malnutrition

Definition

Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function.

Description

Malnutrition occurs in people who are either under-nourished or over-nourished. Undernutrition is a consequence of consuming too few essential nutrients or using or excreting them more rapidly than they can be replaced.

Infants, young children, and teenagers need additional nutrients. So do women who are pregnant or breastfeeding. Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding (hemorrhage), or kidney failure. Nutrient intake can be restricted by age-related illnesses and conditions, excessive dieting, severe injury, serious illness, a lengthy hospitalization, or substance abuse.

The leading cause of death in children in developing countries is protein-energy malnutrition. This type of malnutrition is the result of inadequate intake of calories from proteins, vitamins, and minerals. Children who are already undernourished can suffer from protein-energy malnutrition when rapid growth, infection, or disease increases the need for protein and essential minerals.

In the United States, nutritional deficiencies have generally been replaced by dietary imbalances or excesses associated with many of the leading causes of death and disability. Overnutrition results from eating too much, eating too many of the wrong things, not exercising enough, or taking too many vitamins or other dietary replacements.

Risk of overnutrition is also increased by being more than 20% overweight, consuming a diet high in fat and salt, and taking high doses of:

• nicotinic acid (niacin) to lower elevated cholesterol levels
• vitamin B₆ to relieve premenstrual syndrome
• vitamin A to clear up skin problems
• iron or other trace minerals not prescribed by a doctor

Nutritional disorders can affect any system in the body and the senses of sight, taste, and smell. Malnutrition begins with changes in nutrient levels in blood and tissues. Alterations in enzyme levels, tissue abnormalities, and organ malfunction may be followed by illness and death.

— Mary K. Fyke

Impaired health caused by a dietary deficiency, excess, or imbalance. To support human life, energy (from fat, carbohydrate, and protein), water, and more than 40 different food substances must be obtained from the diet in appropriate amounts. Malnutrition can result from the chronic intake of any of these substances at levels above, as well as below, ranges that are adequate and safe, but commonly the term refers only to deficient intake.

The number of people throughout the world who suffer from nutritional deficiencies as a result of inadequate dietary intake is uncertain, but even the most conservative estimates place that figure at hundreds of millions; many experts consider the actual number to approach 1 billion. Most malnourished people live in developing countries where income, education, and housing are inadequate to buy, transport, store, and prepare food and where nutritional deficiencies are almost always related to poverty. In industrialized countries, chronic conditions of deficient dietary intake occur far less frequently but are reported occasionally among people who are dieting to lose weight, fasting, or on an unusually restrictive (“fad”) diet. Pregnant women, infants, and children are most at risk for inadequate dietary intake because their nutritional requirements are relatively high.

Nutritional deficiencies also occur as a result of illness, injury, or alcohol or drug abuse that interferes with appetite; the inability to eat; defective digestion, absorption, or metabolism of food molecules; or disease states that increase nutrient losses. Secondary malnutrition has been observed frequently among medical and surgical patients who are treated in hospitals for prolonged periods of time. Regardless of cause, the effects of malnutrition can range from minor symptoms to severe syndromes of starvation, protein-calorie malnutrition, or single-nutrient deficiencies. See also Metabolic disorders.

The chronic intake of energy below the level of expenditure induces rapid losses in body weight and muscle mass accompanied by profound changes in physiology and behavior. Together, these effects cause a starving person to become weak, apathetic, depressed, and unable to work productively and to do whatever is necessary to reverse the malnutrition. The consequences of nutritional deficiencies are seen first in tissues that are growing rapidly. These changes are most evident in the gastrointestinal tract, skin, blood cells, and nervous system as indigestion, malabsorption, skin lesions, anemia, or neurologic and behavior changes. Of special concern is the loss of immune function that accompanies severe malnutrition.

The combined effects of malnutrition and infection in young children are referred to as protein-calorie malnutrition. It classified into two entities, marasmus and kwashiorkor, on the basis of physical appearance and the relative proportions of protein and calories in the diet. Children with the marasmus form appear generally wasted as a result of diets that are chronically deficient in calories as well as protein and other nutrients. Children with kwashiorkor are also very thin but have characteristically bloated bellies due to fluid retention and accumulation of fat in the liver, symptoms attributed to diets relatively deficient in protein. See also Adipose tissue; Protein metabolism.

Deficiency conditions due to lack of a single vitamin or mineral occur rarely and usually reflect the lack of the most limiting nutrient in a generally deficient diet. In industrialized countries, single-nutrient deficiencies are most evident in individuals who abuse alcohol or drugs. Classic conditions of deficiency of niacin (pellagra), thiamine (beriberi), vitamin C (scurvy), and vitamin D (rickets) have virtually disappeared as a result of food fortification programs and the development of food distribution systems that provide fresh fruits and vegetables throughout the year. Iron-deficiency anemia also has declined in prevalence, although children in low-income families remain at risk. In developing countries, however, such conditions are still observed among people whose diets depend on one staple food as the major source of calories. A condition of substantial current public health importance is vitamin A deficiency, which is the principal cause of blindness and a major contributor to illness and death among children in developing countries. See also Anemia; Vitamin.

Disturbance of form or function arising from deficiency or excess of one or more nutrients. See also cachexia; obesity; protein-energy malnutrition; vitamin toxicity.

Condition caused by an unbalanced diet with certain foods being deficient, in excess, or in the wrong proportions. See also kwashiorkor; marasmus; and obesity.

Any disorder concerning nutrition. It may result from a poor diet or from impaired utilization of foods ingested.

Definition

Malnutrition is a condition that develops when the body does not get the proper amount of protein, energy (calories), vitamins, and other nutrients it needs to maintain healthy tissues and organ function.

Description

Poor eating habits or lack of available food may lead to malnutrition. Malnutrition occurs in children who are either undernourished or overnourished. Children who are overnourished may become overweight or obese, which may lead to long-term health problems and social stress.

Undernutrition

Undernutrition is a consequence of consuming little energy and other essential nutrients, or using or excreting them more rapidly than they can be replaced. This state of malnutrition is often characterized by infections and disease. Malnutrition intensifies the effect of every disease. Severe malnutrition is most often found in developing countries. Rarely in the United States do children suffer from severe malnutrition that is not related to severe chronic illness. Deficiency in one nutrient occurs less often than deficiency in several nutrients. A child suffering from malnutrition is usually deficient in a variety of nutrients.

The leading cause of death in children in developing countries is protein-energy malnutrition. This type of malnutrition is the result of inadequate intake of protein and energy. Children who are already undernourished can suffer from protein-energy malnutrition when rapid growth, infection, or disease increases the need for protein and essential nutrients.

Overnutrition

In the United States, nutritional deficiencies have generally been replaced by dietary imbalances or excesses associated with many of the leading causes of death and disability. Overnutrition results from eating too much, eating too many of the wrong foods, not exercising enough, or taking too many vitamins or other dietary replacements.

Risk of overnutrition is also increased by being more than 20 percent overweight, consuming a diet high in fat and salt, and taking high doses of:

• nicotinic acid (niacin) to lower elevated cholesterol levels
• vitamin B₆ to relieve premenstrual syndrome
• vitamin A to clear up skin problems
• iron or other trace minerals not prescribed by a doctor

Nutritional disorders can affect any system in the body and the senses of sight, taste, and smell. Malnutrition begins with changes in nutrient levels in blood and tissues. Alterations in enzyme levels, tissue abnormalities, and organ malfunction may be followed by illness and death.

Complications

Poorly nourished children often have weakened immune systems, thus increasing their chances of illness. Underweight, malnourished teenagers (such as those with an eating disorder) have an increased risk of osteoporosis and may not have menstrual periods. They may have heart and other organ problems with severe malnutrition. Malnutrition, if left untreated, can lead to physical or mental disability, or even death.

Children who are overweight have an increased risk for long-term conditions and diseases, including cardiovascular disease, high cholesterol, high blood pressure, type 2 diabetes, asthma, sleep apnea, and certain cancers. Health consequences range from a higher risk of premature death to chronic conditions that reduce a person's quality of life.

Demographics

Malnutrition is a major cause of illness and death throughout the world. Throughout the developing world, malnutrition affects almost 800 million people, or 20 percent of the population. Approximately half of the 10.4 million children who die each year are malnourished. It often causes disease and disability in the children who survive. Diarrheal diseases are also a major world health problem, and may be a cause of malnutrition. Nearly all of these deaths occur in impoverished parts of Africa and Asia, where they often result from contamination of the water supply by animal and human feces.

Worldwide, the most common form of malnutrition is iron deficiency, affecting up to 80 percent of the population, as many as four or five billion people.

In contrast, children in many parts of the world are becoming increasingly overweight. What was thought of as a problem for industrialized nations only until recently, is now affecting children in developing countries. Approximately 25–30 percent of school-age children in the United States are overweight.

Causes and Symptoms

Worldwide, poverty and lack of food are the primary reasons why malnutrition occurs. Families of low-income households do not always have enough healthy food to eat. When there is a household food shortage, children are the most vulnerable to malnutrition because of their high energy needs.

There is an increased risk of malnutrition associated with chronic diseases, especially disease of the intestinal tract, kidneys, and liver. Children with chronic diseases like cancer, cystic fibrosis, AIDS, celiac disease, and intestinal disorders may lose weight rapidly and become susceptible to malnutrition because they cannot absorb valuable vitamins, iron, and other necessary nutrients. Children who are lactose intolerant have difficulty digesting milk and milk products, and may be at risk for malnutrition, particularly a calcium deficiency.

