introduction on malnutrition essay

Privacy and cookies policy

We use cookies on our website to help us understand how you use the site and to make improvements. These may be used to track your visit to our website or to enable us to personalise your browsing experience, and they may be shared with Google Analytics so that your data can be processed. Privacy and cookies policy

Introduction

Why malnutrition matters.

Malnutrition is a universal problem that has many forms. It affects most of the world’s population at some point in their lifecycle, from infancy to old age. No country is untouched. It affects all geographies, all age groups, rich people and poor people, and all sexes. It is a truly universal problem.

Malnutrition manifests itself in many ways, all of them distinctive (Box 1.1), but all of them overlapping in countries, communities, households and people. While anyone can experience malnutrition, people who are particularly vulnerable include young children, adolescent girls, pregnant and lactating women, older people, people who are ill or immuno-compromised, indigenous people and people in poverty. Groups migrating or displaced due to conflicts, droughts, floods and other natural disasters, famines or land tenure issues are also at acute risk and vulnerable to malnutrition.

Collectively, malnutrition is responsible for more ill health than any other cause – good health is not possible without good nutrition. All forms of malnutrition are associated with various forms of ill health and higher levels of mortality. Undernutrition explains around 45% of deaths among children under five, mainly in low and middle-income countries. [1] The health consequences of overweight and obesity contribute to an estimated 4 million deaths (7.1% of all deaths) and 120 million healthy years of life lost (disability-adjusted life years or DALYs) [2] across the global population (4.9% of all DALYs among adults). [3]

Malnutrition is also a social and economic problem, holding back development across the world with unacceptable human consequences. Malnutrition costs billions of dollars a year and imposes high human capital costs – direct and indirect – on individuals, families and nations. Estimates suggest that malnutrition in all its forms could cost society up to US$3.5 trillion per year, with overweight and obesity alone costing US$500 billion per year. [4] The consequences of malnutrition are increases in childhood death and future adult disability, including diet-related non-communicable diseases (NCDs), as well as enormous economic and human capital costs. [5]

Conversely, as detailed in the 2017 Global Nutrition Report , improving nutrition can have a powerful and positive multiplier effect across multiple aspects of development, including poverty, environmental sustainability, and peace and stability. As the late Kofi Annan, former UN Secretary-General, wrote in 2018, “Nutrition is one of the best drivers of development: it sparks a virtuous cycle of socioeconomic improvements, such as increasing access to education and employment.” Without significant progress to end malnutrition in all its forms, countries will simply not be able to attain the Sustainable Development Goals (SDGs) set out to transform our world by 2030.

Malnutrition has many different causes working at different levels. Access to water, sanitation and hygiene, income, education and quality health services are all important. A common cause across all forms of malnutrition is a suboptimal diet (including inadequate breastfeeding for babies). Poor diets are the second-leading risk factor for deaths and DALYs globally, accounting for 18.8% of all deaths, of which 50% are due to cardiovascular disease. [6] While improving diets alone is not necessarily enough to address malnutrition, it is a necessary component of reducing disability and death from malnutrition across all ages and income brackets.

BOX 1.1 The many forms of malnutrition

Undernutrition – lack of proper nutrition, caused by not having enough food, not eating enough food containing substances necessary for growth and health, and other direct and indirect causes.

Stunting in children under five – a form of growth failure which develops over a long period of time in children under five years of age when growing with limited access to food, health and care. Stunting is also known as ‘chronic undernutrition’, although this is only one of its causes. In children, it can be measured using the height-for-age nutritional index. Stunting is often associated with cognitive impairments such as delayed motor development, impaired brain function and poor school performance, as it often causes these negative impacts.

Wasting in children under five – children who are thin for their height because of acute food shortages or disease. Also known as ‘acute malnutrition’, wasting is characterised by a rapid deterioration in nutritional status over a short period of time in children under five years of age. Wasted children are at higher risk of dying. In children, it can be measured using the weight-for-height nutritional index or mid-upper arm circumference (MUAC). There are different levels of severity of acute malnutrition: moderate acute malnutrition (MAM) and severe acute malnutrition (SAM).

Micronutrient deficiencies – suboptimal nutritional status caused by a lack of intake, absorption or use of one or more vitamins or minerals. Excessive intake of some micronutrients may also result in adverse effects. The international community has focused on several micronutrients that remain issues globally including iron, zinc, vitamin A, folate and iodine, as they are the most difficult to satisfy without diverse diets. One general indicator of micronutrient deficiencies is anaemia, as this syndrome is caused by the deficiency of many of them, and its effects are exacerbated by several diseases.

Moderate and severe thinness or underweight in adults – a body mass index (BMI) less than 18.5 indicates underweight in adult populations while a BMI less than 17.0 indicates moderate and severe thinness. It has been linked to clear-cut increases in illness in adults studied in three continents and is therefore a further reasonable value to choose as a cut-off point for moderate risk. A BMI less than 16.0 is known to be associated with a markedly increased risk for ill health, poor physical performance, lethargy and even death; this cut-off point is therefore a valid extreme limit.

Overweight and obesity in adults – the abnormal or excessive fat accumulation that may impair health. BMI is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. Overweight and obesity are major causes of many NCDs, including non-insulin-dependent diabetes mellitus, coronary heart disease and stroke. They also increase the risks for several types of cancer, gallbladder disease, musculoskeletal disorders and respiratory symptoms.

Source: UNICEF for undernutrition, World Health Organization (WHO) for overweight, WHO for thinness and child overweight, WHO for anaemia. [7]

Commitments and targets to track progress to end malnutrition

Recognising the seriousness of malnutrition for global health, in 2012 and 2013, the member states of the World Health Organization (WHO) adopted a series of targets to significantly reduce the burden of many of these forms of malnutrition by 2025 (Figure 1.1). Adopted through two separate resolutions at its annual meeting, the World Health Assembly, the targets recognised the need to reduce many of the different forms of malnutrition. In 2012, the ‘Comprehensive implementation plan on maternal, infant and young child nutrition’ included targets on stunting and wasting among children under five years of age, anaemia among women of reproductive age and low birth weight among newborns. It also committed to no increase in childhood overweight and to increase the rate of exclusive breastfeeding of babies under six months old.

One year later, the World Health Assembly adopted the Global Monitoring Framework for the Prevention and Control of NCDs, which sets ‘voluntary’ targets to monitor progress in achieving targets on the four NCDs that cause the greatest amount of deaths, three of which have diet-related causes (cardiovascular disease, diabetes and some cancers) and their risk factors. Four of these targets are relevant for nutrition, to: reduce salt intake, and (related to that) reduce raised blood pressure; reduce overall mortality from cardiovascular disease, cancer and diabetes, and halt the rise in diabetes and obesity.

Recognising the importance of nutrition for development, in 2015, UN member states adopted an ambitious target: to “end malnutrition in all its forms” by 2030 as part of the SDGs (target 2.2). The SDGs also included a target to reduce mortality from NCDs by one third (target 3.4). Together these significantly overlap with the 2025 targets [8] with a broader emphasis: ending malnutrition in all its forms at all parts of the lifecycle. [9] This emphasis was taken forward by the UN Decade of Action on Nutrition 2016–2025, adopted in 2015 by the UN to accelerate implementation of action towards SDG target 2.2 and help realise the commitments made at the Second International Conference on Nutrition in 2014.

FIGURE 1.1 2025 targets for nutrition

The global nutrition targets 2025 are as follows: Target 1 is a 40% reduction in the number of children under 5 who are stunted. This is defined as children aged 0–59 months who are more than 2 standard deviations below the median height-for-age of the WHO Child Growth Standards. Target 2 is a 50% reduction of anaemia in women of reproductive age. Prevalence of anaemia is the percentage of pregnant women whose haemoglobin level is less than 110 grams per litre at sea level or the percentage of non-pregnant women whose haemoglobin level is less than 120 grams per litre at sea level. Target 3 is a 30% reduction in low birth weight. This is defined as infants born in each population and over a given period who weigh less than 2,500 grams. Target 4 is no increase in childhood overweight. This is defined as children aged 0–59 months who are more than 2 SD above the from median weight-for-height of the WHO Child Growth Standards. Target 5 is an increase in the rate of exclusive breastfeeding in the first 6 months to at least 50%. This is defined as infants 0–5 months of age who are fed exclusively with breast milk. Target 6 is to reduce and maintain childhood wasting to less than 5%. This is defined as children aged 0–59 months who are more than 2 SD below the median weight-for-height of the WHO Child Growth Standards. The global non-communicable disease targets for 2025 (diet-related) are as follows: Target 4 is a 30% relative reduction in mean population intake of salt. This is defined of mean population recommended intake is 2g/day. Target 6 is TARGET: A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure according to national circumstances. Raised blood pressure is defined as blood pressure, systolic and/or diastolic blood pressure ≥140/90 mmHg, aged 18 or over. Target 7 is to halt the rise in obesity and diabetes. Adult overweight is defined as BMI ≥25 kg/m2. Adult obesity is defined as BMI ≥30 kg/m2. Diabetes is defined as fasting glucose ≥7.0 mmol/L, on medication for raised blood glucose or with a history of diagnosis of diabetes, aged 18 or over.

• http://www.who.int/nutrition/global-target-2025/en

The Global Nutrition Report – tracking progress of commitments and actions

Since 2014, the Global Nutrition Report has existed to keep track of progress against these targets, along with the financing, commitments and actions designed to reach them. Drawing on internationally collected data, the basic picture to have emerged from the report in the past five years (2014–2018) is clear: the burden of malnutrition remains high, and not enough progress has been made to reduce malnutrition. Through tracking the financing, commitments and actions designed to end malnutrition in all its forms in the past five years, the Global Nutrition Report has, along with many others, shown that there is inadequate implementation of policies, programmes and interventions – even those with proven efficacy or effectiveness – and lack of actions across other sectors so vital to ending malnutrition. Likewise, it has found that only a tiny proportion of spending by national governments in their own countries, and by international development organisations, goes on improving nutrition. Through tracking commitments made to improving nutrition, such as at the Nutrition for Growth Summit in 2013, it has found them to be inadequately SMART (specific, measurable, achievable, relevant and timely) so making it difficult to tell what difference they have really made.

Yet despite this discouraging picture, we also know that there is progress: many are committed, global attention to nutrition is high, data collection and synthesis is getting better all the time, and much has been learned about how to address the problem more effectively. We are at a crossroads: the state of malnutrition is dire, but opportunities to end it have never been greater. In this UN Decade of Action on Nutrition 2016–2025 and the SDG era, there has been significant progress in our understanding of the problem – through the data available and its analysis – and what is needed to address it. The uncomfortable question is not so much: why are things so bad? But why are things not better when we know so much more than before?

The 2018 Global Nutrition Report

The purpose of the Global Nutrition Report is to collate and communicate high-quality, comprehensive and credible data on nutrition as a means of tracking progress, guiding and inspiring action, and committing and financing the end of malnutrition in all its forms. To quote again the late, former UN Secretary-General Kofi Annan, “Data gaps undermine our ability to target resources, develop policies and track accountability. Without good data, we’re flying blind. If you can’t see it, you can’t solve it.” [10]

In 2018 we bring together new sources of data to continue to strive for a more comprehensive picture of malnutrition and to track change. The 2018 Global Nutrition Report is a data update. It shines a light on where there has been progress – and where major problems still lie. It highlights new innovations in data and the status of financing. It places actions that have been taken under the spotlight. Throughout it highlights data that can help us better understand the nature of the burden of malnutrition. For if we are to end malnutrition in all its forms, we must understand the nature of the problem we are dealing with.

