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2. MALNUTRITION IN INDIA

3. INTRODUCTION
CAUSES
CONSEQUENCES
PREVENTION & CONTROL
CONTENT

4. INTRODUCTION
• What is malnutrition?
Malnutrition is a state of nutrition in which a deficiency or
excess (or imbalance) of energy, protein and other
nutrients causes measurable adverse effects on tissue /
body form (body shape, size and composition) and
function and clinical outcome. Wide-ranging changes in
physiological function occur in malnourished patients
leading to increased rates of morbidity and mortality. The
term malnutrition does include obesity, however BAPEN is
focused on the problem of “undernutrition”. BAPEN is a
multi-professional association and registered charity
established in 1992. Its membership is drawn from doctors,
dietitians, nurses, patients, pharmacists and from the
health policy, industry, public health and research sectors.
The Malnutrition Advisory Group (MAG) is a Standing
Committee of BAPEN.

5. TYPES OF MALNUTRITION
• Undernutrition – insufficient food is eaten.
• Overnutrition – consumption of excessive
quantity of food.
• Imbalance – disproportion among essential
nutrients.
• Specific deficiency – relative or absolute lack
of nutrients.

6. CAUSES
• Malnutrition occurs when a person does not receive adequate nutrients from diet.
This causes damage to the vital organs and functions of the body. Lack of food is the
most cause of malnutrition in the poorer and developing countries.
• However, in developed countries like UK or USA the cause may be more varied. For
example, those with a high calorie diet deficient in vital vitamins and minerals are
also considered malnourished. This includes the obese and the overweight.

7. THE CAUSES OF MALNUTRITION INCLUDE
• Lack of food: this is common among the low income group as well
as those who are homeless.
• Those having difficulty eating due to painful teeth or other painful
lesions of the mouth. Those with dysphagia or difficulty swallowing
are also at risk of malnutrition. This could be due to a blockage in
the throat or mouth or due to sores in the mouth.
• Loss of appetite. Common causes of loss of appetite include
cancers, tumors, depressive illness and other mental illnesses, liver
or kidney disease, chronic infections etc.
• Those with a limited knowledge about nutrition tend to follow an
unhealthy diet with not enough nutrients, vitamins and minerals
and are at risk of malnutrition.
• Elderly living alone, disabled persons living alone or young
students living on their own often have difficulty cooking healthy
balanced meals for themselves and may be at risk of malnutrition.

8. • The demand for energy from food exceeds the amount of
food taken. This includes those who have suffered a serious
injury, burn or after major surgical procedures. This also
includes pregnant women and children whose growth and
needs for the unborn baby causes increased demand for
nutrients and calories that may be deficient in a normal
diet.
• Among children lack of knowledge of adequate feeding
among parents is the leading cause of malnutrition
worldwide.
• Premature babies are at a higher risk of malnutrition as are
infants at the time of weaning.
• Childhood cancers, heart defects from birth (congenital
heart disease), cystic fibrosis and other major long term
diseases in children are the leading cause of malnutrition.
• Neglected children, orphans and those living in care homes
are at risk of malnutrition.

9. • The elderly (over 65 years of age are), especially those living in
care facilities are at a higher risk of malnutrition. These
individuals have long term illnesses that affect their appetite
and ability to absorb nutrients from food and they may also
have difficulty feeding themselves. In addition, there may be
concomitant mental ailments like depression that affect
appetite and food intake.
• Those who abuse drugs or are chronic alcoholics.
• Those with eating disorders like anorexia nervosa have
difficulty maintaining adequate nutrition.
• Those with digestive illnesses like ulcerative colitis or Crohn’s
disease or malabsorption syndrome have difficulty in
assimilating the nutrients from diet and may suffer from
malnutrition.
• Those with diarrhea or persistent nausea or vomiting.
• Some medications tend to alter the body’s ability to absorb
and break down nutrients and taking these may lead to
malnutrition.

10. CONSEQUENCES
• What are the consequences of malnutrition?
Malnutrition affects people in every country.
Around 1.9 billion adults worldwide are overweight, while 462 million are
underweight. An estimated 41 million children under the age of 5 years are overweight
or obese, while some 159 million are stunted and 50 million are wasted. Adding to this
burden are the 528 million or 29% of women of reproductive age around the world
affected by anemia, for which approximately half would be amenable to iron
supplementation. (World Health Organization)
Many families cannot afford to access enough nutritious foods like fresh fruit and
vegetables, legumes, meat and milk, while foods and drinks high in fat, sugar and salt
are cheaper and more readily available, leading to a rapid rise in the number of
children and adults who are overweight and obese, in poor as well as rich countries.

11. WHO IS SUFFERING MALNUTRITION
• Malnutrition affects first and foremost children
under the age of two, but young children less than
five years of age, adolescents, pregnant or
lactating mothers, the elderly and the chronically
ill (including those with HIV/AIDS and TB) are also
vulnerable.
• Overall, individuals who reside in developing
countries are more likely to suffer from
malnutrition than those who reside in developed
countries, due to the higher prevalence of poverty
and infectious disease in developing nations.
However, there are a number of factors which may
predispose an individual to malnutrition,
regardless of their area of residence.

13. SYMPTOMS OF MALNUTRITION
• Loss of appetite
• Weight loss – clothes, rings, dentures may become
loose
• Tiredness, loss of energy, skin may become thin, dry
inelastic
• Reduced ability to perform normal tasks
• Reduced physical performance – for example, not
being able to walk as far or as fast as usual
• Altered mood – malnutrition can be associated with
lethargy and depression
• Poor concentration
• Poor growth in children

14. PREVENTION AND CONTROL OF
MALNUTRITION
• Breastfeeding a baby for at least six months is
considered the best way to prevent early-
childhood malnutrition. Talking to a doctor before
putting a child on any kind of diet, such as vegan,
vegetarian, or low-carbohydrate, can help assure
that the child gets the full supply of nutrients that
he or she needs.
• Generally, malnutrition is caused by lack of
nutritional components it can be prevented by
providing special diet such as fruit, vegetable, milk
product, oils, meat and beans etc. with sufficient
amount in timely. There are primary prevention,
secondary prevention and tertiary prevention for
malnutrition.

15. PRIMARY PREVENTION
1. Health Promotion:
• Health education to mothers about good nutrition
and food hygiene health workers
• Distribution of supplements (distribution of iron ,
folic acid and vitamin A)
• Promotion of breastfeeding
• Development of low cost weaning foods
• Measures to improve family diet
• Nutritional education
• Home economics
• Family planning and birth spacing
• Family environment

16. 2. Specific Protection:
• Specific protein diet, eggs, milk, fresh fruit
• Immunization
• Fortification of food
SECONDARY PREVENTION
• Periodic nutrition surveillance.
• Early diagnosis and adequate treatment.
• Early diagnosis of any lag of growth .
• Early diagnosis and treatment of infection including diarrhea.
• Developing the program for early dehydration of children with diarrhea.
• Developing supplementary feeding program during epidemics.
• Regular deworming of school and preschool children.

17. TERTIARY
PREVENTION
• Nutritional rehabilitation.
• Nutritional rehabilitation
services.
• Hospital treatment .
• Follow up of cases.