Symptoms of malnutrition vary, depending on what nutrients are deficient in the body. Unintentionally losing weight may be a sign of malnutrition. Children who are malnourished may be skinny or bloated and may be short for their age (stunted). Their skin is pale, thick, dry, and easily bruised. Rashes and changes in pigmentation are common.

Hair is thin, tightly curled, and easily pulled out. Joints ache and bones are soft and tender. The gums bleed. The tongue may be swollen, or shriveled and cracked. Visual disturbances include night blindness and increased sensitivity to light and glare.

Other symptoms of malnutrition include:

• fatigue
• dizziness
• anemia
• diarrhea
• disorientation
• goiter (enlarged thyroid gland)
• loss of reflexes and lack of coordination
• muscle twitches
• decreased immune response
• scaling and cracking of the lips and mouth

Children who are overnourished are visibly overweight or obese, and consume more food than their bodies need (or expend too little energy through physical activity).

When to Call the Doctor

Parents who worry about malnutrition can discuss their concerns with a doctor, registered dietitian, or other health care provider. Though not an exhaustive list, treatment should be sought for a child if:

• there is a change in bodily functions (impairment)
• the child is not growing
• the child faints
• the child rapidly loses hair
• a girl at puberty stops menstruating or is underweight and fails to start menstruating

Diagnosis

Overall appearance, behavior, body-fat distribution, and organ function can alert a family physician, internist, or nutrition specialist to the presence of malnutrition. Parents may be asked to record what a child eats during a specific period. X rays or a CT scan can determine bone density and reveal gastrointestinal disturbances, as well as heart and lung damage.

Blood and urine tests are used to measure levels of vitamins, minerals, and waste products. Nutritional status can also be determined by:

• comparing a child's weight to standardized charts
• calculating body mass index (BMI) according to a formula that divides height into weight
• measuring skin-fold thickness or the circumference of the upper arm

Treatment

Normalizing nutritional status starts with a nutritional assessment. This process enables a registered dietitian or nutritionist to confirm the presence of malnutrition, assess the effects of the disorder, and formulate a diet that will restore adequate nutrition. For children suffering malnutrition due to an illness or underlying disorder, the condition should be treated concurrently.

Nutritional Concerns

Children who cannot or will not eat, or who are unable to absorb nutrients taken by mouth, may be fed intravenously (parenteral nutrition) or through a tube inserted into the gastrointestinal tract (enteral nutrition).

Tube feeding is often used to provide nutrients to children who have burns, inflammatory bowel disease, or other long-term conditions that cause chronic malnutrition or malabsorption (e.g. cystic fibrosis or AIDS), and interfere with the ability to take in enough calories. This procedure involves inserting a thin tube through the nose and carefully guiding it along the throat until it reaches the stomach or small intestine. If long-term tube feeding is necessary, the tube may be placed directly into the stomach or small intestine through an incision in the abdomen.

Tube feeding cannot always deliver adequate nutrients to children who:

• are severely malnourished
• require surgery
• are undergoing chemotherapy or radiation treatments
• have been seriously burned
• have persistent diarrhea or vomiting
• have a gastrointestinal tract that is not functional

Intravenous feeding can also supply some or all of the nutrients these children need.

Doctors or registered dietitians can help parents can monitor overweight or obese children. These professionals may suggest a weight loss program if the child is more than 40 percent overweight. Keeping weight gain under control can be accomplished by changing eating habits, lowering fat intake, and increasing physical activity.

Prognosis

Some children with protein-energy malnutrition recover completely. Others have many health problems throughout life, including mental disabilities and the inability to absorb nutrients through the intestinal tract. Prognosis is dependent on age and the length and severity of the malnutrition, with young children having the highest rate of long-term complications and death. Death usually results from heart failure, electrolyte imbalance, or low body temperature. Children with semiconsciousness, persistent diarrhea, jaundice, or low blood sodium levels have a poorer prognosis.

A good prognosis exists for overweight children who make lifestyle changes and adhere to a diet and exercise program.

Prevention

Every child admitted to the hospital for poor weight gain or malnutrition should be screened for the presence of illnesses and conditions that could lead to protein-energy malnutrition. Children with higher-than-average risk for malnutrition should be more closely assessed, and evaluated often.

Nutritional Concerns

Proper nutrition is required to ensure optimal health. Consumption of a wide variety of foods, with adequate vitamin and mineral intake, is the basis of a healthy diet. Researchers state that no single nutrient is the key to good health, but that optimum nutrition is derived from eating a diverse diet, including a variety of fruits and vegetables. Because foods such as fruits and vegetables provide many more nutrients than vitamin supplements, food is the best source for acquiring needed vitamins and minerals.

Breastfeeding a baby for at least six months is considered the best way to prevent early-childhood malnutrition. The United States Department of Agriculture and Health and Human Services recommends that all Americans over the age of two:

• consume plenty of fruits, grains, and vegetables
• eat a variety of foods that are low in fats and cholesterol, and contain only moderate amounts of salt, sugars, and sodium
• engage in moderate physical activity for at least 30 minutes, at least several times a week
• achieve or maintain their ideal weight
• use alcohol sparingly or avoid it altogether

Iron deficiency can be prevented by consuming red meat, egg yolks, and fortified breads, flour, and cereals.

Parental Concerns

Infants, young children, and teenagers need additional nutrients to provide for growth requirements. This is also true for women who are pregnant or breastfeeding; a mother's nutritional status affects her baby. Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding (hemorrhage), or kidney failure. Nutrient intake can be restricted by age-related illnesses and conditions, excessive dieting, severe injury, serious illness, a lengthy hospitalization, or substance abuse.

Children usually eat as much or as little as they need in order to feel satisfied. Children should be allowed to select what they want to eat among healthy food choices; they should be allowed to stop eating when they feel full. An underweight, overweight, or normal weight child should be allowed to decide how much to eat or whether to eat at all, within reason.

Parents must proactively prevent childhood obesity by recognizing weight imbalances when they begin. They can help an overweight child to lose weight (if medically necessary) by being supportive, rather than scolding. Parents should offer their children nutritious food choices and encourage physical activity. With proper intervention, an overweight child is not destined to become an overweight adult, but weight loss goals should be realistic.

Resources

Books

Kleinman, Ronald E., and the American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition Handbook, 5th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003.

Physicians Committee for Responsible Medicine. HealthyEating for Life for Children. Hoboken, NJ: Wiley, 2002.

Willett, Walter C., and P.J. Skerrett. Eat, Drink, and BeHealthy: The Harvard Medical School Guide to Healthy Eating. New York: Simon & Schuster Source, 2002.

Organizations

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. (847) 434-4000.

American College of Emergency Physicians. 1125 Executive Circle, Irving, TX 75038-2522. (800) 798-1822.

American College of Nutrition. 300 S. Duncan Ave. Ste. 225, Clearwater, FL 33755. (727) 446-6086.

American Dietetic Association. 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. (800) 877-1600.

Food and Nutrition Information Center. Agricultural Research Service, USDA, National Agricultural Library, Room 105, 10301 Baltimore Boulevard, Beltsville, MD 20705-2351. Web site: www.nal.usda.gov/fnic/fniccomments.html.

[Article by: Mary K. Fyke Crystal Heather Kaczkowski, MSc.]

For more information on malnutrition, visit Britannica.com.

Condition caused by an unbalanced diet with nutrients being deficient, in excess, or in the wrong proportions. Many people, including athletes, suffer from mild malnutrition that adversely affects their physical performance.

Malnutrition results from the chronic dietary intake of nutrients or energy that provides considerably less or more than is required to be considered adequate or appropriate to support the everyday needs of the human body. Such adverse nutrient intakes are detrimental to human health and may lead to a state of deficiency, dependency, toxicity, or obesity. Malnutrition includes undernutrition, which means the body is not receiving nearly enough nutrients, and overnutrition, which means the intake of nutrients is grossly excessive.

Undernutrition

Undernutrition continues to be a significant cause of malnutrition in developing countries, although it is relatively rare in developed countries. Poverty in developing countries contributes more to undernutrition than a lack of global food production and is considered the chief cause of malnutrition. Families that are poor do not have the economic, social, or environmental resources to purchase or produce enough food. Poor soil conditions may also contribute to a family's inability to grow enough food to prevent malnutrition and the accompanying complications to health. Additionally, for the urban poor, low wages, underemployment, and food prices beyond the reach of families also contribute to undernutrition.

Prolonged dietary intakes deficient in energy or calories, protein, fat, vitamins, and minerals lead to illness and eventually death if not corrected. Undernutrition may also be the result of psychological disorders, such as anorexia nervosa, which manifests as an unwillingness to eat enough food to sustain life. Elderly adults often have a decrease both in appetite and intestinal function and are at an increased risk for undernutrition. Children, particularly infants and those under five years of age are also at an increased risk for undernutrition due to a greater need for energy and nutrients during periods of rapid growth and development. Infants born to undernourished mothers are more likely to be low birth weight infants. Addiction to alcohol or drugs may also lead to undernutrition when the addicted individuals favor alcohol and/or drug intake over adequate food intake. Severe, prolonged diarrhea, renal failure, infection, or diseases that cause the malabsorption of nutrients in the small intestine also may cause undernutrition even if dietary intake is adequate. It is obvious that the causes of undernutrition are varied and complex, requiring solutions that may also be complex.