This year we dig deeper into what the 2014 Global Nutrition Report termed the ‘new normal’ – that countries, communities and people experience a range of different forms of malnutrition and that addressing all of them is critical if we are to hold ourselves accountable for reaching all nutrition targets. We understand better just what countries and individual people are faced with: overlapping and coexisting burdens of the different forms of malnutrition. With a new interactive Global Nutrition Report website, we show more disaggregated nutrition data by sex, geography and socioeconomic divisions, and a stronger focus on nutritionally vulnerable populations such as adolescent girls, women and young children. We also dig deeper into the data of a crucial common cause of malnutrition in all its forms: diet composition.

While the data on malnutrition is clear, its burden high and progress unacceptably slow, the opportunity to end malnutrition has never been greater. There are signs of progress with reductions in stunting, a slight decrease in underweight women and many countries on track to achieve at least one global nutrition target. Solutions have never been more available, and the global community has never been better placed to end it. In recent years there have been numerous steps forward to enable us to better understand the nature of the burden of malnutrition in all its forms as well as its causes – and thus guide and inspire action and improve our ability to track progress. We have more knowledge, better data and successful models to base collective action, allowing us to more fully identify where we still need to act. We thus have an unprecedented window of opportunity to meet these goals and the means to end malnutrition.

The report takes the reader through the data journey, by presenting the data on the burden of malnutrition, identifying three critical areas in urgent need of further research and attention, digging deep through data on what people eat and why it matters, and looking at financing and success against commitments made. The report ends by presenting five critical steps that must be taken now to get the world on track.

Photo: © ILO/Joaquin Bobot Go

Share Introduction

• English Chapter 1 2018 Global Nutrition Report (PDF 6.4MB) 2018 Global Nutrition Report Launch slide deck (2018 Global Nutrition Report Launch slide deck.pptx) 2018 Global Nutrition Report Launch slide deck (PDF 1.2MB) 2018 Global Nutrition Report London launch slide deck (PDF 1.0MB) 2018 Global Nutrition Report London launch slide deck (2018 Global Nutrition Report London launch slide deck)
• French Chapitre_1_208_Rapport_sur_la_Mondiale (PDF 6.2MB) 2018 Global Nutrition Report (PDF 15.7MB)
• Spanish Capítulo_1_2018 Informe de la Nutricion Mundial.pdf (PDF 6.2MB) 2018 Global Nutrition Report (PDF 10.2MB)

Download the 2018 Global Nutrition Report

Black R.E., Victora C.G. and Walker S.P. et al, 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382:9890, 2013, pp. 427–51.

DALY is the summary measure used to give an indication of overall burden of disease. One DALY represents the loss of the equivalent of one year of full health. Using DALYs, the burden of diseases that cause premature death but little disability (such as drowning or measles) can be compared with that of diseases that do not cause death but do cause disability (such as cataract causing blindness). Source: www.who.int/gho/mortality_burden_disease/daly_rates/text/en

GBD 2015 Causes of Death Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. The New England Journal of Medicine, 377:1, 2017, pp. 13–27.

Global Panel, 2016. The Cost of Malnutrition: Why Policy Action is Urgent. Available at: https://glopan.org/sites/default/files/pictures/CostOfMalnutrition.pdf

Global Panel on Agriculture and Food Systems for Nutrition. Cost of malnutrition, https://glopan.org/cost-of-malnutrition (accessed 1 October 2018).

GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 2017, pp. 1345–422.

UNICEF for undernutrition: UNICEF, 2012. Nutrition glossary. Available at: www.unicef.org/tokyo/jp/Nutrition_ Glossary.pdf; WHO for overweight: WHO, 2018. Obesity and overweight. Available at: www.who.int/news-room/fact-sheets/detail/obesity-and-overweight ; WHO for thinness and child overweight: WHO, 2010. Nutrition Landscape Information System (NLIS): Country profile indicators Interpretation Guide. Available at: www.who.int/nutrition/nlis_interpretation_guide.pdf ; WHO for anaemia: WHO. Anaemia. Available at: www.who.int/topics/anaemia/en

The text of the SDGs specifies that reaching target 2.2 will involves achieving by 2025 the internationally agreed targets on stunting and wasting in children under 5 years of age, while also addressing the nutritional needs of adolescent girls, pregnant and lactating women, and older people.

It should be noted that while the overall emphasis is broader, target 2.2 includes indicators only on childhood stunting, wasting and overweight. Adult overweight and obesity is not tracked in the SDGs, leaving this indicator, which is skyrocketing all over the world, a voluntary target to work towards.

Annan K. Data can help to end malnutrition across Africa. Nature, 555:7, 2018. Available at: www.nature.com/articles/d41586-018-02386-3

Essay on Malnutrition

Students are often asked to write an essay on Malnutrition in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Malnutrition

What is malnutrition.

Malnutrition means not getting the right amount of nutrients. Your body needs a mix of proteins, carbohydrates, fats, vitamins, and minerals from food to stay healthy. If you eat too much or too little of these, you may get malnutrition.

Causes of Malnutrition

People can become malnourished if they do not eat enough food or if the food they eat does not give them the nutrients they need. Poverty, disease, and lack of food are big reasons why someone might not get enough nutrients.

Effects of Malnutrition

Not eating the right food can make you sick. It can slow down growth in kids and make it hard for the body to fight off illness. It can also cause tiredness and trouble focusing.

Fighting Malnutrition

To stop malnutrition, it’s important to eat a variety of healthy foods. Governments and organizations try to help by making sure people have enough food and know about good eating habits.

250 Words Essay on Malnutrition

Malnutrition is when a person’s body does not get the right amount of nutrients it needs to stay healthy. Nutrients are substances in food, like vitamins and minerals, that help our bodies grow and work properly. If someone doesn’t eat enough food or doesn’t eat a variety of foods, they can become malnourished.

Types of Malnutrition

There are two main types of malnutrition. The first type happens when a person doesn’t eat enough food, which is called undernutrition. This can make them very thin and weak. The second type is when a person eats too much of the wrong kinds of food, which can make them overweight but still not healthy because they’re not getting the right nutrients.

Malnutrition can be caused by not having enough food to eat, which is a big problem in many parts of the world. Sometimes, even if there is enough food, people might not eat the right kinds of food. Sickness can also cause malnutrition because it can make it hard for the body to handle food or take in nutrients.

When a person is malnourished, they can get sick more easily and might have trouble learning or doing well in school. Children are especially at risk because they need lots of nutrients to grow up strong and healthy.

Solving Malnutrition

To fix malnutrition, it’s important to make sure that everyone has enough food and that the food is full of the nutrients that our bodies need. Education about healthy eating is also key so that people know what kinds of food are best for them.

500 Words Essay on Malnutrition

Malnutrition is a health problem that happens when a person’s diet does not have the right amount of nutrients. Nutrients are the parts of food that our bodies need to grow, have energy, and stay healthy. These include things like vitamins, minerals, proteins, fats, and carbohydrates. When someone doesn’t eat enough food, or the food they eat does not give them the right nutrients, they can become malnourished.

The second type is called ‘overnutrition’. This is when a person eats too much food or too much of a certain type of nutrient, like fat or sugar. Overnutrition can lead to being overweight or obese, which can cause other health issues like heart disease or diabetes.

Malnutrition can be caused by many things. In some places, there is not enough food for everyone, which can make it hard for people to get the nutrients they need. Sometimes, even if there is enough food, it might not be the right kind of food to give the body all the nutrients it needs.

Malnutrition can cause a lot of health problems. For children, it can mean they do not grow properly, both physically and mentally. They might have trouble learning at school and get sick more often. For adults, malnutrition can make it hard to work and take care of their families. It can also lead to long-term health issues that can be hard to fix.

Preventing and Treating Malnutrition

To stop malnutrition, it is important for people to have access to a variety of foods that are full of nutrients. Education about what kinds of foods are healthy can also help. For those who are already malnourished, treatment might include special foods or supplements that give a boost of nutrients. In severe cases, medical care might be needed to help a person recover.

If you’re looking for more, here are essays on other interesting topics:

Apart from these, you can look at all the essays by clicking here .

Leave a Reply Cancel reply

Save my name, email, and website in this browser for the next time I comment.

Fact sheets

• Facts in pictures
• Publications
• Questions and answers
• Tools and toolkits
• Endometriosis
• Excessive heat
• Mental disorders
• Polycystic ovary syndrome
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases

Feature stories

• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment in WHO
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal
• Fact sheets /

Malnutrition

• Malnutrition, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight, obesity, and resulting diet-related noncommunicable diseases.
• In 2022, 2.5 billion adults were overweight, including 890 million who were living with obesity, while 390 million were underweight.
• Globally in 2022, 149 million children under 5 were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 37 million were overweight or living with obesity.
• Nearly half of deaths among children under 5 years of age are linked to undernutrition. These mostly occur in low- and middle-income countries. The developmental, economic, social and medical impacts of the global burden of malnutrition are serious and lasting, for individuals and their families, for communities and for countries.
• The developmental, economic, social and medical impacts of the global burden of malnutrition are serious and lasting, for individuals and their families, for communities and for countries.

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition addresses 3 broad groups of conditions:

• undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age);
• micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and
• overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers).

Various forms of malnutrition

Undernutrition.

There are 4 broad sub-forms of undernutrition: wasting, stunting, underweight, and deficiencies in vitamins and minerals. Undernutrition makes children in particular much more vulnerable to disease and death.

Low weight-for-height is known as wasting. It usually indicates recent and severe weight loss because a person has not had enough food to eat and/or they have had an infectious disease, such as diarrhoea, which has caused them to lose weight. A young child who is moderately or severely wasted has an increased risk of death, but treatment is possible.

Low height-for-age is known as stunting. It is the result of chronic or recurrent undernutrition, usually associated with poor socioeconomic conditions, poor maternal health and nutrition, frequent illness, and/or inappropriate infant and young child feeding and care in early life. Stunting holds children back from reaching their physical and cognitive potential.

Children with low weight-for-age are known as underweight. A child who is underweight may be stunted, wasted or both.

Micronutrient-related malnutrition

Inadequacies in intake of vitamins and minerals often referred to as micronutrients, can also be grouped together. Micronutrients enable the body to produce enzymes, hormones and other substances that are essential for proper growth and development.

Iodine, vitamin A, and iron are the most important in global public health terms; their deficiency represents a major threat to the health and development of populations worldwide, particularly children and pregnant women in low-income countries.

Overweight and obesity

Overweight and obesity is when a person is too heavy for his or her height. Abnormal or excessive fat accumulation can impair health.

Body mass index (BMI) is an index of weight-for-height commonly used to classify overweight and obesity. It is defined as a person’s weight in kilograms divided by the square of his/her height in meters (kg/m²). In adults, overweight is defined as a BMI of 25 or more, whereas obesity is a BMI of 30 or more. Among children and adolescents, BMI thresholds for overweight and obesity vary by age.

