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Nutritional Management | Causes and Types of Malnutrition

Nutritional Management | Causes of Malnutrition, Types and Ways of Nutritional Management


Malnutrition a deficiency or excess of one or more minerals, vitamins or other essential ingredients may arise from malobsorption of digested food or metabolic malfunction of own or more parts of the body as well as from an unbalanced diet. Poor eating habits in children under the age of 5 can often be traced directly with malnutrition. In the context of developing countries malnutrition is used to denote under nutrition or deficiency of food nutrients in diet (DOHS 2004/05: 29).

Malnutrition is one of the leading causes of morbidity and mortality in childhood ages. It is not limited to the poor nor is good nutrition a monopoly of the rich. Well-being is determined by what people eat, the way they live or are cared for and how they react to their environment preventing. Malnutrition must start with satisfying the basic and changing physiological needs of human beings from before conception to old age. A healthy diet includes carbohydrates, fats, protein, minerals and vitamins. When the intake and balance of these essential nutrients are insufficient, growth and development falter and risk of infection and nutritional disorder increase. A nation’s most valuable asset is its health, well- fed children losing growing up in innumerable homes all over the country. All parents want to take best possible care of their children, who are the future citizens. However, in the rural areas, the parental care offered seriously falters, because the parents do not know what the best way is for their children.

In the context of Nepal 31percent of people especially in rural areas live below the poverty line and they can’t buy sufficient food to eat (NDHS, 2006). Surveys have shown that Nepal has one of the highest malnutrition rates among developing countries. Poor nutrition is recognized as one of the main reason for high infant and child mortality in Nepal. Malnutrition remains serious obstacle to survival, growth and development.

Malnutrition is a major problem among the children in Nepal. The low weight deliveries, which account for 29 percent of the total birth reflects the poor maternal status during pregnancy. Statistics on average weight gained during pregnancy for Nepal are not available this is very low in the whole region i.e.5 to 7 k.g. The most prevalent of nutritional problem affecting children living in an economical impoverished environment is protein energy malnutrition (PEM). This affects 1.7 million children of under 5 years. The other forms of malnutrition are iodine deficiency disorder (IDD), vitamin A deficiency and iron deficiency anemia (IDA).

Protein Energy Malnutrition is one of the most prevalent problems of nutrition causing death and disability among children in developing countries like Nepal. Growth retardation and wasting are the main symptoms of PEM. It occurs particularly in weakling and children in the first years of life. It is not only an important cause of childhood morbidity and mortality. But leads to permanent impairment of physical and possibly of mental growth of those who survive.

Causes of Malnutrition

  • Inadequate or improper food intake
  • Impaired absorption
  • Excessive loss from the body – It occurs in almost all chronic diseases e.g. chronic diarrhea, chronic Renal/ failure e.t.c.

Infection may also lead to malnutrition. When a child has infection, does not eat properly and his metabolism is also reduced, more over him may have episodes of diarrhea.

Types of Malnutrition

The basic etiological factors of PEM are inadequate food intake, birth in quality and quantity. This is primarily due to poverty, ignorance, infections and parasitic diseases, not ably diarrhea, respiratory infections measles and intestinal worms. In fact it is a vicious circle, contributing to infection by weakening the child. There are other numerous contributing factors as the family size, maternal health and failure of lactation, premature termination of breast feeding and adverse cultural practices relating to child rearing, long working hours for mothers and low literacy status of women are the main factors (park 2000, pp 428- 429).

Runche (moderate undernutriton)


Kwashiorkor is one of the serious forms o protein energy malnutrition. it is seen most frequently in children one to three years of age, but it may occur at any age. It is found in children who have a diet that is usually insufficient in energy and protein often in other nutrients. Often the food provided to the child is mainly due carbohydrate; it may be very bulky, it may not be provided very frequently.

Kwashiorkor is often associated with, or even precipitated by, infectious diseases. Diarrhea, respiratory infections, measles, whooping cough, intestinal parasites, and other infections are common underlying causes of protein energy malnutrition and may precipitate children into either kwashiorkor or nutritional marasmus. These infections often result in loss of appetite, which is important as a cause of serious protein energy malnutrition. Infections, especially those resulting in fever, lead to an increased loss of nitrogen from the body, which can only replaced by protein in the diet.