Nutrients Required to Prevent Undernutrition

The nutrients required in adequate amounts by the body to prevent undernutrition are carbohydrates, fat or lipids, protein, vitamins, minerals, and water. Carbohydrates provide the body with energy (about 4 kilocalories per gram of carbohydrate consumed). Carbohydrates also protect protein stores in the body. A minimal intake of 50 to 100 grams (1.8 to 3.5 oz.) of carbohydrates is required to prevent the development of ketones that the brain can use somewhat inefficiently for energy. The brain optimally uses carbohydrate for energy, but when carbohydrate intake is inadequate for several weeks, the body does not metabolize fatty acids completely in order to produce ketones for energy. In addition to ketone formation resulting from insufficient carbohydrate consumption, body protein will also be lost, and the body will generally become weakened.

Fats or lipids provide essential fatty acids upon metabolism following consumption. Essential fatty acids are obtained from dietary lipids and are termed essential because the human body cannot synthesize them. Essential fatty acids are important for human health because they participate in immune processes, vision, are an integral part of cell structures, and participate in hormone-like compound production. If an inadequate intake of lipids is routinely consumed, the body becomes deficient in essential fatty acids. This results in skin problems, diarrhea, and an increase in infections with a corresponding decrease in the ability of the body to heal wounds. Lipids also provide energy for the body (about 9 kilocalories per gram (28 kilocalories per ounce of fat consumed), can be stored for future use as energy, insulate the body and protect body organs, and aid in the absorption and transport of fat-soluble vitamins (vitamins A, D, E, and K) throughout the body. The fat-soluble vitamins are important for vision (vitamin A), bone metabolism (vitamin D), providing antioxidant protection from free radicals (vitamin E), and blood coagulation (vitamin K), among other functions.

Protein is a very important nutrient because so many substances in the body are made from it. Proteins are made when amino acids are combined in specific sequences to form specific proteins. The sequence of the amino acids determines the shape of the protein, and the shape of the protein, in turn, determines the function of the protein. Amino acids can be obtained from plant or animal sources. There are nine essential amino acids: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. The human body is not able to synthesize these amino acids, so they must be derived from the foods we eat. There are eleven nonessential amino acids that the human body is able to make: alanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine, proline, serine, and tyrosine. As stated previously, amino acids are necessary for protein synthesis, but they are also important because they provide the body with a special form of nitrogen that the body cannot get from carbohydrates or lipids. Protein, like carbohydrate, provides approximately 4 kilocalories per gram of protein consumed, but requires much more metabolizing and processing by the liver and kidneys to put the energy from protein to use. Protein is a part of every cell in the human body. Blood proteins enable the body to maintain the right balance of fluid inside and outside of cells. When adequate protein is not consumed, there is a lower concentration of blood proteins in the bloodstream, which causes the balance of fluids inside and outside of cells in tissues to be thrown off, resulting in swelling of tissues or edema, which can lead to serious medical problems. Proteins also help regulate the pH, or acid-base balance, in the blood, are necessary for the synthesis of many hormones and enzymes, and participate in important cell formation for cells vital for the immune system. Amino acids from protein can also be used to produce glucose, which is a positive thing for providing glucose after an overnight fast. But in the case of starvation, excessive muscle tissue is wasted and results in diminished health. Protein-energy malnutrition results from near starvation and may be seen in the body tissues in either a wet, dry, or combined form. The dry form, marasmus, is caused by deficiency of protein and nonprotein nutrients, with the individual being very thin from the loss of muscle and body fat. The wet form, kwashiorkor, is caused primarily by protein deficiency, with energy deficiency being secondary, and is accompanied by edema. The combined form, marasmic kwashiorkor, results from protein and energy deficiency with edema and more body fat than is seen in marasmus.

There are also water-soluble vitamins in addition to the fat-soluble vitamins. Because water-soluble vitamins are not stored in any appreciable amounts in the body, but are excreted readily in urine, it is relatively easy to become depleted of them. Fat-soluble, in contrast, are stored in adipose tissue and the liver, and consequently it is more difficult to become deficient of them. The water-soluble vitamins are the B vitamins and vitamin C. The B vitamins are thiamin, riboflavin, niacin, pantothenic acid, biotin, pyridoxine, folate, and vitamin B₁₂. All of the water-soluble vitamins except vitamin C have coenzyme functions and are involved in a variety of reactions including energy metabolism, DNA synthesis, nerve function, protein and carbohydrate metabolism, and fat synthesis. Vitamin C is involved in protecting the body from oxidative damage caused by substances called free radicals. It also functions in connective tissue synthesis, hormone synthesis, and neurotransmitter synthesis. Physiological consequences of deficiency include inflammation of the mouth and tongue (riboflavin deficiency); diarrhea, dermatitis (niacin deficiency); edema, weakness (thiamin deficiency); tongue soreness, anemia (biotin deficiency); fatigue, tingling in hands (pantothenic acid deficiency); poor growth, inflammation of the tongue (folate deficiency); poor nerve function, macrocytic anemia (vitamin B₁₂ deficiency); and poor wound healing, bleeding gums (vitamin C deficiency).

Minerals are important nutrients that must be obtained from foods consumed, as the human body is unable to synthesize them. Some factors that influence mineral bioavailability (the extent to which minerals in food consumed is available for the body to put to use) are the amount of mineral content in the soil in which the food providing the mineral was grown; dietary fiber consumed in the same meal as a food containing the minerals; mineral-mineral interactions; and vitamin-mineral interactions. Sodium, potassium, chloride, calcium, phosphorus, magnesium, and sulfur are the major minerals. Deficiencies of these minerals lead to such symptoms as muscle cramps (sodium), irregular heartbeat (potassium), convulsions in infants (chloride), an increased risk for osteoporosis (calcium), diminished bone support (phosphorus), and poor heart function (magnesium). There are also so-called trace minerals that are only required in very small amounts to contribute to optimal health. These trace minerals are iron, zinc, selenium, iodide, copper, fluoride, chromium, manganese, and molybdenum. When inadequate amounts of foods containing the trace minerals are consumed, symptoms begin to appear. These symptoms include low blood iron (iron), skin rash/poor growth and development (zinc), muscle weakness (selenium), goiter (iodide), anemia/poor growth (copper), increased risk for dental cavities (fluoride), and high blood glucose after eating (chromium).

Developed countries typically have water supplies that are monitored for safety by government agencies and are provided in large enough quantities that a lack of drinking water is not the norm. Developing countries, however, may not have water that is free from contamination, or because of drought or other natural disasters do not have a large enough water supply for human consumption or to provide water for livestock or crops. Water is vital for life and, without it, an adult can survive only a few days because the human body does not have the ability to store water. Water is found inside of cells as intracellular fluid and outside of cells as extracellular fluid. A proper balance between intracellular and extracellular water is necessary to prevent complications such as edema. Water also is responsible for regulating body temperature, most notably through the cooling-off process accomplished by perspiration. Water is necessary to provide lubrication for joints such as the knees. Without adequate water in the form of amniotic fluid in the womb of a pregnant woman, the growing fetus does not have sufficient support to prevent injury should the mother fall or be otherwise jarred abruptly. Water is also the primary avenue utilized by the body to rid itself of waste products. While water does not supply energy as carbohydrates, protein, and fats are able to do, it is still a very important nutrient necessary to prevent malnutrition.

Overnutrition

Overnutrition results when energy expenditure is grossly exceeded by energy intake and leads to overweight and obesity. Developed countries, with their abundant food supplies and processed foods, are most afflicted with overnutrition and the medical complications associated with it. Due to the excessive intake of food products, the amount of fat-soluble vitamins and minerals in the body can rise to toxic levels because they are stored in the body. Developed countries have greater incidences of cardiovascular disease, blood lipids, diabetes mellitus, hypertension, respiratory problems, gallbladder disease, arthritis, and cancer, all of which are connected to complications stemming directly from overnutrition.

Methods of Evaluating Malnutrition

Malnutrition is diagnosed based on the findings of a medical and diet history, physical examination, and laboratory tests. The results are then compared with norms of weight for height, body mass index (body weight in kilograms divided by height in meters squared), dietary intake, physical findings, and plasma levels of nutrients and nutrient-dependent substances such as hemoglobin. The physical examination would necessarily include anthropometric measurements, as well as close examination of the skin, hair, and mouth for symptoms of malnutrition. For example, depigmentation of the hair is indicative of undernutrition, and a body weight that is 20 percent above the average desirable body weight as determined by insurance company standardized charts would indicate overnutrition. A triceps skinfold test may be utilized to determine the body's energy stores. Laboratory tests are used to reveal the extent to which amino acid nutrition is meeting the body's needs to determine undernutrition, or plasma lipids in the diagnosis of overnutrition. In the field when assessing nutritional status, the medical and diet history and physical examination may be the only tools accessible to the physician or nurse, particularly in developing countries.

Who Is At Increased Risk for Malnutrition?

The risk for malnutrition is increased for a variety of reasons. Increased nutritional needs during growth, pregnancy, lactation, old age, infection, certain cancer therapies, or immune deficiency disorders increase the risk of malnutrition. Diets that focus on a narrow range of foods may not provide the variety of nutrients required and lead to deficiencies. Those experiencing famine, with the accompanying reduction in available food, are at great risk for malnutrition in the form of undernutrition. Lack of money to purchase an adequate diet or cultural practices that dictate which members in the family get a large or small amount of food may also lead to malnutrition. Any medical condition that effects the absorption of nutrients from foods, or requires medication that has adverse consequences on appetite, may cause malnutrition if the condition is long term. Taking megadoses of vitamin/mineral supplements may result in toxic levels of the substances taken in the body with the outcome being a state of overnutrition.