Overweight and obesity result from an imbalance between energy consumed (too much) and energy expended (too little). Globally, people are consuming foods and drinks that are more energy-dense (high in sugars and fats) and engaging in less physical activity.

Diet-related noncommunicable diseases

Diet-related noncommunicable diseases (NCDs) include cardiovascular diseases (such as heart attacks and stroke, and often linked with high blood pressure), certain cancers, and diabetes. Unhealthy diets and poor nutrition are among the top risk factors for these diseases globally.

Scope of the problem

In 2022, approximately 390 million adults aged 18 years and older worldwide were underweight, while 2.5 billion were overweight, including 890 million who were living with obesity. Among children and adolescents aged 5-19 years, 390 million were overweight, including 160 million who were living with obesity. Another 190 million were living with thinness (BMI-for-age more than two standard deviations below the reference median).

In 2022, an estimated 149 million children under the age of 5 years were suffering from stunting, while 37 million were living with overweight or obesity.

Nearly half of deaths among children under 5 years of age are linked to undernutrition. These mostly occur in low- and middle-income countries.

Who is at risk?

Every country in the world is affected by one or more forms of malnutrition. Combating malnutrition in all its forms is one of the greatest global health challenges.

Women, infants, children, and adolescents are at particular risk of malnutrition. Optimizing nutrition early in life –including the 1000 days from conception to a child’s second birthday – ensures the best possible start in life, with long-term benefits.

Poverty amplifies the risk of, and risks from, malnutrition. People who are poor are more likely to be affected by different forms of malnutrition. Also, malnutrition increases health care costs, reduces productivity, and slows economic growth, which can perpetuate a cycle of poverty and ill-health.

The United Nations Decade of Action on Nutrition

On 1 April 2016, the United Nations (UN) General Assembly proclaimed 2016–2025 the United Nations Decade of Action on Nutrition. The Decade is an unprecedented opportunity for addressing all forms of malnutrition. It sets a concrete timeline for implementation of the commitments made at the Second International Conference on Nutrition (ICN2) to meet a set of global nutrition targets and diet-related NCD targets by 2025, as well as relevant targets in the Agenda for Sustainable Development by 2030 – in particular, Sustainable Development Goal (SDG) 2 (end hunger, achieve food security and improved nutrition and promote sustainable agriculture) and SDG 3 (ensure healthy lives and promote wellbeing for all at all ages).

Led by WHO and the Food and Agriculture Organization of the United Nations (FAO), the UN Decade of Action on Nutrition calls for policy action across 6 key areas:

• creating sustainable, resilient food systems for healthy diets;
• providing social protection and nutrition-related education for all;
• aligning health systems to nutrition needs, and providing universal coverage of essential nutrition interventions;
• ensuring that trade and investment policies improve nutrition;
• building safe and supportive environments for nutrition at all ages; and
• strengthening and promoting nutrition governance and accountability, everywhere.

WHO response

WHO aims for a world free of all forms of malnutrition, where all people achieve health and wellbeing. According to the 2016–2025 nutrition strategy, WHO works with Member States and partners towards universal access to effective nutrition interventions and to healthy diets from sustainable and resilient food systems. WHO uses its convening power to help set, align and advocate for priorities and policies that move nutrition forward globally; develops evidence-informed guidance based on robust scientific and ethical frameworks; supports the adoption of guidance and implementation of effective nutrition actions; and monitors and evaluates policy and programme implementation and nutrition outcomes.

This work is framed by the Comprehensive implementation plan on maternal, infant, and young child nutrition , adopted by Member States through a World Health Assembly resolution in 2012. Actions to end malnutrition are also vital for achieving the diet-related targets of the Global action plan for the prevention and control of noncommunicable diseases 2013–2020 , the Global strategy for women’s, children’s, and adolescent’s health 2016–2030 , and the 2030 Agenda for sustainable development .

• Breastfeeding
• The WHO Child Growth Standards
• Double burden of malnutrition
• Comprehensive implementation plan on maternal, infant and young child nutrition
• Global action plan for the prevention and control of NCDs 2013-2020
• Global nutrition targets for 2025
• Second International Conference on Nutrition (ICN2)
• UN Decade of Action on Nutrition 2016-2025

Current Perspective on Malnutrition and Human Health

• First Online: 11 August 2023

Cite this chapter

• Alka Kurmi 11 , 12 ,
• D. K. Jayswal 13 ,
• Dharmendra Saikia 11 &
• Narayan Lal 14  

Part of the book series: Sustainable Plant Nutrition in a Changing World ((SPNCW))

298 Accesses

1 Citations

Malnutrition is a serious issue that affects the entire world and is brought on by a lack of dietary supplements (protein, vitamins, minerals and nutrients). It directly affects people’s lives and societies, contributing to a variety of health issues as well as reduced learning capacity, work capacity and earning potential. A lack of micronutrients, particularly Zn, Cu, I and Fe, affects about 75% of the world’s population, which can result in a number of health problems. Nutrition is a key variable in the environment that is adaptable and can be used to lower the burden of disease over the course of a person’s lifetime. In order to combat the issues related to malnutrition, numerous studies are being conducted in the fields of medical, agricultural and industrial sciences. These studies focus on improving human health through supplementation and providing the population with the right, sufficient amount of safe nutrients. A sustainable agricultural method known as biofortification is used to increase the concentration of specific micronutrients in staple foods and edible plant portions in order to lower the mortality and morbidity rates associated with malnutrition. According to certain findings, biofortification can also help to prevent micronutrient deficiencies and the risk of harmful metals in plants. Agronomic biofertilisation, conventional plant breeding, genetic engineering, gene modification or manipulation (CRISPR-Cas9) and increased micronutrient content can be achieved using biofortification techniques such as management of metal homeostasis and carrier proteins, which will increase nutrient concentration and production. Therefore, these approaches may be useful in eradicating malnutrition from society.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime
• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Biofortification: A Remedial Approach Against Malnutrition in Rural and Tribal Population

Micronutrient Deficiencies in Humans and Animals: Strategies for Their Improvement

Role of the Food and Supplement Industries in Human Health

ACC/SCN. (2000). Fourth report on the world nutrition situation: Nutrition throughout the life cycle . ACC/SCN in Collaboration with IFPRI.

Google Scholar  

Altarelli, M., Ben-Hamouda, N., Schneider, A., & Berger, M. M. (2019). Copper deficiency: Causes, manifestations, and treatment. Nutrition in Clinical Practice, 34 , 504–513.

Article   CAS   Google Scholar  

Bailey, R. L., West, K. P., Jr., & Black, R. E. (2015). The epidemiology of global micronutrient deficiencies. Annals of Nutrition & Metabolism, 66 (supply 2), 22–33. https://doi.org/10.1159/000371618

Balamurugan, R., Mary, R. R., Chittaranjan, S., et al. (2010). Low levels of fecal lactobacilli in women with iron deficiency anaemia in South India. The British Journal of Nutrition, 104 , 931–934.

Bhutta, Z. A., Das, J. K., Rizvi, A., et al. (2013a). Evidence based interventions for improvement of maternal and child nutrition: What can be done and at what cost? Lancet, 382 , 452–477.

Article   Google Scholar  

Bhutta, Z. A., Das, J. K., Walker, N., et al. (2013b). Interventions to address deaths from childhood pneumonia and diarrhoea equitably: What works and at what cost? Lancet, 381 , 1417–1429.

Biesalski, H. K. (2014). Hidden hunger . Springer.

Biesalski, H. K. (2016, May). Nutrition meets the microbiome: Micronutrients and the microbiota. Annals of the New York Academy of Sciences, 1372 (1), 53–64. https://doi.org/10.1111/nyas.13145

Biesalski, H. K., & Nohr, D. (2004). New aspects in vitamin a metabolism: The role of retinyl esters as systemic and local sources for retinol in mucous epithelia. The Journal of Nutrition, 134 , 3453S–3457S.

Biesalski, H. K., Sobeck, U., & Weiser, H. (2001). Topical application of vitamin A reverses metaplasia of rat vaginal epithelium: A rapid and efficient approach to improve mucosal barrier function. European Journal of Medical Research, 6 , 391–398.

CAS   Google Scholar  

Brown, C. C., & Noelle, R. J. (2015). Seeing through the dark: New insights into the immune regulatory functions of vitamin A. European Journal of Immunology, 45 , 1287–1295.

Cantorna, M. T., McDaniel, K., & Bora, S. (2014). Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease. Experimental Biology and Medicine, 239 , 1524–1530.

Cassani, B., Villablanca, E. J., & De Calisto, J. (2012). Vitamin A and immune regulation: Role of retinoic acid in gut associated dendritic cell education, immune protection and tolerance. Molecular Aspects of Medicine, 33 , 63–76.

Caulfield, L. E., Richard, S. A., Rivera, J. A., Musgrove, P., & Black, R. E. (2006). Stunting, wasting, and micronutrient deficiency disorders. In D. T. Jamison, J. G. Breman, & A. R. Measham (Eds.), Disease control priorities in developing countries (2nd ed., pp. 551–568). The International Bank for Reconstruction and Development/The World Bank; Oxford University Press.

Cave, D. P., Abbey, K. L., & Capra, S. M. (2019). Can foodservices in aged care homes deliver sustainable food fortification strategies? A review. International Journal of Food Sciences and Nutrition, 71 , 267–275. [CrossRef].

Cha, H. R., Chang, S., Chang, J., et al. (2010). Downregulation of Th17 cells in the small intestine by disruption of gut flora in the absence of retinoic acid. Journal of Immunology, 184 , 6799–6806.

Committee on Micronutrient Deficiencies, Board on International Health, Food and Nutrition Board, Howson, C. P., Kennedy, E. T., & Horwitz, A. (1998). Prevention of micronutrient deficiencies: Tools for policymakers and public health workers . National Academy Press.

Elia, M. (Ed.). (2000). Guidelines for detection and management of malnutrition. Malnutrition Advisory Group, Standing Committee of BAPEN . BAPEN.

FAO. (2021). The state of food security and nutrition in the world 2021. In Building climate resilience for food security and nutrition . Food and Agriculture Org.

Food and Agriculture Organization of the United Nations (FAO). (2017). The future of food and agriculture – Trends and challenges . FAO.

Forms of malnutrition* highlighted in this key findings report (UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates Key findings of the 2019 edition).

Frasca, L., & Lande, R. (2012). Role of defensins and cathelicidin LL37 in auto-immune and auto-inflammatory diseases. Current Pharmaceutical Biotechnology, 13 , 1882–1897.

Gibson, R. S. (1994). Zinc nutrition and public health in developing countries. Nutrition Research Reviews, 7 , 151–173.

Gibson, R. S. (2011). Strategies for preventing multi-micronutrient deficiencies: A review of experiences with food-based approaches in developing countries. In B. Thompson & L. Amoroso Wallingford (Eds.), Combating micronutrient deficiencies: Food-based approaches (pp. 7–27). CAB International.

Chapter   Google Scholar  

Global Hunger Index 2021 report, provided by Smriti Zubin Irani, the Union Minister for Women and Child Development.

