What is malnutrition?
Malnutrition is a condition that develops when the body does not get the right amount of the nutrients it needs to maintain healthy tissues and organ function. It includes conditions, such as undernutrition, overnutrition and micronutrient deficiency diseases (like vitamin A deficiency, iron deficiency anaemia, iodine deficiency disorders and zinc deficiency).
Malnutrition affects MOSTLY people of the following categories:
⦁ Infants and children from pregnancy to two (2) years of age
⦁ Non-breastfed children
⦁ Pregnant and lactating women
⦁ People suffering from chronic or infectious disease
⦁ People are food insecure
Types of malnutrition
a) Undernutrition
This is a nutrition a deficiency resulting from inadequate intake of food or inability of the body to convert or absorb food. Undernutrition is the most common and easily observable type of malnutrition. Undernutrition often presents itself in two forms: acute and chronic.
1) Underweight/wasting
Acute malnutrition takes place within a short time and can present loss of muscles in bulk. When severe, presents with visible wasting (prominence of bones) and/or symmetrical swelling of the body starting from both feet.
2) Chronic nutrition Stunting
A child’s height is one of the most important indicator of his/her wellbeing. Height reflects the accumulated total of early-life health and diseases. The problems that prevent children from growing tall also prevent them from growing into healthy, productive, smart adults. Height predicts adult economic outcomes. Chronic undernutrition that affects children right from pregnancy to 5 years of age affects their growth and leads to reduced growth in stature (short-for-age). Chronic malnutrition is due to prolonged long term deprivation of proper nutrients/foods to children
b) Micronutrient malnutrition (lack of minerals and vitamins)
This type of malnutrition is called “hidden hunger;” and is due to inadequate intake of dietary mineral salts and vitamins leading to vitamin mineral deficiencies (VMDs). This form of malnutrition cannot be identified easily except in advanced stages when clinical signs appear. Minerals and vitamins are required by the body in very small quantities, they are very important in protecting the body against infections. Usually, their absence in the diet does not cause a person to “feel hungry.”
Micronutrient deficiency disorders of public health significance in Uganda are:
⦁ Iron deficiency anaemia (IDA)
⦁ Vitamin A deficiency (VAD)
⦁ Iodine deficiency disorder (IDD)
⦁ Zinc deficiency disorder (ZDD)
c) Overnutrition
This is the excessive intake of nutrients in foods over a given period of time exposing individuals to poor health. Overnutrition results in overweight, obesity, or vitamin toxicity. Overnutrition may be caused by any of the following factors:
⦁ Eating habits (overeating)
⦁ Health conditions
⦁ Taking too many unprescribed dietary supplements
⦁ Lack of physical activity (sedentary lifestyle)
⦁ Psychological factors (stress)
⦁ Environmental factors (unsafe foods, e.g., heavy metals in food, peer pressure)
⦁ Medication
⦁ Genetic factors
Prevalence of malnutrition in Uganda
Malnutrition is one of the main public health and economic and development problems facing Uganda. Children below the age of five years and women in reproductive age including pregnant women and lactating mothers are mostly affected (UDHS 2011). Children below the age of 5 years suffer mostly from under nutrition with:
⦁ 33% of these children suffer from chronic undernutrition (they are stunted)
⦁ 14% are underweight (body weight too light for their age)
⦁ 49% suffer from iron deficiency anaemia (lack of iron/blood)
⦁ 60% suffer from different forms of iodine deficiency disorders (IDD)
⦁ Likewise women in reproductive age (15–49 years) also suffer from malnutrition:
⦁ 52% of pregnant women and lactating mothers have vitamin A deficiency
⦁ 23% suffered from iron deficiency anaemia
Causes of malnutrition?
There are several interconnected causes of malnutrition, ranging from policy issues to underlying community and cultural situations to house hold conditions and are commonly categorized into immediate causes, underlying cause and basic causes.
Immediate causes include:
⦁ Inadequate dietary intake including poor quality and quantity of food in the diet (poor dietary diversity).
⦁ Infection and diseases such as malaria, diarrhoeal diseases, acute respiratory infections, measles and worm infestations.
⦁ Low intake of foods rich in appropriate nutrients.
⦁ Low intake of substances like vitamin C that enhance nutrient absorption.
⦁ High intake of factors like phytates and tannins that inhibit nutrient absorption.
⦁ Food insecurity.