Correcting Malnutrition in the United States

Since the Great Depression of the 1930s, the federal government of the United States has undertaken the task of alleviating and/or preventing malnutrition. In the 1960s, President John F. Kennedy reestablished the federal government's efforts to end debilitating hunger. Individuals and families who have low incomes may take advantage of several federally sponsored programs to ensure a better quality of nutrient intake. Food stamps are available to those who are usually employed but having difficulty purchasing an adequate food supply by using coupons to purchase food from grocery stores. The Commodity Supplemental Food Program distributes U. S. Department of Agriculture surplus foods through county agencies to such low-income populations as pregnant women and families with young children. The School Lunch and Breakfast Programs offer free or reduced-priced meals based on the Food Guide Pyramid to children of low-income families, with the cost of the reduced-priced meals being based on family income. The Summer Food Service Program offers free, nutritious meals and snacks to low-income children and distributes the meals from a central location during lower and secondary school vacations. There are also programs targeted specifically at different age groups. Preschool children enrolled in organized child-care programs receive meals at no cost, and the child-care program receives reimbursement for the meals through participation in the Child-Care Food Program. For individuals 60 years or older, a free noon meal is provided at centralized sites as part of the Congregate Meals for the Elderly Program. Homebound individuals over 60 years of age can take advantage of home-delivered meals at no cost or for a fee, depending on income, at least five days per week.

World Hunger: Addressing a Global Problem

In 1798 the English clergyman and political economist Thomas Malthus suggested that the world's population was growing at a rate faster than the food supply. The year 2002 finds world population growth exceeding economic growth, and poverty on the rise. Globally less than one-half of 1 percent of the world's yearly production of goods and services goes exclusively to economic development assistance, yet 6 percent goes to support the world's military operations. Civil wars in some countries have substantially retarded progress of the poor and continue to contribute to massive undernutrition. Environmental factors such as soil erosion or lack of fresh water for irrigation of crops exacerbate the problem of providing sufficient quantities of foods for many countries. What is being done to overcome all of these detriments to feeding the world's hungry? Since the 1960s, an American program, the Peace Corps, has been instrumental in providing education, distributing food and medical supplies, and building structures for locals to use in developing nations. National surveys such as the National Family Health Survey conducted in India are valuable tools in the determination of whether any progress is being made to improve the nutritional status of the nation. Advances in biotechnology to genetically alter plants and animals to improve the nutritive quality of the foods produced from them may help to meet increasing food needs both now and in the future. The United Nations and the World Health Organization cry out for governments in developed countries to facilitate greater strides in improvements in malnutrition in undeveloped countries by financial, educational, and scientific interventions. What will be required to eradicate malnutrition in this world is a coming together of the leaders of rich and poor nations to the same degree. Globally, there is an adequate food supply and the technical expertise necessary to address the problems and complications of malnutrition. All that is lacking is the political cooperation to address this devastating situation.

Bibliography

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Charlton, K. E., et al. "Poor Nutritional Status in Older Black South Africans." Asia Pacific Journal of Clinical Nutrition 10, no. 1 (2001): 31–38.

Chen, C. C., L. S. Schilling, and C. H. Lyder. "A Concept Analysis of Malnutrition in the Elderly." Journal of Advanced Nursing 36, no. 1 (2001): 131–142.

Fenton, M., and S. Simon. "Legislating Good Sense: It's Time for Medical Nutrition Therapy to be Part of Standard Care for People with HIV/AIDS." Positive Living 11, no. 1 (2002): 44–45.

Gillet, R. M., and P. V. Tobias. "Human Growth in Southern Zambia: A First Study of Tonga Children Predating the Kariba Dam (1957–1958)." American Journal of Human Biology 14, no. 1 (2002): 50–60.

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—Rebecca J. (Bryant) McMillian

Inadequate nutrition caused by the lack of a balanced diet or by disorders of the digestive system in which the nutrients from food cannot be absorbed properly.

The term used to describe the condition caused by a diet that contains all of the essential nutrients but in suboptimal amounts—an intermediate stage to starvation. It is compatible with life and the same metabolic changes occur as in starvation but to a lesser degree. Ketosis, loss of body weight and muscular power accompany a lower metabolic rate. There is also a fall in body temperature, reduced heart and respiratory rates and sexual activity. Could also be used to describe gross over-nutrition. See also cachexia, starvation.

• milk replacer m. — see milk replacer.

Malnutrition
Classification and external resources
The orange ribbon—an awareness ribbon for malnutrition.
ICD-9	263.9
eMedicine	ped/1360
MeSH	D044342

Malnutrition is the insufficient, excessive or imbalanced consumption of nutrients.^[1][2] A number of different nutrition disorders may arise, depending on which nutrients are under or overabundant in the diet.

The World Health Organization cites hunger as the gravest single threat to the world's public health.^[3] Malnutrition is, by far, the biggest contributor to child mortality, present in half of all cases.^[3] Malnutrition, in the form of iodine deficiency, is the most common preventable cause of mental impairment.^[4] Improving nutrition is widely regarded as the most effective form of aid.^[3][5]

Contents 1 Causes 1.1 Undernutrition 1.1.1 Agricultural productivity 1.1.2 Poverty and food prices 1.1.3 Dietary practices 2 Effects 2.1 Mortality 2.2 Illness 2.3 Psychological 2.4 Cancer 2.5 Metabolic syndrome 2.6 Hyponatremia 3 Fighting malnutrition 3.1 Emergency measures 3.2 Long term measures 3.3 Restricting population size 4 Demographics 4.1 Statistics 4.2 Middle East 4.3 South Asia 4.4 United States 5 See also 5.1 Organizations 6 References 7 External links

Causes

Undernutrition

Agricultural productivity

Food shortages are mostly caused by the lack of technology needed for the higher yields found in modern agriculture, such as nitrogen fertilizers, pesticides and irrigation. Reasons for the unavailability include moves to stop supplying fertilizer on environmental grounds, cited as the the obstacle to feeding Africa by the Green revolution pioneer Norman Borlaug.^[6] As a result of widespread poverty, farmers cannot afford or governments cannot provide the technology. The World Bank and some wealthy donor countries also press nations that depend on aid to cut or eliminate subsidized agricultural inputs such as fertilizer, in the name of free market policies even as the United States and Europe extensively subsidized their own farmers.^[7][8] Many, if not most, farmers cannot afford fertilizer at market prices, leading to low agricultural production and wages and high, unaffordable food prices.^[7]

With 95% of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics, climate change is of great importance to food security in these regions. According to the latest IPCC reports, temperature increases in these regions are "very likely."^[9] Even small changes in temperatures can lead to increased frequency of extreme weather conditions.^[10] Many of these have great impact on agricultural production and hence nutrition. For example, the 1998-2001 central Asian drought brought about an 80% livestock loss and 50% reduction in wheat and barley crops in Iran.^[11] Similar figures were present in other nations. An increase in extreme weather such as drought in regions such as Sub-Saharan would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productiveness of many crop species, also decreasing food security in these regions.^[12]

Thomas Malthus noted overpopulation will outgrow food production as increases in food production occur along a slow arithmetic progression while population growth follows much faster geometric progressions causing food shortages. This argument has long since been refuted on several grounds but has nonetheless served as a backdrop for understanding of the causes of malnutrition. Food supplies can also be disrupted by impacts of natural disasters, from the results of conflict and war, as an impact of the HIV/AIDS pandemic^[13] as a consequence of other health issues such as diarrheal disease or chronic illness [2] from lack of education regarding proper nutrition, or from countless other potential factors.

The use of biofuels as a replacement for traditional fuels may leave less supply of food for nutrition and raises the price of food.^[14] The UN special rapporteur on the right to food, Jean Ziegler proposes that agricultural waste, such as corn cobs and banana leaves, rather than crops themselves be used as fuel.^[15]

Colony collapse disorder is a phenomenon where bees are dying in large numbers. ^[16] Since many agricultural crops worldwide are pollinated by bees, this represents a serious threat to the supply of food.^[17] An epidemic of stem rust on wheat caused by race Ug99 is currently spreading across Africa and into Asia and, it is feared, could wipe out more than 80% of the world’s wheat crops.^[18][19]

Poverty and food prices

The economist Amartya Sen observed that, in recent decades, famine has always a problem of food distribution and/or poverty, as there has been sufficient food to feed the whole population of the world. He states that malnutrition and famine were more related to problems of food distribution and purchasing power.^[20]

It is argued that commodity speculator are increasing the cost of food. As the real estate bubble in the United States was collapsing, it is said that trillions of dollars moved to invest in food and primary commodities, causing the 2007-2008 food price crisis.^[21]

Dietary practices

The lack of breastfeeding leads to malnutrition in infants and children. Possible reasons for the lack in the developing world may be that the average family thinks bottle feeding is better.^[22] The WHO says mothers abandon it because they do not know how to get their baby to latch on properly or suffer pain and discomfort.^[23]

Effects

See also: child mortality and iodine deficiency

Mortality

According to Jean Ziegler (the United Nations Special Rapporteur on the Right to Food for 2000 to March 2008), mortality due to malnutrition accounted for 58% of the total mortality in 2006: "In the world, approximately 62 million people, all causes of death combined, die each year. One in twelve people worldwide are malnourished.^[24] In 2006, more than 36 millions died of hunger or diseases due to deficiencies in micronutrients"^[25].