Graham, R. D., & Welch, R. M. (1996). Breeding for staple food crops with high micronutrient density (Working papers on agricultural strategies for micronutrients NO 3). International Food policy Research Institute.

Grieger, J. A., & Nowson, C. A. (2009). Use of calcium, folate, and vitamin D3–fortified Milk for 6 months improves nutritional status but not bone mass or turnover, in a group of Australian aged care residents. Journal of Nutrition for the Elderly, 28 , 236–254. [CrossRef] [PubMed].

Hetzel, B. S. (1990). Iodine deficiency: An international public health problem. In M. L. Brown (Ed.), Present knowledge in nutrition (pp. 308–313). International Life Sciences Institute, Nutrition Foundation.

Joachimiak, M. P. (2021). Zinc against COVID-19? Symptom surveillance and deficiency risk groups. PLoS Neglected Tropical Diseases, 15 , e0008895. [CrossRef]).

Katona, P., & Katona-Apte, J. (2008). The interaction between nutrition and infection. Clinical Infectious Diseases, 46 , 1582–1588.

Keflie, T. S., Nolle, N., Lambert, C., et al. (2015). Vitamin D deficiencies among tuberculosis patients in Africa: A systematic review. Nutrition, 31 , 1204–1212.

Koch, M., Biesalski, H. K., Stofft, E., et al. (1990). Crystalloid lysozyme inclusions in Paneth cells of vitamin A deficient rats. Cell and Tissue Research, 260 , 625–628.

Kong, J., Zhang, Z., & Musch, M. W. (2008). Novel role of the vitamin D receptor inmaintaining the integrity of the intestinal mucosal barrier. The American Journal of Physiology-Gastrointestinal and Liver Physiology, 294 , G208–G216.

Lal, N. (2020). Bagging of Fruit Bunches: An eco-friendly approach for quality production and protection from physiological disorder in litchi. Agriculture & Food: E-Newsletter, 2 (11), 1–3.

Levrat, M. A., Remsey, C., & Demigne, C. (1991). High propionic acid fermentations and mineral accumulation in the cecum of rats adapted to different levels of inulin. The Journal of Nutrition, 121 , 1730–1737.

Liu, L., Johanson, H. L., Cousens, S., et al. (2012). Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet, 379 , 2151–2161.

Martorell, R. (2007). Effects of malnutrition on health and human development and effective strategies for its prevention. Public Health of Mexico, 49 , 151.

McDaniel, K. L., Restori, K. H., Dodds, J. W., et al. (2015). Vitamin A-deficient hosts become nonsymptomatic reservoirs of Escherichia coli-like enteric infections. Infection and Immunity, 83 , 2984–2991.

Meyer-Hoffert, U., et al. (2008). Secreted enteric antimicrobial activity localizes to the mucous surface layer. Gut, 57 , 764–771.

Mora, J. R., Iwata, M., & Andria, U. H. (2008). Vitamin effects on the immune system: Vitamins A and D on the center stage. Nature Reviews Immunology, 8 , 685–692.

Müller, O., & Krawinkel, M. (2005). Malnutrition and health in developing countries. Canadian Medical Association Journal, 173 , 279–286. [CrossRef].

Muthayya, S., Rah, J. H., Sugimoto, J. D., Roos, F. F., Kraemer, K., & Black, R. E. (2013). The global hidden hunger indices and maps: An advocacy tool for action. PLoS One , 8 , No. e67860.

Peumans, W. J., & Van Damme, E. (1995). Lectins as plant defense proteins. Plant Physiology, 109 , 347–352. [CrossRef].

Picciano, M. F. (2003). Pregnancy and lactation: Physiological adjustments, nutritional requirements and the role of dietary supplements. The Journal of Nutrition, 133 , 1997S–2002S.

Pinstrup-Andersen, P. (2007). Agricultural research and policy for better health and nutrition in developing countries: A food systems approach. Agricultural Economics, 37 , 187–198. [CrossRef].

Ramakrishna, B. S. (2013). Role of the gut microbiota in human nutrition and metabolism. Journal of Gastroenterology and Hepatology, 28 , 9–17.

Sirisinha, S. (2015). The pleiotropic role of vitamin A in regulating mucosal immunity. Asian Pacific Journal of Allergy and Immunology, 33 , 71–89.

Smith, L., & Haddad, L. (1999). Explaining child malnutrition in developing countries: A cross-country analysis (FCND discussion paper 1999 (60)). IFPRI.

Stoltzfus, R. J. (2012). Iron and malaria interactions: Programmatic ways forward. Advances in Nutrition, 3 , 579–582.

Stratton, R., Green, C. J., & Elia, M. (2003). Disease related malnutrition: An evidence-based approach to treatment . Cabi Publishing.

Book   Google Scholar  

United Nations Children’s Fund (UNICEF). (2013). Improving child nutrition: The achievable imperative for global Progress . UNICEF. http://www.unicef.org/infobycountry/indonesia_statistics.html#119 . Accessed 16 Apr 2014

United Nations Millennium Project: Millennium Development Goals. (2000). http://www.unmillenniumproject.org/goals/index.htm . Accessed 9 Apr 2014.

Vaishnava, S., Behrendt, C. L., & Ismail, A. S. (2008). Paneth cells directly sense gut commensals and maintain homoeostasis at the intestinal host–microbial interface. Proceedings. National Academy of Sciences. United States of America, 105 , 20858–20863.

Wisbaum, W. (2011). Child malnutrition. Causes, consequences and strategies for its prevention and treatment . UNICEF.

World Bank. India, Undernourished children: A call for reform and action . Available from: http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,contentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html . Last accessed on 05 Apr 2014.

World Health Organization (WHO). (2018). The nutrition challenge: Food system solutions . WHO.

Zlotkin, S. (2011). Micronutrient deficiencies and effect of supplements on correcting them. Nestlé Nutrition Workshop Series. Paediatric Programme, 68 , 127–134; discussion 134–140.

Download references

Author information

Authors and affiliations.

Bioprospection and Product Development Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow, Uttar Pradesh, India

Alka Kurmi & Dharmendra Saikia

Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India

ICAR-National Agricultural Higher Education Project, New Delhi, India

D. K. Jayswal

ICAR-Indian Institute of Soil Science, Bhopal, Madhya Pradesh, India

Narayan Lal

You can also search for this author in PubMed   Google Scholar

Editor information

Editors and affiliations.

Academy of Biology and Biotechnology, Southern Federal University, Rostov-on-Don, Russia

Vishnu D. Rajput

Soil & Water Department Faculty of Agriculture, Kafrelsheikh University, Kafr El-Shiek, Egypt

Hassan El-Ramady

University Jaunpur, Veer Bahadur Singh Purvanchal, Jaunpur, Uttar Pradesh, India

Sudhir K. Upadhyay

Tatiana Minkina

School of Chemical Engineering, Yeungnam University, Gyeongsan, Korea (Republic of)

Bilal Ahmed

Saglara Mandzhieva

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Kurmi, A., Jayswal, D.K., Saikia, D., Lal, N. (2023). Current Perspective on Malnutrition and Human Health. In: Rajput, V.D., El-Ramady, H., Upadhyay, S.K., Minkina, T., Ahmed, B., Mandzhieva, S. (eds) Nano-Biofortification for Human and Environmental Health. Sustainable Plant Nutrition in a Changing World. Springer, Cham. https://doi.org/10.1007/978-3-031-35147-1_9

Download citation

DOI : https://doi.org/10.1007/978-3-031-35147-1_9

Published : 11 August 2023

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-35146-4

Online ISBN : 978-3-031-35147-1

eBook Packages : Biomedical and Life Sciences Biomedical and Life Sciences (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Malnutrition: Major Risk Factors and Causes Research Paper

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

Causes of malnutrition, works cited.

The normal functioning of body organs is something that requires an adequate amount of mineral salts, fluids, and nutrients that are derived from different food materials. The problem of malnutrition occurs when a person’s nutritional supplements are insufficient, imbalanced, or excess. Many people assume that undernourishment is the only form of malnutrition. The purpose of this paper, therefore, is to analyze the major risk factors and causes of this health predicament.

Thesis statement

Malnutrition is a complex nutritional status caused by not only undernutrition in poor populations but also by overnutrition, poor health conditions, and sedentary lifestyles.

Biesalski and Black argue that malnutrition is caused by a wide range of factors that work synergistically or independently (41). To begin with, individuals who do not get adequate nutrients will have increased chances of being malnourished. In poor countries, many people and children lack balanced diets. Similarly, individuals who fail to develop healthy eating habits or ignore the required nutrients such as vitamins, proteins, minerals, and fats will suffer from malnutrition. Additionally, some diets are usually harmful or indigestible. For instance, chewing gums can be swallowed by children, thereby increasing their chances of developing the problem. Some food materials contain numerous chemicals that can result in malnutrition. This is also a risk factor for chronic infections, cancers, and tumors.

Individuals should be encouraged to regulate their diets (Menon et al. 5). Any irregular eating pattern or intake of unhealthy food materials can result in malnourishment. Irregular meals are known to cause ingestion and bloating. Children living in dirty environments will lack pure light and clean oxygen. These attributes will make it impossible for the body to process various food materials and nutrients (Khan et al. 28).

Sahn believes that people who fail to get adequate rest and sleep will have increased chances of becoming malnourished (31). For instance, studies have revealed that children who watch television for long hours will not get adequate sleep. This malpractice is linked to poor digestion and an imbalanced intake of nutrients. The process will eventually result in malnutrition. These aspects explain why people should focus on their nutritional requirements in order to overcome this health problem.

There are some risk factors that are associated with malnutrition. For instance, heavy and tedious activities can affect a person’s digestive process. Children are usually at a higher risk of developing this problem. Some health conditions such as ringworms, measles, and kwashiorkor will expose more children to malnutrition. Such diseases are known to disorient normal body functions, thereby affecting the rate at which the body absorbs various nutrients.

Sahn goes further to explain how individuals who fail to engage in exercises and physical activities record slowed digestive processes (89). Dysphasia, a condition associated with eating difficulty, has been linked to malnutrition by different scientists (Biesalski and Black 102). Consequently, the affected persons tend to have higher chances of becoming obese.

Khan et al. indicate that starvation is a leading cause of malnutrition in the underdeveloped world (29). Many homeless persons and children living in poverty do not get enough food. This reason explains why such individuals have higher chances of suffering from malnutrition. Similarly, people who have various eating problems or disorders will not maintain their body’s nutrition levels. A good example of such a conditions is anorexia nervosa (Oxlade et al. 4). Poverty is something that has been associated with homelessness and discrimination. People living in low-income neighborhoods or marginalized societies will develop a wide range of nutritional problems.

Lack of adequate information is another potential cause of malnutrition in the developed world. The role of human services professionals and nutritionists is to guide people and empower them to design balanced diets for their families (Menon et al. 11). Unfortunately, many individuals with good salaries fail to focus on the right dietary intakes or requirements. They also ignore the nutritional statuses of their children, thereby exposing them to diseases such as obesity.