Underlying causes include:
⦁ Household food insecurity including poor access to a diverse diet, inadequate quantity of food available and accessible, and seasonal fluctuations in food availability.
⦁ Inadequate maternal and childcare, including suboptimal maternal
⦁ nutrition and infant feeding practices, often a result of heavy workloads for women and frequent births.
⦁ Poor access to healthcare and inadequate water and sanitation,leading to increased illness.
⦁ Inadequate and/or incorrect feeding practices.
⦁ Inadequate caring capacity for example inadequate time, inadequate knowledge.
⦁ Low levels of family education, awareness, knowledge and motivation.
⦁ Intrahousehold maldistribution of access to food, health services and care.
⦁ Poor food preparation, storage, preservation and processing practices at household levels.
⦁ Beliefs and practices that restrict access to certain foods for some family members (food taboos).
⦁ Poor health services and/or agricultural infrastructure.
⦁ Lack of institutional capacity in nutrition and/or personnel trained in the various components of community nutrition programs.
⦁ Low production of diversified nutritious foods.
⦁ Lack of household level gardening.
⦁ Insufficient marketing infrastructure for key food.
⦁ Poorly developed commercial food processing industry.
Basic causes include:
⦁ Limited livelihood opportunities and unequal economic structure.
⦁ Inadequate educational opportunities.
⦁ Priorities guiding the allocation of public funding and other resources.
⦁ Quality of social and political leadership, e.g., poor economic or physical access to markets.
⦁ Little or no productive land.
⦁ High prevalence of certain endemic diseases, e.g., tuberculosis and HIV/AIDS.
⦁ Low status of and lack of resource control by women.
⦁ Failure to consider nutrition needs in agriculture and health policy-making.
⦁ Lack of resources to produce nutrient-rich foods.
⦁ Poor economic or physical access to markets.
⦁ Little or no productive land.
⦁ Lack of access to safe water for drinking, hygiene and/or irrigation.
⦁ Seasonality of food availability.
⦁ Low status of and lack of resource control by women.
Consequences (Cost) of Malnutrition
a) Consequences of Undernutrition
⦁ Malnutrition, especially undernutrition, has grave consequences, including child deaths, diseases, and disabilities:
⦁ Child Mortality: Newborns with low birth weight—less than 2.5 kg—are at a higher risk of mortality compared to babies born with normal weight. For example, a severely stunted child is four times more likely to die than a healthy one, while a severely wasted child has up to nine times the chance of dying compared to a healthy child (Lancet, 2008).
⦁ Micronutrient Deficiencies: Lack of important micronutrients like vitamin A, zinc, and iron weakens the immune system, increasing susceptibility to illnesses and even death. For instance, anemia raises the risk of maternal and perinatal deaths for both the mother and infant during pregnancy and early life. Vitamin A deficiency can also cause blindness.
⦁ Socioeconomic Consequences: Malnutrition reduces physical productivity, health, and educational attainment, all of which negatively impact socioeconomic development, especially in countries like Uganda.
⦁ Long-Term Economic Consequences: Malnutrition carries effects into adulthood by reducing individuals’ earning capacity and overall economic productivity.
Malnutrition decreases productivity and economic growth
⦁ When malnourished individuals are sick, they are weak and cannot perform their daily work for example sick farmers.
⦁ Individuals with iron deficiency anaemia (particularly women) become tired easily and cannot work for longer hours.
⦁ Shortage of iodine decreases IQ and causes a productivity loss.
⦁ Farmers with low literacy levels are less likely to adopt improved agricultural practices hence leading to poor agricultural production and productivity.
⦁ People with low literacy levels are bound to have poor health seeking behaviours and access to quality health services.
⦁ Mothers with low education level are likely to follow poor feeding practices hence affecting the nutritional and health status of family members.
⦁ Contributes to poverty.
⦁ Cost of treating illnesses attributable to malnutrition.
b) Consequences of overnutrition
Malnutrition can lead to multiple medical conditions including:
⦁ Coronary heart disease (heart attack)
⦁ Diabetes (high blood sugar)
⦁ Gout (swollen painful joints)
⦁ Hypertension (high blood pressure)
⦁ Overweight
⦁ Obesity
⦁ Death
LOW-CARBOHYDRATE DIETS
There is no single authoritative definition of a low-carbohydrate diet, and in the absence thereof, such diets are generally defined by their common focus—namely, restricting intake of total carbohydrate below some particular threshold. A reasonable, operational definition may be derived from the Dietary Reference Intakes of the Institute of Medicine, which establish the recommended range for normal carbohydrate intake at between 45% and 65% of total calories (45). Total mean daily carbohydrate intake below 45% of total calories is therefore a low-carbohydrate diet. Interest in carbohydrate-restricted diets is long-standing, particularly in the context of diabetes management, and especially during the era before the advent of insulin therapy.