According to the World Health Organization, malnutrition is by far the biggest contributor to child mortality. Underweight births and inter-uterine growth restrictions cause 2.2 million child deaths a year. Poor or non-existent breastfeeding causes another 1.4 million. Other deficiencies, such as lack of vitamin A or zinc, for example, account for 1 million. According to The Lancet, malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower educational achievements. Their own children also tend to be smaller. Hunger was previously seen as something that exacerbates the problems of diseases such as measles, pneumonia and diarrhea. But malnutrition actually causes diseases as well, and can be fatal in its own right.^[3]

Illness

Malnutrition increases the risk of infection and infectious disease; for example, it is a major risk factor in the onset of active tuberculosis.^[26] In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem. Lower energy and impaired function of the brain also represent the downward spiral of malnutrition as victims are less able to perform the tasks they need to in order to acquire food, earn an income, or gain an education.

Nutrients	Deficiency	Excess
Energy	Starvation, Marasmus	Obesity, diabetes mellitus, Cardiovascular disease
Simple carbohydrates	none	diabetes mellitus, Obesity
Complex carbohydrates	none	Obesity
Saturated fat	low sex hormone levels [27]	Cardiovascular disease (claimed by most doctors and nutritionists)
Trans fat	none	Cardiovascular Disease
Unsaturated fat	none	Obesity
Fat	Malabsorption of Fat-soluble vitamins, Rabbit Starvation (If protein intake is high)	Cardiovascular Disease (claimed by some)
Omega 3 Fats	Cardiovascular Disease	Bleeding, Hemorrhages
Omega 6 Fats	none	Cardiovascular Disease, Cancer
Cholesterol	none	Cardiovascular disease (claimed by many)
Protein	kwashiorkor	Rabbit starvation
Sodium	hyponatremia	Hypernatremia, hypertension
Iron	Anemia	Cirrhosis, heart disease
Iodine	Goiter, hypothyroidism	Iodine Toxicity (goiter, hypothyroidism)
Vitamin A	Xerophthalmia and Night Blindness, low testosterone levels	Hypervitaminosis A (cirrhosis, hair loss)
Vitamin B1	Beri-Beri
Vitamin B2	Cracking of skin and Corneal Unclearation
Niacin	Pellagra	dyspepsia, cardiac arrhythmias, birth defects
Vitamin B12	Pernicious Anemia
Vitamin C	Scurvy	diarrhea causing dehydration
Vitamin D	Rickets	Hypervitaminosis D (dehydration, vomiting, constipation)
Vitamin E	nervous disorders	Hypervitaminosis E (anticoagulant: excessive bleeding)
Vitamin K	Hemorrhage
Calcium	Osteoporosis, tetany, carpopedal spasm, laryngospasm, cardiac arrhythmias	Fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, pancreatitis, increased urination
Magnesium	Hypertension	Weakness, nausea, vomiting, impaired breathing, and hypotension
Potassium	Hypokalemia, cardiac arrhythmias	Hyperkalemia, palpitations

Psychological

The Lancet, a British medical journal, reported that “Iodine deficiency is the most common cause of preventable mental impairment worldwide.”^[4] Even moderate iodine deficiency, especially in pregnant women and infants, lowers intelligence by 10 to 15 I.Q. points, shaving incalculable potential off a nation’s development.^[4] The most visible and severe effects — disabling goiters, cretinism and dwarfism — affect a tiny minority, usually in mountain villages. But 16 percent of the world’s people have at least mild goiter, a swollen thyroid gland in the neck.^[4]

Research indicates that improving the awareness of nutritious meal choices and establishing long-term habits of healthy eating has a positive effect on a cognitive and spatial memory capacity, potentially increasing a student's potential to process and retain academic information.

Some organizations have begun working with teachers, policymakers, and managed foodservice contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university level institutions. Health and nutrition have been proven to have close links with overall educational success.^[28] Currently less than 10% of American college students report that they eat the recommended five servings of fruit and vegetables daily.^[29] Better nutrition has been shown to have an impact on both cognitive and spatial memory performance; a study showed those with higher blood sugar levels performed better on certain memory tests.^[30] In another study, those who consumed yogurt performed better on thinking tasks when compared to those who consumed caffeine free diet soda or confections.^[31] Nutritional deficiencies have been shown to have a negative effect on learning behavior in mice as far back as 1951.^[32]

"Better learning performance is associated with diet induced effects on learning and memory ability".^[33]

The "nutrition-learning nexus" demonstrates the correlation between diet and learning and has application in a higher education setting.

"We find that better nourished children perform significantly better in school, partly because they enter school earlier and thus have more time to learn but mostly because of greater learning productivity per year of schooling."^[34]

91% of college students feel that they are in good health while only 7% eat their recommended daily allowance of fruits and vegetables.^[29]

Nutritional education is an effective and workable model in a higher education setting.^[35][36]

More "engaged" learning models that encompass nutrition is an idea that is picking up steam at all levels of the learning cycle.^[37]

There is limited research available that directly links a student's Grade Point Average (G.P.A.) to their overall nutritional health. Additional substantive data is needed to prove that overall intellectual health is closely linked to a person's diet, rather than just another correlation fallacy.

Nutritional supplement treatment may be appropriate for major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder, the four most common mental disorders in developed countries.^[38] Supplements that have been studied most for mood elevation and stabilization include eicosapentaenoic acid and docosahexaenoic acid (each of which are an omega-3 fatty acid contained in fish oil, but not in flaxseed oil), vitamin B12, folic acid, and inositol.

Cancer

Cancer is now common in developing countries. According a study by the International Agency for Research on Cancer, "In the developing world, cancers of the liver, stomach and esophagus were more common, often linked to consumption of carcinogenic preserved foods, such as smoked or salted food, and parasitic infections that attack organs." Lung cancer rates are rising rapidly in poorer nations because of increased use of tobacco. Developed countries "tended to have cancers linked to affluence or a 'Western lifestyle' — cancers of the colon, rectum, breast and prostate — that can be caused by obesity, lack of exercise, diet and age."^[39]

Metabolic syndrome

Several lines of evidence indicate lifestyle-induced hyperinsulinemia and reduced insulin function (i.e. insulin resistance) as a decisive factor in many disease states. For example, hyperinsulinemia and insulin resistance are strongly linked to chronic inflammation, which in turn is strongly linked to a variety of adverse developments such as arterial microinjuries and clot formation (i.e. heart disease) and exaggerated cell division (i.e. cancer). Hyperinsulinemia and insulin resistance (the so-called metabolic syndrome) are characterized by a combination of abdominal obesity, elevated blood sugar, elevated blood pressure, elevated blood triglycerides, and reduced HDL cholesterol. The negative impact of hyperinsulinemia on prostaglandin PGE1/PGE2 balance may be significant.

The state of obesity clearly contributes to insulin resistance, which in turn can cause type 2 diabetes. Virtually all obese and most type 2 diabetic individuals have marked insulin resistance. Although the association between overweight and insulin resistance is clear, the exact (likely multifarious) causes of insulin resistance remain less clear. Importantly, it has been demonstrated that appropriate exercise, more regular food intake and reducing glycemic load (see below) all can reverse insulin resistance in overweight individuals (and thereby lower blood sugar levels in those who have type 2 diabetes).

Obesity can unfavourably alter hormonal and metabolic status via resistance to the hormone leptin, and a vicious cycle may occur in which insulin/leptin resistance and obesity aggravate one another. The vicious cycle is putatively fuelled by continuously high insulin/leptin stimulation and fat storage, as a result of high intake of strongly insulin/leptin stimulating foods and energy. Both insulin and leptin normally function as satiety signals to the hypothalamus in the brain; however, insulin/leptin resistance may reduce this signal and therefore allow continued overfeeding despite large body fat stores. In addition, reduced leptin signalling to the brain may reduce leptin's normal effect to maintain an appropriately high metabolic rate.

There is a debate about how and to what extent different dietary factors— such as intake of processed carbohydrates, total protein, fat, and carbohydrate intake, intake of saturated and trans fatty acids, and low intake of vitamins/minerals—contribute to the development of insulin and leptin resistance. In any case, analogous to the way modern man-made pollution may potentially overwhelm the environment's ability to maintain homeostasis, the recent explosive introduction of high glycemic index and processed foods into the human diet may potentially overwhelm the body's ability to maintain homeostasis and health (as evidenced by the metabolic syndrome epidemic).

Hyponatremia

Excess water intake, without replenishment of sodium and potassium salts, leads to hyponatremia, which can further lead to water intoxication at more dangerous levels. A well-publicized case occurred in 2007, when Jennifer Strange died while participating in a water-drinking contest.^[40] More usually, the condition occurs in long-distance endurance events (such as marathon or triathlon competition and training) and causes gradual mental dulling, headache, drowsiness, weakness, and confusion; extreme cases may result in coma, convulsions, and death. The primary damage comes from swelling of the brain, caused by increased osmosis as blood salinity decreases. Effective fluid replacement techniques include Water aid stations during running/cycling races, trainers providing water during team games such as Soccer and devices such as Camel Baks which can provide water for a person without making it too hard to drink the water.

