38 percent of children worldwide under 6 months are exclusively breastfed, education programs could have large impacts on children malnutrition rates.[22] However, breastfeeding cannot fully prevent PEM if not enough nutrients are consumed.[29] A course of treatment with cheap antibiotics such as amoxicillin or cefdinir has been shown in a clinical trial to improve the response and survival rate of severely malnourished children to an outpatient treatment plan which provided therapeutic food.[99][103] This confirms the recommendation, "In addition to the provision of RUTF [ready-to-use therapeutic food], children need to receive a short course of basic oral medication to treat infections." contained in "Community-based management of severe acute malnutrition, A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund."[104] Elderly__ Essential nutrients are one of the main requirements of elderly care. Malnutrition and being underweight are more common in the elderly than in adults of other ages.[105] If elderly people are healthy and active, the aging process alone does not usually cause malnutrition.[23] However, changes in body composition, organ functions, adequate energy intake and ability to eat or access food are associated with aging, and may contribute to malnutrition.[106] Sadness or depression can play a role, causing changes in appetite, digestion, energy level, weight, and well-being.[23] A study on the relationship between malnutrition and other conditions in the elderly found that Malnutrition in the elderly can result from gastrointestinal and endocrine system disorders, loss of taste and smell, decreased appetite and inadequate dietary intake.[106] Poor dental health, ill-fitting dentures, or chewing and swallowing problems can make eating difficult.[23] As a result of these factors, malnutrition is seen to develop more easily in the elderly.[107] Rates of malnutrition tend to increase with age in the elderly population; a study in Clinical Nutrition noted that less than 10 percent of the “young” elderly (up to age 75) are malnourished, while 30 to 65 percent of the elderly in home care, long-term care facilities, or acute hospitals are malnourished.[108] Many elderly people require assistance in eating, which may contribute to malnutrition.[107] Because of this, one of the main requirements of elderly care is to provide an adequate diet and all essential nutrients.[109] Researchers in Australia conducting mini-nutritional assessments (MNAs) reported that malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission.[110] Malnutrition and weight loss can contribute to sarcopenia with loss of lean body mass and muscle function.[105] Abdominal obesity or weight loss coupled with sarcopenia lead to immobility, skeletal disorders, insulin resistance, hypertension, atherosclerosis, and metabolic disorders.[106] A paper from the Journal of the American Dietetic Association noted that routine nutrition screenings represent one way to detect and therefore decrease the prevalence of malnutrition in the elderly.[23] |
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