Nutritional Marasmus

In most countries marasmus, the other severe form of protein energy malnutrition is now much more prevalent than kwashiorkor. In marasmus the main deficiency is one of food in general, and therefore also of energy. It may occur at any age, most commonly up to about three and a half years, but in contrast to kwashiorkor it is more common during the first year of life. Nutritional marasmus is in fact a form of starvation, and the possible underlying causes are numerous.For what ever reason, the child does not get adequate supplies of breast milk or of any alternative.

Perhaps the most important precipitating causes of marasmus are infectious and parasitic diseases of childhood. These include measles, whooping cough, diarrhea, malaria and other parasitic diseases. Chronic infections such as tuberculosis may also lead to marasmus. Other causes of marasmus are premature birth, mental deficiency and digestive upsets such as mal- absorption or vomiting. A very common cause is early cessation of breastfeeding.

Marasmic- Kwashiorkor

Children with features of both nutritional marasmus and kwashiorkor are diagnosed as having marasmic kwashiorkor. In the Wellcome classification this diagnosis is given for a child with severe malnutrition who is found to have both oedema and a weight for age below 60 percent of that expected for his or her age. Children with marasmic kwashiorkor have all the features of nutritional marasmus including severe wasting, lack of subcutaneous fat and poor growth, and in addition to oedema, which is always present, they may also have any of the features of kwashiorkor described above. There may be skin changes including flaky- paint dermatosis, hair changes, mental changes, and hepatomegaly. Many of these children have diarrhea.

Nutritional Dwarf

On casual observation the nutritional dwarf may appear perfectly normal. It is only when the age of the patient is known that the short stature becomes apparent. However, dental development is less retarded than height, so that the facial shape of these children is inappropriate for their size. Nutritional dwarf is the less serious form of malnutrition. It is found in children who have a diet that is usually insufficient in energy and protein and often in other nutrients.

Factors Affecting Malnutrition

Family size

Wary and Aguire (1969) showed in their study in Colombia that the rate of PEM in children in families of four or fewer was lower than the rate of families with five or more children and the rate was increased with the increasing number of children.

Mamarbachi, D. (1980) also found the same result in their study in Tripoli, Riley. They stated that 84 percent of anemic children came from families, which had more than 8 children.

Breast feeding

The most appropriate for an infant is the child’s own mother’s milk. A healthy infant can suck within few minutes of the birth and indeed it is recommended that they should do so in order to establish a breast feeding.

Ahn and Maclean (1983) found that exclusive breast feeding in the first six months of life can provide full nutrition and a sources of vitamin A, C, D is recommended until 8 to 10 months when the child has weaned.

Birth interval /spacing

Wary and Aguirre (1969) and Lambart (1982) studied the birth interval of children. The former study was in Colombia and the later was in the south pacific. Both studies found that the prevalence of malnutrition was very high in children whose birth interval was less than 3 years. Wary and Aguirre suggested from their finding that “an interval of at least three years between children in this community protect the older child, to some extent from malnutrition.” The birth interval in the south pacific in the past was 2 or 3 years but due to the effect of urbanization it is now only 1 year.

Supplementary Feeding

Regarding the time of introduction of supplementary foods, many researchers have reported that before the age of 4 months, supplementary feeding does not have any significant benefit (Becroft and Bailey, 1965). Babies who are breast fed milk on demand generally grow normally for 4 to 6 months. The faltering of growth is likely to start after six months of age and the child will develop mild to moderate PEM and many become seriously malnourished. (Thompson and Black, 1975)

Knowledge of mother on nutrition

Knowledge of mother on nutrition play an important role in the nutrition of child because it can affect length of breast feeding the timing of weaning periods the types of supplementary food and other factors.

Many studies of children on malnutrition find a relationship between knowledge on nutrition and PEM. UNICEF (1996), found that the average of children whose mother had higher knowledge on nutrition was higher than those of lower knowledge. PEM was least common in children those mothers who had higher knowledge of nutrition.

Nutritional Management

  • Growth monitoring
  • Oral dehydration therapy
  • Breast feeding and birth spacing
  • Immunization

In short for they are called GOBI.

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