Fighting malnutrition

Main articles: Ready-to-Use Therapeutic food and famine relief

Fighting malnutrition, mostly through fortifying foods with micronutrients (vitamins and minerals), improves lives at a lower cost and shorter time than other forms of aid, according to the World Bank.^[41] The Copenhagen Consensus, which look at a variety of development proposals, ranked micronutrient supplements as number one. ^{[5] [42]} However, roughly $300m of aid goes to basic nutrition each year, less than $2 for each child below two in the 20 worst affected countries.^[3] In contrast, HIV/AIDS, which causes fewer deaths than child malnutrition, received $2.2 billion—$67 per person with HIV in all countries.^[3]

Emergency measures

Micronutrients can be obtained through fortifying foods.^[5] Fortifying foods such as peanut butter sachets (see Plumpy'Nut) and Spirulina have revolutionized emergency feeding in humanitarian emergencies because they can be eaten directly from the packet, do not require refrigeration or mixing with scarce clean water, can be stored for years and ,vitally, can be absorbed by extremely ill children.^[43] The United Nations World Food Conference of 1974 declared Spirulina as 'the best food for the future' and its ready harvest every 24 hours make it a potent tool to eradicate malnutrition. Additionally, supplements, such as Vitamin A capsules or Zinc tablets to cure diarrhea in children, are used.^[44]

There is a growing realization among aid groups that giving cash or cash vouchers instead of food is a cheaper, faster, and more efficient way to deliver help to the hungry, particularly in areas where food is available but unaffordable.^[45] The UN's World Food Program, the biggest non-governmental distributor of food, announced that it will begin distributing cash and vouchers instead of food in some areas, which Josette Sheeran, the WFP's executive director, described as a "revolution" in food aid.^[45][46] The aid agency Concern Worldwide is piloting an method through a mobile phone operator, Safaricom, which runs a money transfer program that allows cash to be sent from one part of the country to another.^[45]

However, for people in a drought living a long way from and with limited access to markets, delivering food may be the most appropriate way to help.^[45] Fred Cuny stated that "the chances of saving lives at the outset of a relief operation are greatly reduced when food is imported. By the time it arrives in the country and gets to people, many will have died."^[47] US Law, which requires buying food at home rather than where the hungry live, is inefficient because approximately half of what is spent goes for transport.^[48] Fred Cuny further pointed out "studies of every recent famine have shown that food was available in-country — though not always in the immediate food deficit area" and "even though by local standards the prices are too high for the poor to purchase it, it would usually be cheaper for a donor to buy the hoarded food at the inflated price than to import it from abroad."^[49] Ethiopia has been pioneering a program that has now become part of the World Bank's prescribed recipe for coping with a food crisis and had been seen by aid organizations as a model of how to best help hungry nations. Through the country's main food assistance program, the Productive Safety Net Program, Ethiopia has been giving rural residents who are chronically short of food, a chance to work for food or cash. Foreign aid organizations like the World Food Program were then able to buy food locally from surplus areas to distribute in areas with a shortage of food.^[50]

Long term measures

Main article: food security

The effort to bring modern agricultural techniques found in the West, such as nitrogen fertilizers and pesticides, to Asia, called the Green revolution, resulted in decreases in malnutrition similar to those seen earlier in Western nations. This was possible because of existing infrastructure and institutions that are in short supply in Africa, such as a system of roads or public seed companies that made seeds available.^[51] Investments in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces food prices.^[7][52] For example, in the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced against World Bank strictures, farmers produced record-breaking corn harvests as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter.^[7] This lowered food prices and increased wages for farm workers.^[7] Proponents for investing in agriculture include Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa’s farmers.^[7]

Breast-feeding education helps. Breastfeeding in the first two years and exclusive breastfeeding in the first six months could save 1.3 million children’s lives. ^[53] In the longer term, firms are trying to fortify everyday foods with micronutrients that can be sold to consumers such as wheat flour for Beladi bread in Egypt or fish sauce in Vietnam and the iodization of salt.^[43]

Restricting population size

Restricting population size is a proposed solution. Thomas Malthus argued that population growth could be done by natural disasters and voluntary limits through “moral restraint.”^[54] Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth.^[55] Garret Hardin takes an anti-immigration, isolationist approach arguing that “…all sovereign states must accept the responsibility of solving their population problems in their own territories" and that immigration acts as a sort of pressure release valve which allows countries to continue to ignore solving their population problems.^[56]

For Amaryta Sen, “no matter how a famine is caused, methods of breaking it call for a large supply of food in the public distribution system. This applies not only to organizing rationing and control, but also to undertaking work programmes and other methods of increasing purchasing power for those hit by shifts in exchange entitlements in a general inflationary situation.”^[57]

One suggested policy framework to resolve access issues is termed food sovereignty, the right of peoples to define their own food, agriculture, livestock, and fisheries systems in contrast to having food largely subjected to international market forces. Food First is one of the primary think tanks working to build support for food sovereignty. Neoliberals advocate for an increasing role of the free market. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.

Demographics

Statistics

See also: Global Hunger Index

There were 923 million hungry people in the world in 2007, an increase of 80 million since 1990,^[58] despite the fact that the world already produces enough food to feed everyone - 6 billion people - and could feed the double - 12 billion people.^[59]

Year	1990	1995	2005	2007
Hungry people in the world (millions)[60]	842	832	848	923

Year	1970	1980	1990	2005	2007
Share of hungry people in the developing world[61][62]	37 %	28 %	20 %	16 %	17 %

• On the average, a person dies every second as a result of hunger - 4000 every hour - 100 000 each day - 36 million each year - 58 % of all deaths (2001-2004 estimates).^[63][64][65]
• On the average, a child dies every 5 seconds as a result of hunger - 700 every hour - 16 000 each day - 6 million each year - 60% of all child deaths (2002-2008 estimates).^{[66][67][68][69][70]}

Percentage of population affected by undernutrition by country, according to United Nations statistics.

Number of undernourished people (million) in 2001-2003, according to the FAO, the following countries had 5 million or more undernourished people [3]:

Country	Number of Undernourished (million)
India	217.05
China	154.0
Bangladesh	43.45
Democratic Republic of Congo	37.0
Pakistan	35.2
Ethiopia	31.5
Tanzania	16.1
Philippines	15.2
Brazil	14.4
Indonesia	13.8
Vietnam	13.8
Thailand	13.4
Nigeria	11.5
Kenya	9.7
Sudan	8.8
Mozambique	8.3
North Korea	7.9
Yemen	7.1
Madagascar	7.1
Colombia	5.9
Zimbabwe	5.7
Mexico	5.1
Zambia	5.1
Angola	5.0

Note: This table measures "undernourishment", as defined by FAO, and represents the number of people consuming (on average for years 2001 to 2003) less than the minimum amount of food energy (measured in kilocalories per capita per day) necessary for the average person to stay in good health while performing light physical activity. It is a conservative indicator that does not take into account the extra needs of people performing extraneous physical activity, nor seasonal variations in food consumption or other sources of variability such as inter-individual differences in energy requirements.

FAO seems to have handed over ( more or less) calculation of the number hungry by adopting Wold Bank numbers in 2007/8 and then USDA data in 2008/9.

Malnutrition and undernourishment are cumulative or average situations, and not the work of a single day's food intake (or lack thereof). This table does not represent the number of people who "went to bed hungry today."

Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community may be at risk if it lacks health-related services, but on a smaller scale certain households or individuals may be at even higher risk due to differences in income levels, access to land, or levels of education ^[71]. Also 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 ^[72]. Children and the elderly tend to be especially susceptible. Approximately 27 percent of children under 5 in developing world are malnourished, and in these developing countries, malnutrition claims about half of the 10 million deaths each year of children under 5.

Middle East

Malnutrition rates in Iraq had risen from 19% before the US-led invasion to a national average of 28% four years later.^[73]

South Asia

According to the Global Hunger Index, South Asia has the highest child malnutrition rate of world's regions.^[74] India contributes to about 5.6 million child deaths every year, more than half the world's total.^[75] The 2006 report mentioned that "the low status of women in South Asian countries and their lack of nutritional knowledge are important determinants of high prevalence of underweight children in the region" and was concerned that South Asia has "inadequate feeding and caring practices for young children".^[75]

Half of children in India are underweight,^[76] one of the highest rates in the world and nearly double the rate of Sub-Saharan Africa.^[77]

Research on overcoming persistent under-nutrition published by the Institute of Development Studies, argues that the co-existence of India as an 'economic powerhouse' and home to one-third of the world's under-nourished children reflects a failure of the governance of nutrition: "A poor capacity to deliver the right services at the right time to the right populations, an inability to respond to citizens' needs and weak accountability are all features of weak nutrition governance."^[78] The research suggests that to make under-nutrition history in India the governance of nutrition needs to be strengthened and new research needs to focus on the politics and governance of nutrition. At the current rate of progress the MDG1 target for nutrition will only be reached in 2043 with severe consequences for human wellbeing and economic growth.^[79]

United States

Childhood malnutrition is generally thought of as being limited to developing countries, but although most malnutrition occurs there, it is also an ongoing presence in developed nations. For example, in the United States of America, one out of every six children is at risk of hunger.^[80] A study, based on 2005-2007 data from the U.S. Census Bureau and the Agriculture Department, shows that an estimated 3.5 million children under the age of five are at risk of hunger in the United States.^[81] In developed countries, this persistent hunger problem is not due to lack of food or food programs, but is largely due to an underutilization of existing programs designed to address the issue, such as food stamps or school meals. Many citizens of rich countries such as the United States of America attach stigmas to food programs or otherwise discourage their use. In the USA, only 60% of those eligible for the food stamp program actually receive benefits.^[82] The U.S. Department of Agriculture reported that in 2003, only 1 out of 200 U.S. households with children became so severely food insecure that any of the children went hungry even once during the year. A substantially larger proportion of these same households (3.8 percent) had adult members who were hungry at least one day during the year because of their households' inability to afford enough food.[4]

See also

• List of countries by percentage of population suffering from undernourishment
• Anorexia nervosa
• Dehydration
• Essential nutrient
• Famine
• Food
• Food price crisis
• Global Hunger Index
• Hunger
• Illnesses related to poor nutrition
• Micronutrient
• Nutrition
• NutritionDay (in Europe)
• Obesity
• Plumpy'nut
• Specific appetite
• Spirulina
• Starvation
• Underweight