Some might also lack adequate nutrients and mineral salts. These malpractices will result in malnutrition. Finally, people living in regions that lack adequate medical facilities are at risk of being undernourished (Oxlade et al. 7). This is the case because the health statuses of such persons are not monitored frequently. Some of the underlying diseases that can disorient various digestive processes tend to go undetected. Other potential causes of malnutrition include diarrhea, heart disease, smoking, and drug abuse.

This discussion has revealed that malnutrition is a serious health problem that takes different forms such as obesity and undernourishment. People should be keen to focus on each of these causes of malnutrition in order to improve their nutritional status. These attributes should, therefore, be examined keenly in an attempt to develop powerful models to deal with this preventable health predicament. Governments and local agencies must implement effective campaigns and initiatives to sensitize more people about the causes of malnutrition and the best approaches to improve people’s health outcomes.

Biesalski, Hans K., and Robert E. Black. Hidden Hunger: Malnutrition and the First 1,000 Days of Life: Causes, Consequences and Solutions. Karger Publications, 2016.

Khan, Alamgir, et al. “Causes, Signs and Symptoms of Malnutrition Among the Children.” Journal of Nutrition and Human Health, vol. 1, no. 1, 2017, pp. 24-37.

Menon, Sonia, et al. “Convergence of a Diabetes Mellitus, Protein Energy Malnutrition, and TB Epidemic: The Neglected Elderly Population.” BMC Infectious Diseases, vol. 16, no. 361, 2016, pp. 1-14.

Oxlade, Olivia, et al. “Estimating the Impact of Reducing Under-Nutrition on the Tuberculosis Epidemic in the Central Eastern States of India: A Dynamic Modeling Study.” PLOS ONE , vol. 10, no. 6, 2015, pp. 1-15.

Sahn, David E. The Fight Against Hunger and Malnutrition: The Role of Food, Agriculture, and Targeted Policies. Oxford University Press, 2015.

• Can Vegetarian Diets Be Healthy?
• Obesity Explained by Drive Reduction Theory
• Child Malnutrition: Term Definition
• Malnutrition in the Elderly: The Main Causes
• Malnutrition in Children as a Global Health Issue
• Processed Foods and High Fructose Corn Syrup Effects
• Nutrition Role in Skin Care and Wellness
• Public Health Concern: Obesity in Young People
• Food & Beverage Choices and Health Impacts
• Proper Nutrition and Health Conditions
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2021, May 13). Malnutrition: Major Risk Factors and Causes. https://ivypanda.com/essays/malnutrition-major-risk-factors-and-causes/

"Malnutrition: Major Risk Factors and Causes." IvyPanda , 13 May 2021, ivypanda.com/essays/malnutrition-major-risk-factors-and-causes/.

IvyPanda . (2021) 'Malnutrition: Major Risk Factors and Causes'. 13 May.

IvyPanda . 2021. "Malnutrition: Major Risk Factors and Causes." May 13, 2021. https://ivypanda.com/essays/malnutrition-major-risk-factors-and-causes/.

1. IvyPanda . "Malnutrition: Major Risk Factors and Causes." May 13, 2021. https://ivypanda.com/essays/malnutrition-major-risk-factors-and-causes/.

Bibliography

IvyPanda . "Malnutrition: Major Risk Factors and Causes." May 13, 2021. https://ivypanda.com/essays/malnutrition-major-risk-factors-and-causes/.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.11(10); 2021

Original research

Malnutrition in all its forms and associated factors affecting the nutritional status of adult rural population in bangladesh: results from a cross-sectional survey, shagoofa rakhshanda.

1 Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh

Lingkan Barua

2 Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh

Mithila Faruque

Palash chandra banik, a k m fazlur rahman, saidur mashreky, associated data.

bmjopen-2021-051701supp001.pdf

bmjopen-2021-051701supp002.pdf

Data are available upon reasonable request. The corresponding author will make the data available when required, with valid reasons.

Introduction

The burden of malnutrition is widely evaluated in Bangladesh in different contexts. However, most of them determine the influence of sociodemographic factors, which have limited scope for modification and design intervention. This study attempted to determine the prevalence of underweight, overweight and obesity and their modifiable lifestyle predictors in a rural population of Bangladesh.

This study was part of a cross-sectional study that applied the WHO Package of Essential Noncommunicable Disease Interventions in a rural area of Bangladesh to assess the burden of diabetes, hypertension and their associated risk factors. Census was used as the sampling technique. Anthropometric measurement and data on sociodemographic characteristics and behavioural risk factors were collected following the standard protocol described in the WHO STEP-wise approach. Analysis included means of continuous variables and multinomial regression of factors.

The mean body mass index of the study population was 21.9 kg/m 2 . About 20.9% were underweight, 16.4% were overweight and 3.5% were obese. Underweight was most predominant among people above 60 years, while overweight and obesity were predominant among people between 31 and 40 years. Higher overweight and obesity were noted among women. Employment, consumption of added salt and inactivity increased the odds of being underweight by 0.32, 0.33 and 0.14, respectively. On the other hand, the odds of being overweight or obese increased by 0.58, 0.55, 0.78, 0.21 and 0.25 if a respondent was female, literate, married, housewife and consumed red meat, and decreased by 0.38 and 0.18 if a respondent consumed added salt and inadequate amounts of fruits and vegetables, respectively. Consumption of added salt decreases the odds of being overweight or obese by 0.37.

The study emphasised malnutrition to be a public health concern in spite of the dynamic sociodemographic scenario. Specific health messages for targeted population may help improve the nutritional status. Findings from further explorations may support policies and programmes in the future.

Strengths and limitations of this study

• This study assessed the current status of malnutrition and look at its association with different modifiable risk factors among adults in a selected rural population of Bangladesh.
• Census was used as the sampling technique and data were collected from all adults except those institutionalised in a hospital, prison, nursing home or other similar institutions.
• The study could only investigate a third of the individuals since the community clinics were not attended by everyone who were included in the household survey.

As studies show, malnutrition is one of the risk factors responsible for non-communicable diseases (NCDs) globally. 1 2 About one-third of people in any community have at least one form of malnutrition, which includes disorders caused by excessive and/or imbalanced intake, leading to obesity and overweight, and disorders caused by deficient intake of energy or nutrients, leading to stunting, wasting and micronutrient deficiencies. Both overnutrition and undernutrition are caused by intake of unhealthy and poor quality diets. 1 Body mass index (BMI) is an indicator of healthy weight, underweight, overweight and obesity. 2 Studies show that the prevalence of obesity and overweight has been increasing over time. 3 Globally, about 39% of adult population are overweight and 13% are obese as of 2016. 4 At least 2.8 million people die each year due to causes related to obesity and overweight. 5 Data from a national survey show that in Bangladesh about 30.4%, 18.9% and 4.6% of adults were underweight, overweight and obese, respectively. 6

Unhealthy dietary behaviour, low physical activity, genetics, family history of certain diseases, community environment and usage of some drugs can lead to obesity and overweight. 7 Obesity and overweight are two of the key risk factors for NCDs such as cardiovascular diseases and diabetes mellitus, which are known major public health concerns. 8–10 Cardiovascular and respiratory diseases, cancer and diabetes are responsible for about 41 million deaths each year. 1 11 Diabetes and hypertension have some common and important risk factors, such as unhealthy diet, inadequate physical inactivity, tobacco use, abnormal lipid profiles and overweight/obesity. 12 About 85.0% of premature deaths from NCDs now occur in low-income and middle-income countries, where greater burden of undernutrition and infectious diseases also exists. 1 13 In economically well-off countries, NCDs are noted disproportionately among vulnerable and disadvantaged groups. 2 On the other hand, in less developed economies, childhood undernutrition affects health, survival, growth and development in rural population. 1 Globally, undernutrition contributes to around 45% of deaths among under-5 children, the majority of which occur in low-income and middle-income countries. 1

Attempting to look closely at the link between unhealthy diets and NCDs, it is seen to be the logical outcome of the dramatic shift in current food systems, which focus on increasing availability of inexpensive, high-calorie foods at the expense of diversity replacing local, often healthier diets. Availability of micronutrient-rich foods (eg, fresh fruits, vegetables, legumes, pulses and nuts) has not improved equally for everyone. Unhealthy foods with salt, sugars, saturated fat/trans fat, sweetened drinks, and processed and ultra-processed foods have become cheaper and more widely available. 1 Studies show that reduction in risk factors through lifestyle modifications helps greatly in reducing the burden of most NCDs, including hypertension, diabetes, malnutrition and mental disorders. 14 15 Studies in rural Bangladesh found that 55% of women ate rice twice a day as the staple food, while about 80% and 18% of women ate chicken on a weekly and monthly basis, respectively. 16 17

Under these circumstances, developing countries like Bangladesh can benefit from interventions that help the primary healthcare facilities to be ready to tackle different NCDs that are predisposed by overweight, obesity and undernutrition. This study provides an opportunity to find the influencing factors and predictors of malnutrition in the current changing lifestyle among selected communities. This study was conducted to determine the prevalence of underweight, overweight and obesity and their predictors in a rural population of Bangladesh. Previous studies in Bangladesh have looked at the risk factors of malnutrition in association with different sociodemographic characteristics. 18–26 This study builds up on the previous studies by examining the association of various risk factors with underweight, overweight and obesity on a large data set of adult population.

Study design, setting and participants

This was a cross-sectional study that incorporated quantitative methods to fulfil the study objectives. It was part of an implementation research in a randomly selected union (smallest rural administrative and local government units), Dhangara, among the three unions (Brammagachha, Chandaikona and Dhangara) of the Raiganj subdistrict in the Sirajganj district of Bangladesh. The three unions of Raiganj have been under an active health and demographic surveillance system of the implementing organisation Centre for Injury Prevention and Research Bangladesh since 2006. Dhangara Union has 12 323 households with a population size of 51 759, of whom 35 704 were adult population (≥18 years old) during the data collection.

Census was used as the sampling technique and included all adults except those who were mentally challenged or institutionalised in a hospital, prison, nursing home or other similar institutions. The duration of the study was 6 months, from January to June 2019, while data were collected from March to June 2019.

Data collection instrument and procedure

As a part of an implementation research, this study collected data by screening out the sociodemographic and cardiometabolic risk factors of chronic diseases (hypertension, diabetes) and determine their prevalence. The study adapted the procedure as described in the WHO Package of Essential Noncommunicable Disease Interventions model. 27

Data were collected electronically at the household level using an Android-based mobile platform software. Interviewer-administered face-to-face interview was used to collect data. The questionnaire was prepared based on the STEP-wise approach to Surveillance (STEPS) of NCD risk factors by the WHO (version 3.2). The STEPS questionnaire was modified and used to ask questions on sociodemographic characteristics, behavioural risk factors (such as tobacco and alcohol consumption, physical activity, dietary habits, added salt intake) and occurrence of chronic disease, and to measure physical and biochemical parameters (height, weight, blood glucose, blood pressure). The English STEPS questionnaire was first translated to Bangla and then finalised after necessary modification following pretesting on a suitable population. Data collectors having requisite background were recruited and intensively trained before the commencement of data collection.