Interest in low-carbohydrate eating resurged over recent decades, in the context of epidemic obesity and the pursuit of effective strategies for weight loss and weight control (77, 79, 80). In particular, low-carbohydrate advocacy has tended to emphasize the population-level failures of low-fat recommendations for weight control and chronic disease prevention (2). Such assertions are a valid appraisal of prevailing nutritional epidemiology but almost certainly misrepresent the underlying intentions of the dietary guidance in this case, and many others, as discussed below (86). Intervention studies of short to moderate duration demonstrate the efficacy of lowcarbohydrate diets for weight loss, with potentially beneficial metabolic effects and favorable implications for quality of life (19, 20, 32, 41, 52, 117, 144, 163, 165). Such studies cannot and do not, however, unbundle the effects of (a) carbohydrate restriction per se, on which the theory of the approach is predicated, and (b) calorie restriction, which is a virtually inevitable concomitant of choice restriction in general (80), and, perhaps especially, (c) restriction directed at carbohydrate, which constitutes the macronutrient class that provides the majority of calories for almost all omnivorous species (77). Carbohydrate-restricted diets are calorie restricted as well. In the absence of calorie restriction, high-protein, low-carbohydrate diets can contribute to weight gain and adverse metabolic effects (147). However, metabolic benefits of low-carbohydrate dieting under diverse circumstances have been reported (47, 73, 159). This covariance of carbohydrate and calorie intake complicates the assessment of the metabolic effects of low-carbohydrate eating. Most relevant intervention studies involve weight loss, with attendant cardiometabolic benefits. If and when improvement in cardiometabolic biomarkers is induced by the acute phase of weight loss, the determination of specific concurrent effects of dietary pattern on those same indices is precluded. Low-carbohydrate eating may augment or attenuate the cardiometabolic benefits of the weight loss induced by caloric restriction. The relevant literature remains equivocal, with most studies suggesting benefit from low-carbohydrate eating per se incomparison, generally, to either the typical Western diet or some version of a low-fat diet, with persistent concerns and uncertainty about longer-term effects on health outcomes (18, 39, 95). Low-carbohydrate diets, of necessity, shift dietary intake to relatively higher levels of fat and/or protein as a percentage of total calories. The literature addressing high-protein diets thus constitutes an extension of the low-carbohydrate theme. In the context of widespread obesity, protein is noteworthy for its high satiety index (14), and high-protein intake offers the potential benefits related to enhanced satiation.
LOW-GLYCEMIC DIETS
The particular focus of low-glycemic diets is on limiting the overall dietary glycemic load by restricting the intake of foods with a high glycemic index and/or glycemic load. This often extends to the exclusion of certain vegetables and many if not all fruits, along with processed foods containing refined starches and/or added sugars. No particular threshold value for glycemic load is consistently invoked, however. In an age of epidemic diabetes, attention to the glycemic effects of food is sensible at the least. Federal authorities have declined the incorporation of the glycemic index or glycemic load into population-level dietary guidance, citing the state of evidence (152). This position may pertain more to the challenges of measuring and communicating glycemic metrics than to the availability of trial data, however. Clinical trial data are available and generally support efforts to reduce the glycemic load of the diet. Studies focused on this strategy have demonstrated benefits in the areas of weight loss, insulin metabolism, diabetes control, inflammation, and vascular function (108). Benefits have been seen in studies of both adults and children (118). Conversely, a high dietary glycemic load has been associated with adverse health effects. A recent meta-analysis concluded that high glycemic load and index are associated with increased risk of cardiovascular disease, especially for women (109). Often absent from discussions of low-glycemic diets is the consideration that, as with other dietary categories, there are various means to the same ends. McMillan-Price et al. studied alternative approaches to achieving a reduced glycemic load (116) and demonstrated that a highfiber, mostly plant-based approach offered metabolic advantages over a high-protein approach.