Organizations

• World Food Programme
• Share Our Strength
• Food and Agriculture Organization
• Intergovernmental Institution for the use of Micro-algae Spirulina Against Malnutrition (IIMSAM)
• Hungrykids.org
• GAIN Global Alliance for Improved Nutrition

References

1. ^ malnutrition at Dorland's Medical Dictionary
2. ^ Sullivan, arthur; Steven M. Sheffrin (2003). [http://www.pearsonschool.com/index.cfm?locator=PSZ3R9&PMDbSiteId=2781&PMDbSolutionId=6724&PMDbCategoryId=&PMDbProgramId=12881&level=4 Economics: Principles in action Tna WWE WW WWE WWE WWE W E LPKo;avdks;lgjlnlf[';a zbhng'h v g b bx b sgz gf sz xbg gsz bg gnx B zd gv f]. Upper Saddle River, New Jersey 07458: Pearson Prentice Hall. pp. 481. ISBN 0-13-063085-3. http://www.pearsonschool.com/index.cfm?locator=PSZ3R9&PMDbSiteId=2781&PMDbSolutionId=6724&PMDbCategoryId=&PMDbProgramId=12881&level=4. 
3. ^ ^{a b c d e f} Malnutrition The Starvelings
4. ^ ^{a b c d} In raising the world’s IQ the secret is in salt
5. ^ ^{a b c} The Hidden Hunger
6. ^ http://www.theatlantic.com/issues/97jan/borlaug/borlaug.htm Forgotten benefactor of humanity
7. ^ ^{a b c d e f} Ending Famine, Simply by Ignoring the Experts
8. ^ Zambia: fertile but hungry
9. ^ "Climate Change 2007: Synthesis Report." 12-17 Nov 2007. Intergovernmental Panel on Climate Change. 5 Nov 2008 <http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr.pdf>.
10. ^ "Climate Change 2007: Synthesis Report." 12-17 Nov 2007. Intergovernmental Panel on Climate Change. 5 Nov 2008 <http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr.pdf>.
11. ^ Battista, David. "Climate Change in Developing Countries." University of Washington. Seattle. 27 Oct 2008.
12. ^ "Climate Change 2007: Synthesis Report." 12-17 Nov 2007. Intergovernmental Panel on Climate Change. 5 Nov 2008 <http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr.pdf>.
13. ^ Baro, Mamadou and Tara F. Duebel "Persistent Hunger: Perspectives on Vulnerability, Famine, and Food Security in Sub-Saharan Africa" Annual Anthropological Review. (2006) 35:521-38.
14. ^ http://news.bbc.co.uk/2/hi/europe/7472532.stm Biofuel use increasing poverty
15. ^ http://news.bbc.co.uk/2/hi/americas/7065061.stm Biofuels ‘crime against humanity'
16. ^ [1] Honey Bee Die-Off Alarms Beekeepers, Crop growers and researchers
17. ^ http://news.bbc.co.uk/2/hi/americas/6438373.stm Vanishing bees threaten US crops
18. ^ Millions face famine as crop disease rages
19. ^ http://articles.latimes.com/2009/jun/14/science/sci-wheat-rust14 A time bomb for world wheat crop
20. ^ Sen, A.K. Poverty and Famines: An Essay on Entitlement and Deprivation. Oxford: Oxford University Press. (1981)
21. ^ http://www.spiegel.de/international/world/0,1518,549187,00.html The role of speculators in the global food crisis
22. ^ BBC news. Breastfeeding declines in Asia
23. ^ http://www.reuters.com/article/healthNews/idUSTRE56U25T20090731 Breastfeeding could save 1.3 million lives
24. ^ http://library.thinkquest.org/C002291/high/present/stats.htm
25. ^ Jean Ziegler, L'Empire de la honte, Fayard, 2007 ISBN 978-2-253-12115-2 p.130.
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29. ^ ^{a b} "American College Health Association National College Health Assessment Spring 2006 Reference Group data report (abridged)". J Am Coll Health 55 (4): 195–206. 2007. PMID 17319325. 
30. ^ Benton D, Sargent J (July 1992). "Breakfast, blood glucose and memory". Biol Psychol 33 (2-3): 207–10. PMID 1525295. 
31. ^ Kanarek RB, Swinney D (February 1990). "Effects of food snacks on cognitive performance in male college students". Appetite 14 (1): 15–27. PMID 2310175. 
32. ^ Whitley JR, O'Dell BL, Hogan AG (September 1951). "Effect of diet on maze learning in second generation rats; folic acid deficiency". J. Nutr. 45 (1): 153–60. PMID 14880969. 
33. ^ Umezawa M, Kogishi K, Tojo H, et al. (February 1999). "High-linoleate and high-alpha-linolenate diets affect learning ability and natural behavior in SAMR1 mice". J. Nutr. 129 (2): 431–7. PMID 10024623. 
34. ^ Glewwe P, Jacoby H, King E (2001). "Early childhood nutrition and academic achievement: A longitudinal analysis". Journal of Public Economics 81 (3): 345–68. 
35. ^ Managed food service contractors react quickly to the demands of their clients achievement: A longitudinal analysis. Journal of Public Economics, 81(3), 345-368.
36. ^ Guernsey L (1993). "Many colleges clear their tables of steak, substitute fruit and pasta". Chronicle of Higher Education 39 (26): A30. 
37. ^ Duster T, Waters A (2006). "Engaged learning across the curriculum: The vertical integration of food for thought". Liberal Education 92 (2): 42. 
38. ^ Lakhan SE, Vieira KF (2008). "Nutritional therapies for mental disorders". Nutr J 7: 2. doi:10.1186/1475-2891-7-2. PMID 18208598. http://www.nutritionj.com/content/7/1/2. 
39. ^ Coren, Michael (2005-03-10). "Study: Cancer no longer rare in poorer countries". CNN. http://www.cnn.com/2005/HEALTH/03/09/cancer.study/index.html. Retrieved 2007-01-01. 
40. ^ "Why is too much water dangerous?". BBC News. 2007-01-15. http://news.bbc.co.uk/1/hi/magazine/6263029.stm. Retrieved 2008-11-09. 
41. ^ [ http://www.nytimes.com/2008/12/04/opinion/04kristof.html Raising the world’s IQ]
42. ^ Let them eat micronutrients
43. ^ ^{a b} [ http://news.bbc.co.uk/2/hi/business/8114750.stm Firms target nutrition for the poor]
44. ^ http://www.time.com/time/magazine/article/0,9171,1914655,00.html Can one pill tame the illness no one wants to talk about?
45. ^ ^{a b c d} UN aid debate: give cash not food?
46. ^ Cash roll-out to help hunger hot spots
47. ^ Andrew S. Natsios (Administrator U.S. Agency for International Development)
48. ^ Let them eat micronutrients
49. ^ memorandum to former Representative Steve Solarz (United States, Democratic Party, New York) - July 1994
50. ^ A model of African food aid is now in trouble
51. ^ http://www.nytimes.com/2007/10/10/world/africa/10rice.html?_r=1&hp&oref=slogin In Africa, prosperity from seeds falls short
52. ^ How a Kenyan village tripled its corn harvest
53. ^ http://news.bbc.co.uk/2/hi/health/3022558.stm Millions of children dying needlessly.
54. ^ Malthus, Robert Thomas. 1976 (1798). An Essay on the Principle of Population. Philip Appleman, ed. New York: Norton.
55. ^ Chapman, Robert. 1999. “No Room at the Inn, or Why Population Problems are Not All Economic.” Population and Environment, 21(1): 81-97.
56. ^ Hardin, Garrett. 1992. “The Ethics of Population Growth and Immigration Control.” In Crowding Out the Future: World Population Growth, US Immigration, and Pressures on Natural Resources, Robert W. Fox and Ira H. Melham, eds. Washington, DC: Federation for American Immigration Reform.
57. ^ Sen, Amartya. 1982. Poverty and Famines: An Essay on Entitlements and Deprivation, Oxford: Clarendon Press.
58. ^ Food and Agriculture Organization Economic and Social Development Department. “The State of Food Insecurity in the World, 2008 : High food prices and food security - threats and opportunities”. Food and Agriculture Organization of the United Nations, 2008, p. 2. “FAO’s most recent estimates put the number of hungry people at 923 million in 2007, an increase of more than 80 million since the 1990–92 base period.”.
59. ^ Jean Ziegler. “Promotion And Protection Of All Human Rights, Civil, Political, Economic, Social And Cultural Rights, Including The Right To Development: Report of the Special Rapporteur on the right to food, Jean Ziegler”. Human Rights Council of the United Nations, January10, 2008.“According to the Food and Agriculture Organization of the United Nations (FAO), the world already produces enough food to feed every child, woman and man and could feed 12 billion people, or double the current world population.”
60. ^ Food and Agriculture Organization Economic and Social Development Department. “The State of Food Insecurity in the World, 2008 : High food prices and food security - threats and opportunities”. Food and Agriculture Organization of the United Nations, 2008, p. 48.
61. ^ Food and Agriculture Organization Agricultural and Development Economics Division. “The State of Food Insecurity in the World, 2006 : Eradicating world hunger – taking stock ten years after the World Food Summit”. Food and Agriculture Organization of the United Nations, 2006, p. 8. “Because of population growth, the very small decrease in the number of hungry people has nevertheless resulted in a reduction in the proportion of undernourished people in the developing countries by 3 percentage points – from 20 percent in 1990–92 to 17 percent in 2001–03. (…) the prevalence of undernourishment declined by 9 percent (from 37 percent to 28 percent) between 1969–71 and 1979–81 and by a further 8 percentage points (to 20 percent) between 1979–81 and 1990–92.”.
62. ^ Food and Agriculture Organization Economic and Social Development Department. “The State of Food Insecurity in the World, 2008 : High food prices and food security - threats and opportunities”. Food and Agriculture Organization of the United Nations, 2008, p. 6. “Good progress in reducing the share of hungry people in the developing world had been achieved – down from almost 20 percent in 1990–92 to less than 18 percent in 1995–97 and just above 16 percent in 2003–05. The estimates show that rising food prices have thrown that progress into reverse, with the proportion of undernourished people worldwide moving back towards 17 percent.”.
63. ^ Jean Ziegler. “The Right to Food: Report by the Special Rapporteur on the Right to Food, Mr. Jean Ziegler, Submitted in Accordance with Commission on Human Rights Resolution 2000/10”. United Nations, February 7, 2001, p. 5. “On average, 62 million people die each year, of whom probably 36 million (58 per cent) directly or indirectly as a result of nutritional deficiencies, infections, epidemics or diseases which attack the body when its resistance and immunity have been weakened by undernourishment and hunger.”.
64. ^ Commission on Human Rights. “The right to food : Commission on Human Rights resolution 2002/25”. Office Of The High Commissioner For Human Rights, United Nations, April 22, 2002, p. 2. “every year 36 million people die, directly or indirectly, as a result of hunger and nutritional deficiencies, most of them women and children, particularly in developing countries, in a world that already produces enough food to feed the whole global population”.
65. ^ United Nations Information Service. “Independent Expert On Effects Of Structural Adjustment, Special Rapporteur On Right To Food Present Reports: Commission Continues General Debate On Economic, Social And Cultural Rights”. United Nations, March 29, 2004, p. 6. “Around 36 million people died from hunger directly or indirectly every year.”.
66. ^ Food and Agriculture Organization Staff. “The State of Food Insecurity in the World, 2002: Food Insecurity : when People Live with Hunger and Fear Starvation”. Food and Agriculture Organization of the United Nations, 2002, p. 6. “6 million children under the age of five, die each year as a result of hunger.”
67. ^ Food and Agriculture Organization of the United Nations Economic and Social Dept. “The State of Food Insecurity in the World 2004: Monitoring Progress Towards the World Food Summit and Millennium Development Goals”. Food and Agriculture Organization of the United Nations, 2004, p. 8. “Undernourishment and deficiencies in essential vitamins and minerals cost more than 5 million children their lives every year”.
68. ^ Jacques Diouf. “The State of Food Insecurity in the World 2004: Monitoring Progress Towards the World Food Summit and Millennium Development Goals”. Food and Agriculture Organization of the United Nations, 2004, p. 4. “one child dies every five seconds as a result of hunger and malnutrition”.
69. ^ Food and Agriculture Organization, Economic and Social Dept. “The State of Food Insecurity in the World 2005: Eradicating World Hunger - Key to Achieving the Millennium Development Goals”. Food and Agriculture Organization of the United Nations, 2005, p. 18. “Hunger and malnutrition are the underlying cause of more than half of all child deaths, killing nearly 6 million children each year – a figure that is roughly equivalent to the entire preschool population of Japan. Relatively few of these children die of starvation. The vast majority are killed by neonatal disorders and a handful of treatable infectious diseases, including diarrhoea, pneumonia, malaria and measles. Most would not die if their bodies and immune systems had not been weakened by hunger and malnutrition moderately to severely underweight, the risk of death is five to eight times higher.”.
70. ^ Human Rights Council. “Resolution 7/14. The right to food”. United Nations, March 27, 2008, p. 3. “6 million children still die every year from hunger-related illness before their fifth birthday”.
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72. ^ Nube, M. and G.J.M. van dem Boom. "Gender and Adult Undernutrition in Developing Countries." Annals of Human Biology (2003) 30:5:520-537.
73. ^ Third of Iraqi children now malnourished four years after US invasion Reuters. 16 March, 2007
74. ^ "2008 Global Hunger Index Key Findings & Facts". 2008. http://www.ifpri.org/media/200610GHI/GHIFindings.asp. 
75. ^ ^{a b} "'Hunger critical' in South Asia". BBC. 2006. http://news.bbc.co.uk/2/hi/south_asia/6046718.stm. 
76. ^ Survey Says Nearly Half of India's Children Are Malnourished, CBS News, February 10, 2007
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78. ^ Lifting the Curse: Overcoming Persistent Undernutrition in India IDS Bulletin 40(4): 2, July 2009
79. ^ Lifting the Curse: Overcoming Persistent Undernutrition in India IDS Bulletin Vol 40, Number 4, July 2009
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81. ^ "3.5M Kids Under 5 On Verge Of Going Hungry
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External links