Screening at community level posed specific challenges that were identified and addressed, such as the time of day or day of the week to reach a particular population, such as office goers, farmers and home makers, especially for men. The use of active surveillance provided the advantage of having a full list of households and addresses, which ensured full coverage of the survey area. Data collectors were provided with the list and information required to track each household. If the respondent was unable to provide information when the data collector visited, a new time was scheduled for the screening as per convenience of the household member and the data collector. All possible measures were taken to ensure full coverage of the population.

During household data collection, existing chronic diseases (hypertension, diabetes, cardiovascular disease, etc) among the members were explored. Each participant was interviewed for approximately 25–30 min. Treatment and other medical documents were reviewed to confirm the disease conditions, and show cards were used for food and physical activity to ensure quality data. In some cases, where a person was not able to respond to data collectors’ queries (those who were ill or had some form of disability), an appropriate person from the household, for example the caregiver, was asked to answer on behalf provided he/she could give the exact information.

The household survey participants were advised to visit the nearby community clinic (CC) on the next day in a fasting state (not taking food and water for 8–12 hours) to assess their physical and biochemical parameters. In the CC, standard weight scale, height measurement scales, measuring tape and automated digital blood pressure machine were used to record weight, height, waist circumference, hip circumference and blood pressure, respectively. Fasting capillary glucose was measured by a standard glucometer maintaining all necessary aseptic precautions. Blood pressure was measured twice: first, after a 15 min rest time, and the second one 3 min after the first measurement. The mean of the two measurements was used to determine actual blood pressure. Physical measurements were carried out by well-trained male and female assistants maintaining adequate privacy. The data collected at the CC were synced with those collected at the household level. The flow chart of the study methods applied to collect data is shown in figure 1 .

Flow chart of study methods applied to collect data from a selected rural population of Bangladesh. NCDs, non-communicable diseases.

Ascertainment of key variables

• Age: respondents were asked what their age (in years) was at the time of data collection.
• Sex: respondents were asked which sex (male or female) did they identify themselves as at the time of data collection.
• Education: respondents were asked what was the highest level of education (no schooling, primary, and secondary and above) obtained by them at the time of data collection.
• Marital status: respondents were asked if they were ever married or never married.
• Occupation: respondents were asked about their occupation. Occupation was classified as unemployed, service holder, farmer, self-employed and housewife.
• Red meat intake: respondents who said that they ate red meat on a weekly basis were categorised as consumers of red meat.
• Fried food intake: respondents who said that they ate fried food on a weekly basis were categorised as consumers of fried food.
• Processed food intake: respondents who said that they ate processed food on a weekly basis were categorised as consumers of processed food.
• Sugary drink intake: respondents who said that they ate sugary drinks on a weekly basis were categorised as consumers of sugary drinks.
• Added salt intake: respondents who said they took extra dietary salt while eating any cooked meal were categorised as consumers of added dietary salt.
• Adequate amount of fruit and vegetable: respondents whose dietary intake of fruit and vegetable corresponded to WHO recommended five servings were considered as taking adequate amount of fruit and vegetable. 28
• Physical activity: respondents were asked about their work-related physical activities, the number of days a week and the amount of time (in minutes) per day that they spend on vigorous and moderate activities. This was then converted to metabolic equivalent of task-minutes (MET-min) to find out the intensity of physical activity, which was then categorised. The categories were less active or sedentary (≤600 MET-min/week), moderately active (between 600 and 3000 MET-min/week), and highly or vigorously active (≥3000 MET-min/week). 29
• Underweight: respondents were considered as underweight when their BMI was less than 18.5 kg/m 2 . 30
• Normal weight: respondents were considered to have normal weight when their BMI was between 18.5 and 25.0 kg/m 2 . 30
• Overweight: respondents were considered overweight when their BMI was between 25.0 and 29.9 kg/m 2 . 30
• Obese: respondents were considered obese when their BMI was over 30.0 kg/m 2 . 30

Data analysis

Data were entered in a predesigned Microsoft Office Excel format which was later imported into statistical software STATA V.12. The raw data were initially checked for completeness, consistency, and absence of missing data, errors and outliers. Afterwards, data were carefully cleaned and edited for consistency and for preserving for longer time. Descriptive and relevant statistical analyses were performed on this cleaned data set. The results were then presented in tables and illustrations. Of the 22 270 respondents at the household level, a total of 11 244 visited the CC for the required physical measurements. After cleaning the data, the final analysis was done with a sample of 11 064 respondents.

To assess the distribution of anthropometric measurements among the respondents, the means of the continuous variables were calculated and presented in a tabulated form with range and SD. A pie chart was used to show the overall nutritional status of the respondents. Descriptive analysis was done to show the distribution of nutritional status and presented as percentage. To identify the sociodemographic and behavioural risk factors affecting malnutrition, multinomial regression analysis was used. In this regard, at first, the assumptions of regression analysis were checked and no violations of these assumptions were found. These assumptions included multicollinearity, outlier, normality, linearity, homoscedasticity and the independence of observations. Univariate analysis was performed to determine the eligibility of the variables before including them in the multinomial regression analysis. The variables included were age, sex, education, marital status, occupation, physical activity, red meat intake, fried food intake, processed food intake, sugary drink intake, added salt intake and inadequate intake of fruits and vegetables. During the univariate analysis, only the variables which showed p<0.05 ( online supplemental table 1 ) were considered eligible for inclusion in the multinomial regression analysis. The dependent variable was categorised as underweight, normal weight, overweight and obesity. As per literature review, overweight and obesity have similar predictors. As such, overweight and obesity were merged together into one category, and normal weight was considered as reference. The regression table for each outcome variable included the presentation of the factors with the corresponding OR, and those with OR >1 were considered as predictors. The estimates of precision were all presented at a 95% CI, as appropriate. The significant threshold of p value for all the tables included in the analysis was less than 0.05.

Supplementary data

Patient and public involvement.

Data were collected from all adults at the household level. Further anthropometric data were collected at the health facilities from those who visited the CC. However, the public were not directly involved in the research. They did not play any role during the establishment of the research questions, designing or implementing the study, measuring the study outcomes, or interpretation of the results.

Ethical consideration

Participants had the right to withdraw at any point after starting the interview. Rigour, accuracy and impartiality were ensured during data collection through inperson and digital monitoring systems.

Anthropometric measurements

The mean anthropometric measurements of the respondents and the SD with the minimum and maximum values are shown in table 1 . The mean weight, height and BMI of the respondents were 51.4 kg, 153.4 cm and 21.9 kg/m 2 , respectively. The mean waist circumference, hip circumference and waist to hip ratio were 79.9 cm, 87.2 cm and 0.9, respectively.

Mean anthropometric measurements of respondents with SD and minimum and maximum values (N=11 064)

Considering BMI, 59.2% of the respondents were within normal range, that is, between 18.5 and 25.0 kg/m 2 . Underweight was found in 20.9% of the respondents, while overweight and obesity were found in 16.4% and 3.5% of the respondents, respectively ( figure 2 ).

Nutritional status of respondents (N=11 064). BMI, body mass index.

Sociodemographic characteristics

The sociodemographic characteristics of the respondents are stratified by nutritional status and shown in table 2 . Irrespective of age, normal nutritional status was noted in about 55.5%–61.2% of the respondents, as shown in table 2 . Underweight was reported to be highest at 31.3% among ≥60 years, while overweight and obesity were highest at 21.0% and 5.1%, respectively, among the 31–40 years age group. About 62.5% of men and 57.5% of women were within the normal range of weight. About 24.7% of men and 19.0% of women were underweight. Higher overweight and obesity were noted among women, with 18.8% and 4.6%, respectively. Irrespective of years of schooling, normal weight was recorded in 59.2% of the respondents. Being underweight was more common among those with no schooling (26.8%), while being overweight and obesityobese were more common among those with education up to or above secondary level (20.3% and 4.6%, respectively). Normal weight was seen in about 60.0%, irrespective of marital status. Being underweight was more common in those never married (29.3%), while being overweight and obese were more common in those ever married (17.0% and 3.7%, respectively). Being underweight was more common among unemployed and farmers, with 31.2% and 31.9%, respectively. On the other hand, being overweight was more common among service holders (23.8%) and being obese was more common among home makers (4.8%). The sociodemographic characteristics stratified by nutritional status were further stratified by sex ( online supplemental table 2 ).

Sociodemographic characteristics of respondents, stratified by nutritional status (N=11 064)

Underweight: BMI is less than 18.5 kg/m 2 ; normal weight: BMI is 18.5–25.0 kg/m 2 ; overweight: BMI is 25.0–29.9 kg/m 2 ; obese: BMI is over 30.0 kg/m 2 .

BMI, body mass index.

Behavioural risk factors

Nutritional status with respect to behavioural risk factors is shown in table 3 . Irrespective of the risk factors considered, normal weight was noted in 57.3%–60.5% of the respondents. Considering each risk factor, being underweight was noted to be more common among those who led sedentary lifestyle (25.1%), did not take red meat (21.9%), ate fried food (21.3%), took sugary drinks (21.7%), took added salt (23.2%) and had inadequate intake of fruits and vegetables (21.4%). On the other hand, being overweight and obese were noted to be more common among those who did moderate to vigorous exercise (16.7% and 3.3%–3.9%, respectively), took red meat (19.9% and 4.0%), did not eat fried food (16.8% and 3.7%), did not take sugary drinks (16.9% and 3.6%), did not take added salt (19.3% and 4.7%), and those who did not take inadequate and took adequate fruits and vegetables (18.2% and 4.3%). Those who did not consume processed food were more likely to be overweight (16.5%), while those who consumed processed food were more likely to be obese (4.2%).

Behavioural risk factors of respondents, stratified by nutritional status (N=11 064)

Factors affecting malnutrition

Table 4 shows the multinomial regression analysis of the data. For this analysis, overweight and obese were merged into one variable as overweight/obese. It was found that the odds of being underweight will decrease by 0.25, 0.35, 0.40 and 0.14 if a respondent is less than 45 years of age, literate, married and consumed red meat, respectively. Employment, consumption of added salt and inactivity increase the odds of being underweight by 0.32, 0.33 and 0.14, respectively.

Factors affecting malnutrition in all its forms among the study population using multinomial regression analysis considering normal body weight as reference (N=11 064)

*Significant at a threshold of p<0.05.

AOR, adjusted odds ratio; BMI, body mass index.

On the other hand, the odds of being overweight/obese increased by 0.58, 0.55, 0.78, 0.21 and 0.25 if the respondent was female, literate, married, housewife and consumed red meat, and decreased by 0.38 and 0.18 if the respondent consumed added salt and inadequate amount of fruits and vegetables, respectively. Consumption of added salt decreased the odds of being overweight/obese by 0.37.

This cross-sectional study was undertaken among adult population in a selected rural area and was part of an implementation research. Census was used as the sampling strategy, but only a third of the population (those who attended the CC) were included in this study, for which reason the results do not represent census. Several studies have explored the various preconditions and posteffects of malnutrition in all its forms mostly with regard to modifiable sociodemographic factors. This study attempts to explore the same, but with regard to the status of modifiable lifestyle factors. While adequate knowledge and practices can modify the quality of diet and adjust lifestyles, the influence of a combination of economic, social and demographic factors also plays a key role in modifying these. 6 Such complex phenomena may be assessed case by case to determine modification modalities so as to improve the overall health status of a population.

