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Learning objectives

• At the end of this lesson you will be able to
• define the concept of malnutrition
• identify the factors influencing nutritional
  status and
• be aware of the relationships between nutrition,
  food security,
• health and mortality.

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Introduction
What are the factors affecting an individuals
nutritional status?

• Understanding these factors is essential in order
  to
• assess malnutrition,
• design programmes which tackle nutrition
• problems, and
• correctly inform programme management
• and evaluation.

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What is malnutrition?
The term malnutrition indicates a bad nutritional
status.

• Nutritional status is the physiological state of
  an individual, which results from
• the relationship between nutrient intake and
  requirements, and
• the bodys ability to digest, absorb and use
  these nutrients.

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What is malnutrition?
A distinction must be made between Malnutrition
and Undernutrition

• It arises either
• from deficiencies or excesses of specific
  nutrients, or
• from undiversified diets (wrong kinds or
  proportions of foods).

Malnutrition
It is the outcome of insufficient food. It is
caused primarily by an inadequate intake of
dietary or food energy.
Undernutrition
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What is malnutrition?
In many developing countries, under and
overnutrition are occurring simultaneously among
different population groups.
This phenomenon is referred to as the double
burden of malnutrition.
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Causes of malnutrition
Poverty is the root cause of malnutrition. (The
underlying causes are food security, health and
care).
However, overnutrition and dietary imbalances
cut across many socio-economic boundaries.
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Causes of malnutrition
Nutritional status is influenced by multiple and
interrelated factors.
The most important factors can be grouped under
these broad categories
FOOD
HEALTH
CARE
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Causes of malnutrition
Food, health and care are interrelated actions
affecting one area may have significant
consequences on another.
Development policies usually are not included in
the domain of nutrition as such. However, they
impact considerably on the nutritional well-being
of the population.
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Conceptual frameworks
This is the most commonly used framework for
understanding the causes of malnutrition. (adapted
from the UNICEF conceptual framework).
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Conceptual frameworks
Another conceptual framework for
malnutrition the Food Insecurity and
Vulnerability Mapping System (FIVIMS) framework
for food security, livelihoods and nutrition.
Socio-economic and political environment
Care practices
Food consumption

• Performance of the food economy
• availability
• access
• stability

Nutritional status
Food utilization
Health and sanitation
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Nutritional status, health, mortality and low
birth weight
It is important to consider the relationships
between nutritional status and health status,
mortality and low birth weight.
NUTRITIONAL STATUS
LOW BIRTH WEIGHT
Lets see these relationships more in detail...
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Nutritional and health status
Nutrition and health are closely linked
NUTRITIONAL STATUS
disease contributes to malnutrition
HEALTH STATUS
while malnutrition makes an individual more
susceptible to disease.
This can eventually lead to severe malnutrition
and death.
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Nutritional and health status
This vicious cycle is known as the
malnutrition-infection cycle
INADEQUATE DIETARY INTAKE
Weight loss, growth faltering and reduced
immunity, which lower the bodys ability to
resist infection.
leads to
this causes
this results in
Loss of appetite, malabsorption of nutrients,
altered metabolism and increased nutrient needs.
Longer, more severe and more frequent disease
episodes.
leads to
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Nutritional and health status

• Certain diseases are particularly frequent causes
  of poor growth, for example
• diarrhoea,
• respiratory infections,
• HIV/AIDS and
• malaria.

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Nutritional and health status
The relationship between nutrition and disease
can be observed in the seasonal changes in
nutritional status.

• Many communities experience periods in the year
  when malnutrition levels are higher. These are
  influenced by seasonal patterns such as
• cropping patterns,
• food availability,
• disease,
• child care,
• income sources,
• price of foods,
• labour demand.

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Nutritional status and mortality
Mortality increases exponentially with declining
nutritional status.
NUTRITIONAL STATUS
Many factors that impact mortality are often
compromised in situations of conflict and
displacement. In emergencies there may be
varying levels of mortality associated with the
same level of malnutrition.
MORTALITY
Consequently, mortality rates cannot be predicted
from prevailing rates of malnutrition.
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Nutritional status and low birth weight
It is estimated that each year 24 million babies
are born with low birth weight (LBW)-less than
2.5 kg.Ninety five percent of these events occur
in developing countries.
The most significant cause is poor maternal
nutrition.
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Nutritional status and low birth weight
The cycle of poor nutrition perpetuates itself
across generations. This diagram by the Standing
Committee on Nutrition shows the
intergenerational cycle of growth failure
Child growth failure
Low weight and height in teenagers
Low birth weight baby
Early pregnancy
Small adult woman
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Summary

• Malnutrition refers to all deviations from
  adequate nutrition, including undernutrition (and
  overnutrition) resulting from inadequacy (or
  excess) of food.
• Malnutrition carries heavy human and economic
  costs on individuals and households, communities
  and nations. Malnutrition and undernutrition are
  often used as synonyms. However, a clear
  distinction needs to be made at all times.
• The co-existence of undernutrition,
  micronutrient deficiencies, overweight/obesity
  and other nutrition-related chronic diseases
  occurs in the same countries, in the same
  communities and even in the same households
  throughout the world today, posing one of the
  greatest challenges to national policy makers.
  This phenomenon is referred to as the double
  burden of malnutrition.
• Even if poverty is the root cause of
  undernutrition, malnutrition has multiple and
  interrelated causes. The direct causes of
  malnutrition can be grouped under the broad
  categories of food, health and care.

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If you want to know more...

• Nutrition and development a global challenge -
  adapted from Nutrition and development - a global
  assessment, written by FAO and WHO for the
  International Conference on Nutrition, 1992.
• United Nations Standing Committee on
  Nutrition/Administrative Committee on
  Coordination (ACC/SCN) Second report on the World
  Nutrition Situation Vol.1 Global and Regional
  Results, ACC/SCN Geneva, 1992.
• The double burden of malnutrition Case studies
  from six developing countries. FAO Food and
  Nutrition Paper 84, Rome 2006. http//www.fao.org/
  docrep/009/a0442e/a0442e00.htm
• Measurement and Assessment of Food Deprivation
  and Undernutrition - FIVIMS Proceedings,
  International Scientific Symposium held in FAO,
  Rome 26-28 June 2002. FAO 2003.
  http//www.fao.org/DOCREP/005/Y4249E/Y4249E00.HTM
• Conducting small-scale nutrition surveys A
  field manual. FAO, 1990, 186p, English, Spanish,
  French ISBN 202851. http//www.fao.org/docrep/009/
  a0442e/a0442e00.htmContents
• Body mass index - A measure of chronic energy
  deficiency in adults. FAO Food and Nutrition
  Paper 56, 1994. http//www.fao.org/docrep/T1970E/T
  1970E00.htm

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If you want to know more...

• United Nations Standing Committee on Nutrition
  Issue No. 33 Diet-related Chronic Diseases and
  the Double Burden of Malnutrition in West Africa,
  2006, pages 18-20.
• http//www.unsystem.org/scn/Publications/SCNNews/s
  cnnews33.pdf.
• Incorporating Nutrition Considerations into
  Development Policies and Programmes Brief for
  Policy-Makers and Programme Planners in
  Developing Countries, FAO 2004.
  http//www.fao.org/docrep/007/y5343e/y5343e00.htm
• The State of Food Insecurity in the World
  (SOFI) monitoring progress towards the World
  Food Summit and Millennium Development Goals
  (FAO-SOFI, 2004)
• http//www.fao.org/docrep/007/y5650e/y5650e00.htm