Look up malnutrition or undernutrition in Wiktionary, the free dictionary.

This article's external links may not follow Wikipedia's content policies or guidelines. Please improve this article by removing excessive or inappropriate external links. (March 2009)

• Share Our Strength: An organization primarily concerned with hunger problems in developed countries such as the United States.
• The environmental food crisis A study done by the UN on feeding the world population (2009)
• Action Against Hunger - Giving the most basic of Human Rights - The right to Food
• Dan Jakopovich, A Few Basic Facts: On Hunger and Capital, Against the Current, March/April, No.133, 2008.
• The CE-DAT Complex Emergency Database - A source of data on malnutrition and mortality in conflict-affected populations
• A Life Saver Called "Plumpynut", CBS 60 Minutes, October 21, 2007
• MSF Warns More Food Will Not Save Malnourished Children Group Calls for Increased and Expanded Use of New, Innovative Nutritional Products
• Micro-algae Algosophette
• Intergovernmental Institution for the use of Micro-algae Spirulina Against Malnutrition (IIMSAM)
• Reports on World Nutrition Situation The annual reports prepared by UN Standing Committee on Nutrition contain detailed information on common challenges, extent of malnutrition, efforts being taken to address them, and a wealth of other useful information.
• Physical Growth & Nutritional status
• World Hunger Map (from United Nations World Food Programme)
• FAO country statistics
• HungryKids Info on malnutrition from HungryKids
• Fighting Hunger and poverty in Ethiopia (Peter Middlebrook)
• Meds & Food for Kids - Fighting malnutrition in Haiti one child at a time.
• Malnutrition
• And why not Spirulina as solution?
• GAIN - Global Alliance for Improved Nutrition
• School Feeding Programs for Children Interviews with World Food Programme officials about the status of school feeding programs for children in developing countries
• Mother, Infant and Young Child Nutrition & Malnutrition Optimal maternal, infant and young child feeding and caring practices reduce underweight and stunting and set the foundations for appropriate growth.
• Food for Peace: Eisenhower's Unsung Initiative Can Be Obama's Most Powerful Tool for Peace Global hunger article on the History News Network
• "Human Rescue Plan". World Food Programme, 2009 (video).

v • d • e Nutrition disorders (E40-68, 260-269) Hypoalimentation/ malnutrition Protein-energy malnutrition Kwashiorkor · Marasmus · Catabolysis Avitaminosis B vitamins B1: Beriberi/Wernicke's encephalopathy(Thiamine deficiency) · B2: Ariboflavinosis · B3: Pellagra(Niacin deficiency) · B6: Pyridoxine deficiency · B7: Biotin deficiency · B9: Folate deficiency · B12: Vitamin B12 deficiency Other vitamins A: Vitamin A deficiency/Bitot's spots · C: Scurvy · D: Hypovitaminosis D/Rickets/Osteomalacia · E: Vitamin E deficiency · K: Vitamin K deficiency Mineral deficiency Zinc · Iron · Magnesium · Chromium · Selenium (Keshan disease) · Manganese · Molybdenum · Copper · Calcium · Potassium Hyperalimentation Overweight · Obesity Childhood obesity · Obesity hypoventilation syndrome · Abdominal obesity Vitamin poisoning Hypervitaminosis A · Hypervitaminosis D · Hypervitaminosis E Mineral overload see inborn errors of metal metabolism, toxicity nutrition navs: disorders, symptoms+signs/eponymous

v • d • e Diseases of poverty Diseases of poverty AIDS · Malaria · Tuberculosis · Measles · Pneumonia · Diarrheal diseases Neglected diseases Cholera · Chagas disease  · African Sleeping Sickness  · Schistosomiasis  · Schistosomiasis · Guinea worm  · River blindness  · Leishmaniasis Miscellaneous Malnutrition · Priority Review Voucher

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Dansk (Danish)
n. - fejlernæring, underernæring

Nederlands (Dutch)
ondervoeding

Français (French)
n. - malnutrition

Deutsch (German)
n. - Unterernährung

Ελληνική (Greek)
n. - υποσιτισμός

Italiano (Italian)
denutrizione

Português (Portuguese)
n. - desnutrição (f)

Русский (Russian)
недоедание

Español (Spanish)
n. - desnutrición

Svenska (Swedish)
n. - undernäring

中文（简体）(Chinese (Simplified))
营养失调, 营养不良

中文（繁體）(Chinese (Traditional))
n. - 營養失調, 營養不良

한국어 (Korean)
n. - 영양불량

日本語 (Japanese)
n. - 栄養不足, 栄養不良

العربيه (Arabic)
‏(الاسم) سوء تغذيه‏

עברית (Hebrew)
n. - ‮תת-תזונה, תזונה לקויה‬

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