This study found that underweight, overweight and obesity are of similar concern among the adult rural population in Bangladesh. According to the WHO estimates, the age-standardised estimation of the prevalence of overweight among adults in South-East Asia was 21.9% in 2016, which was higher than that found in this study. 17 A study in South Africa found that the mean waist circumference in rural men and women was much higher, putting them at high risk of NCDs. 31 In a nationwide study in Bangladesh, the prevalence of overweight and obesity among children was found to be less than 10%. 18 Other studies among the rural and urban populations of Bangladesh found that the prevalence of overweight and obesity was 15%–18.9% and 3%–4.6%, respectively. 6 19–21 The occurrence of overweight and obesity found in this study was near similar to the combined overweight and obesity as found in other studies in Bangladesh. However, the population of other studies included everyone in the study area, while this study included only the adult population. It was noted in this study that factors such as extreme age, varied occupation and other physiodemographic features influenced the prevalence of obesity and overweight. Since this study was conducted in a surveillance population, the community members may already have been a little more aware of the importance of healthy lifestyles.

In this study, respondents in the 31–40 years age group were the most overweight and obese, while those 60 years and above were the most underweight. Women were found to be more overweight and obese than men, while men were found to be more underweight than women. The study also found that the likelihood of being overweight and obese increased among married and literate women, in contrast to unmarried and illiterate men. On the other hand, literate and married women less than 45 years were less likely to be underweight compared with illiterate and married men more than 45 years of age. Age between 33 and 37 years was also found significantly associated with obesity and overweight in other studies among rural women of Bangladesh (OR: 3.71; 95% CI 2.84 to 4.86; p<0.001). 19 Other studies have shown that urban women aged 30–39 years were obese and/or overweight with a high association (OR: 3.9; 95% CI 1.9 to 7.7; p<0.001). 23 There are studies that also showed that the prevalence of underweight among men more than 50 years of age was much high. 20 32 The findings from this study corroborate with these earlier findings.

The odds of being overweight and obesity increased by 0.25 among respondents who consumed red meat and decreased by 0.38 and 0.18 among those who consumed added salt and inadequate amount of fruits and vegetables. On the other hand, consumption of added salt and inactivity increased the odds of being underweight by 0.33 and 0.14, respectively. A study on Malaysian adults showed that the prevalence of obesity and overweight was higher among men who did vigorous physical activity. In contrast, women who did moderate physical activity were more obese and overweight. 33 Other studies also showed that being underweight was more often associated with vigorous physical activity, while being overweight and obese was more related to sedentary lifestyle. Variable associations were also noted with gender, education level, marital status, working status and wealth index. 19 34 Most likely demographic features influence the source, amount and variety of food intake, and the type of physical activities undertaken based on knowledge and livelihood practices.

The food habit of the rural population in Bangladesh is low in fat and protein and high in carbohydrate. 35–37 This may be why people who perform vigorous physical activity can avoid getting overweight or obese. At the same time if balance is not maintained between intake and output, there is increased likelihood of being obese or overweight, a phenomenon observed among a substantial number of subjects in this study. Rural women tend to regularly perform most household chores, some involving heavy activities, but these activities are not considered as such and overlooked by community members and health workers. Moreover, women tend to eat less food of poor quality while ensuring that other family members get more food of better quality. 38 39 This may be why inactivity has been found to increase the likelihood of being underweight in this study. Studies show that the prevalence of previously undiagnosed comorbidities such as hypertension and diabetes is on the rise in the South-East Asian region. 40 In Bangladesh, about 50%–80% of patients with diabetes and hypertension remain undiagnosed, with a significantly higher percentage among those from lower socioeconomic rural areas. 27 30 People once diagnosed tend to visit health facilities more often than those who remain undiagnosed.

In its document on nutrition, the WHO has pointed at malnutrition in all its forms (characterised by coexisting undernutrition and overweight/obesity) and NCDs within individuals, households, populations and across the life course of individuals. Epidemiological evidence supports that undernutrition early in life, even when in utero, may predispose to overweight and NCDs later in life. At the same time, being underweight in later life is an expression of malnutrition. Again, overweight in mothers is often associated with overweight in their offspring. Biological mechanisms, along with environmental and social influences, are increasingly understood as essential drivers in the global burden of NCDs. 38

In addition to increasing health literacy among the rural population through training and awareness programmes, the government may also take initiatives to encourage household backyard vegetable and fruit gardening, which would help to reduce the overall family expenditure. As an initial support, the government may distribute free (or at nominal price) saplings of fruits and vegetables among the rural population.

The strength of this study is that it attempted to assess the current burden of malnutrition in all its forms and looked at the association of different modifiable risk factors with underweight, overweight and obesity among adults in a selected rural population of Bangladesh. Census was used as the sampling technique and data were collected from all adults except those institutionalised in a hospital, prison, nursing home or other similar institutes. Data from disabled or sick persons were collected from someone in the household who could provide the correct information. The number of such responses was very negligible and most likely did not affect the overall result.

Limitations

Although census was used as the sampling strategy, the study could only investigate a third of the individuals (those who attended the CC). As such, the results do not represent census. The limitation of this study was that household chores performed by women at home were not categorised into sedentary, moderate or vigorous activities, which may have affected the results. Some of the subjects included in the study may have been on medication or may have received lifestyle modification counselling and this may have also affected the results. On the other hand, people who were already diagnosed with diabetes or hypertension tend to visit health facilities more often than those who remain undiagnosed, for which reason the data collected at the CC may have been more on those who were already diagnosed before.

This cross-sectional study found that the prevalence of underweight was near equal to combined overweight and obesity among adults in a selected rural area of Bangladesh. Factors such as age, sex, education, marital status, physical inactivity and intake of added salt were strongly associated with being underweight, while factors such as sex, education, marital status, and consumption of red meat, added salt and fruits and vegetables were associated with being overweight and obese. Physical activity, along with eating habits, influences the nutritional status of adults. Sedentary lifestyle, along with less food consumption, leads to being underweight. Physically active persons who eat more food, such as red meat, tend to be overweight and obese. As such, considering the nutritional status, specific health messages to people on dietary habits and physical activity can go a long way to reduce underweight, overweight and obesity in the community. The effects of health messages can be further explored through qualitative studies so that policy makers and programme managers can take informed decisions while developing policies and implementing programmes.

Supplementary Material

Acknowledgments.

Genuine gratitude is due to the Non-Communicable Disease Control (NCDC) Programme of the Directorate General of Health Services (DGHS) for this study’s financial and technical support.

Twitter: @PalashChandraB7

Contributors: Conceptualisation: SM, AKMFR, MF, RAS, PCB, LB. Data curation: SR, LB. Formal analysis: SR, LB. Methodology: AKMFR, SM, MF, RAS, PCB, LB. Project administration: AKMFR, SM, MF, RAS, PCB, LB. Supervision: SM. Writing the original draft: SR. Writing: SR. Critic review: AKMFR, SM, MF, RAS, PCB, LB. Guarantor: SM

Funding: The study was funded by the Directorate General of Health Services (DGHS) Bangladesh (invitation ref no: DGHS/LD/NCDC/Procurement plan/(GOB) Service/2018-2019/2018/5214/SP-01).

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not required.

Ethics approval

Ethical approval was obtained from the Ethical Review Board of the Centre for Injury Prevention and Research, Bangladesh (ERC number: CIPRB/ERC/2019/003).

• - Google Chrome

Intended for healthcare professionals

• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• Hunger and...

Hunger and malnutrition in the 21st century

Food for thought, click here to read other articles in this collection.

• Related content
• Peer review
• Patrick Webb , professor 1 ,
• Gunhild Anker Stordalen , policy advocate 2 ,
• Sudhvir Singh , policy researcher 2 ,
• Ramani Wijesinha-Bettoni , United Nations 3 ,
• Prakash Shetty , professor 4 ,
• Anna Lartey , director of nutrition 3
• 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
• 2 EAT Forum, Oslo, Norway
• 3 Food and Agriculture Organization of the United Nations, Ringgold Standard Institution, Rome, Italy
• 4 MS Swaminathan Research Foundation, Ringgold Standard Institution, Chennai, India
• Correspondence to: P Webb patrick.webb{at}tufts.edu

Despite record food output globally, hunger is still with us. Patrick Webb and colleagues argue that key policy actions are urgently needed to tackle this scourge and must focus on improving diet quality for all

Today’s world is characterised by the coexistence of agricultural bounty and widespread hunger and malnutrition. 1 Recent years have seen a reversal of a decades old trend of falling hunger, alongside the re-emergence of famine. 1 National and global evidence shows that ensuring an adequate food supply is still an important contribution to eradicating hunger. However, generating more food in the form of staple grains or tubers is not enough. Good nutrition and an end to hunger both require everyone to have an appropriate diet. How can that be achieved?

Characterising the problem

A recent report for the World Committee on Food Security argued that “malnutrition in all its forms—not only hunger, but also micronutrient deficiencies, as well as overweight and obesity—is … a critical challenge not only in the developing but also in the developed countries. Resolving malnutrition requires a better understanding of the determinants and processes that influence diets.” 1 Malnutrition ranges from extreme hunger and undernutrition to obesity ( box 1 ). 2 3 Furthermore, malnutrition is found in all countries, irrespective of their economic development, where people lack high quality diets. 4 5 6 Thus, solutions to hunger and to all forms of malnutrition need to focus on ensuring an adequate supply of food, but equally, on the quality of diets.

Terms and definitions 1 2 3

Hunger is characterised in many ways. It encompasses individual sensations and household behavioural responses, food scarcity (actual or feared) and national food balance sheets that focus on supply of energy (kilocalories) in any country in relation to a minimum threshold of need. The food balance sheet approach is the only standard of measurement used globally. It is based on data collated by the Food and Agriculture Organization of the United Nations. This organisation has replaced its previous use of the word “hunger” in describing this metric with the phrase “chronic undernourishment”. This today is defined as “a person’s inability to acquire enough food to meet daily minimum dietary energy requirements during 1 year” 1

Malnutrition— An all inclusive term that represents all manifestations of poor nutrition. It can mean any or all forms of undernutrition, overweight, and obesity

Undernutrition —Refers to any form of nutritional deficiency, particularly those manifest in maternal underweight, child stunting, child wasting, or micronutrient deficiencies. It does not include reference to overweight and obesity

Maternal underweight— A body mass index (BMI) of <18.5 among women of reproductive age. This typically reflects chronic energy deficiency coupled with a lack of other key macronutrients or micronutrients, ill health, or energy expenditure higher than consumption. A prevalence >20% indicates a serious public health problem

Child stunting —Height for age ≤ −2 standard deviations of the median for children aged 6-59 months, according to World Health Organization child growth standards

Child wasting— Weight for height ≤ −2 standard deviations of the median for children aged 6-59 months, according to WHO child growth standards

Micronutrient deficiencies— A lack of various key vitamins and minerals leads to a range of symptoms that are of global concern. These include anaemia due to iron deficiency and risk of child mortality associated with clinical vitamin A deficiency. Such deficiencies are measured in several ways, including biomarkers (assessed using blood, serum, urine, etc), clinical manifestations, or proxy measures of diet quality

Overweight and obesity —For non-pregnant adults, a BMI ≥25 represents being overweight. The threshold for obesity is a BMI ≥30. Child obesity is of increasing concern and was included in the latest global nutrition goals for 2030 (“no increase in childhood obesity”) 4

Today, risk factors for ill health associated with poor quality diets are the main causes of the global burden of disease. 5 6 Low quality diets lack key vitamins, minerals (micronutrients), and fibre or contain too many calories, saturated fats, salt, and sugar. 7 In 2010, dietary risk factors combined with physical inactivity accounted for 10% of the global burden of disease (measured as disability adjusted life years, which reflect the number of years lost due to ill health, disability, or early death). 8 By 2015, six of the top 11 global risk factors were related to diet, including undernutrition, high body mass index (BMI), and high cholesterol. 9 10 Where governments have invested the economic gains derived from rising productivity in safety nets and services accessible to the poor, this has resulted in national growth. 11 12 13 However, where poverty persists, including in rich nations, hunger also persists.

Several faces of hunger

Hunger is a broad unscientific term that relates to nutrition and health outcomes in various ways. The proportion of people defined as hungry over the long term (usually termed “chronically undernourished”) fell from 18.6% globally in 1990-2002 to under 11% in 2014-16 ( table 1 ). That was a decline of 211 million people while the world’s population increased by 2 billion. 2 Big gains were made in large countries like China and in Brazil, Ethiopia, and Bangladesh ( box 2 ). South America was particularly successful, reducing undernourishment by over 50% in 25 years. 1 Such gains were made possible largely by rapid reduction of poverty, rising levels of literacy, and health improvements that reduced preventable child mortality. 17

Numbers (millions) and prevalence (%) of people with chronic undernourishment, stunting, and wasting* by year and geographical region 2 14

• View inline

Successful resolution of undernutrition: Brazil, Ethiopia, and Bangladesh

Hunger (chronic undernourishment) has remained static at around 800 million people for several decades. This is largely because of rising populations in fragile states and the escalation of armed conflict in numerous parts of the world. 1 2 Nevertheless, child undernutrition has been falling. In 2000, roughly 200 million children under 5 years of age were stunted, but this has fallen to less than 151 million today. Rapid improvements in nutrition have been concentrated in several large nations, which have shown the way with policy success stories

• Brazil saw its prevalence of child stunting decline from 37% in 1974–1975 to 7% in 2006-7. 17 It achieved these gains through a sustained commitment to expand access to maternal and child health services (reaching into previously underserved geographical regions). This was coupled with large scale investment in social reform and safety net programmes that supported a narrowing of the income gap (through equitable poverty reduction), rising numbers of girls in school, declining fertility, and greater stability in income flows and food consumption among the poor. Stable food consumption was achieved through food supplementation targeted at mothers and children, and with cash transfers targeted at the poorest groups. All of this was helped by improved stability of governance. Few of these actions focused explicitly on nutrition, but many were driven by a policy agenda called “zero hunger.” Even with recent economic challenges and changes of government, the gains made over past decades persist

• Ethiopia has faced famines many times between the 1980s and the early 2000s. It has also reduced child stunting from 58% in 2000 to <40% by 2014. 18 Although this figure is still unacceptably high, it represents a fall of about 1.2% a year. 19 Ethiopia also increased enrolment and retention of girls in schools during this period, increased agricultural productivity, and implemented a huge employment based safety net (one of the largest social protection programmes in Africa). However, two other important drivers improved nutrition in this period. Firstly, a move by government to treat nutrition as a multisector challenge (met by numerous line ministry responsibilities) and, secondly, improved sanitation, focused on eradicating open defecation, which was a major impediment to health and the retention of nutrients in the diet 18 19

• Bangladesh is a modern nutrition superstar. It emerged from famine in the 1970s. Successive governments have worked alongside an unusually vibrant non-governmental sector to deal with underlying problems and visible symptoms of malnutrition. While service delivery remains generally weak, widespread targeted interventions were combined with a variety of nutritional measures that deal with underlying problems. 20 Such actions included economic growth policies aimed at the poor, girls’ education, improved sanitation, and a significant turnaround in the agricultural sector, which moved Bangladesh from being a net importer of food to a significant exporter. 18 21 As a result, child stunting fell from almost 57% in 1997 to around 36% in 2014 18 19

However, despite such progress the world still has unacceptably high numbers of undernourished people. Of the roughly 800 million undernourished, 780 million are in low income countries, especially in sub-Saharan Africa and South Asia. 1 The continents of Africa and Asia have the greatest number of people living in extreme poverty, and it is here that extreme hunger and poverty together present the greatest risk of famine.

Famine is the most acute face of hunger. Over 70 million people died in famines during the 20th century. 22 23 24 Most deaths occurred in human induced crises, in which political mismanagement, armed conflict, and discrimination of marginalised political or ethnic groups compounded the effects of environmental shocks, such as droughts or locust invasions. 25 Deaths from famine fell from the mid-1980s onwards. However, as of 2017 four countries were again struggling to cope: Somalia, Yemen, South Sudan, and Nigeria. 26 In each case, instability induced by conflict, terrorism, drought and decades of failed governance have left over 20 million people facing famine, including 1.4 million children “at imminent risk of death.” 27

A major cause of mortality in famines is children becoming severely wasted. Around 52 million children were wasted in 2016, of whom around 70% (36 million) resided in Asia ( table 1 ). 14 Roughly 12.6% of deaths among children under 5 are attributed to wasting worldwide. 28 Although wasting has declined, progress has been slow and some countries have seen a rise, including Pakistan and India. 29 Many of the drivers of wasting are often the same as for stunting—namely, low birth weight, lack of exclusive breast feeding, poor hygiene and sanitation, and infectious disease. 30 While wasting is one sign of acute hunger, stunting (being too short for one’s age) represents chronic distress. Around 151 million preschool children were stunted in 2017, down from 200 million at the turn of the 20th century. 14 Improvements were made in east Asia, including China (today reporting a prevalence of only 6% compared with the global mean of 23%) and Bangladesh as well as in Latin America ( table 1 ). 31 Nevertheless, South Asia and East and Central Africa all still had rates over 32% in 2017.

Coexisting forms of malnutrition related to diet

The coexistence of multiple forms of malnutrition is a global phenomenon. That is, wasting often coexists with stunting in the same geographical areas, and can be found simultaneously in children. 32 For example, around 9% of children in India exhibit both conditions, while the rate in parts of Ghana is reported to be >3%. 32 33 Many countries with a high prevalence of stunting have made limited progress in achieving annual average rates of reduction required to meet global targets. For example, Timor Leste needs an annual reduction of around 5% to reduce stunting by 40% by 2030, but its current reduction rate is barely above zero. 9 Ethiopia also needs an annual average rate of reduction of 5%, but continues to remain at 3%.

Part of the reason for slow progress lies in overlapping micronutrient deficiencies. Inadequate supply of energy and protein both impair a child’s growth, but micronutrient deficiencies also have a role. It has been estimated that roughly 2 billion people, or about 29% of the world’s population, faced micronutrient deficiencies in 2010. 34 35 36 37 Micronutrient deficiencies are also widely present in high income countries. For example, childhood anaemia in 2010 was 26% in the Russian Federation and in Georgia, and 16%, on average, across the European Union. 38

Obesity is conventionally associated with food excess, but it is also associated with micronutrient deficiencies and even with daily hunger, as shown for Malaysia, 39 Canada, 40 and Iran. 41 Indeed, people with obesity can be prone to deficiencies of micronutrients, such as zinc, iron, and vitamins A, C, D, and E. 42 43 44 45 46 Between 1990 and 2010, the prevalence of adults with a high BMI in sub-Saharan Africa tripled. At the same time, hypertension increased by 60%, and the prevalence of high blood glucose rose nearly 30%. 47 The prevalence of overweight and obesity among South Asian women is almost the same today as the prevalence of underweight. 6 Pacific and Caribbean islands and countries in the Middle East and Central America have reached extremely high rates of adult overweight and obesity. Some have a prevalence as high as 80% (eg, Tonga, 84% for men, 88% for women). 48

Many countries today face the dual burden of rising rates of female obesity with continuing high rates of maternal underweight. The latter matters because of ill effects on the mother and on the unborn child. Roughly 30% of stunting by a child’s 3rd birthday can be attributed to being born small for gestational age, which is linked to nutrition before birth and health problems of the mother. 28 Not only is maternal underweight still more prevalent than overweight in rural parts of South Asia and sub-Saharan Africa but adult female underweight rose recently in Senegal, Madagascar, and Mali, mainly in urban settings. 49

Thus, actions are needed in all countries around the world to deal with undernutrition, micronutrient deficiencies, and overweight and obesity simultaneously. No country is exempt. “Triple duty” investments are needed everywhere because wealth and food sufficiency will not in themselves resolve the problems of low quality of diets.

Effective actions to tackle hunger and malnutrition

In 2016, the world hit a new record by producing over 2.5 billion metric tons of cereal grains—up from 1.8 billion tons 20 years earlier. 50 But hunger persists because an increased supply of food alone is neither the solution to hunger nor an answer to malnutrition. Countries that have made recent progress in reducing hunger and improving nutrition have a core set of common characteristics. Firstly, they tend to be politically stable countries that have pursued relatively equitable growth policies (not only increasing wealth for some but reducing poverty overall). Secondly, they employ targeted safety nets for the poor and invest in accessible services (education, clean water, healthcare). Thirdly, they assume responsibility for responding to shocks (economic, environmental, or due to conflict) in timely ways that mitigate human suffering.

Successful actions typically include a mix of targeted so called nutrition specific programming (aimed at preventing or resolving defined nutrition and health problems in individuals) and nutrition sensitive interventions for the whole population that deal with the underlying causes. 9 32 35 Table 2 provides details of evidence based policies and programmes in a variety of sectors, which are known to reduce hunger and deal with malnutrition. 32 In food and agriculture, these may include national price support interventions that increase the supply and accessibility of nutrient rich foods (often perishables, like dairy, fruits and fresh meats), coupled with technical and financial support for women farmers to produce nutrient rich vegetables in their gardens. In health, national policies to support accessible high quality services are critical to ensuring antenatal and postnatal care, particularly combined with targeted nutrition, exclusive breast feeding, and infant feeding messaging. Measures directed at underweight mothers are important for good birth outcomes, as well as varied forms of micronutrient supplementation. 1 In other words, the quality of services, scale of coverage, and the singling out of nutritionally vulnerable demographic groups are all keys to success. 20 47

Examples of actions to tackle hunger and malnutrition across sectors 3 20 47 51

Good nutrition and eradication of hunger comes at a price, but pays for itself in the longer term. Donor funding for nutrition sensitive programmes rose between 2003 and 2015, from 11.8% to 19.4%, reaching around $19bn (£14bn, €16bn) in 2015. 48 Such assistance is deemed to be effective, in that a 10% increase in overall nutrition sensitive aid delivers an estimated 1.1% “decrease in hunger” (measured as chronic undernourishment). 48 The World Bank has argued that a “priority package” of evidence based nutritional interventions that could be readily scaled up would require roughly $23bn over a decade, or $5 per child. 51 52 The World Bank emphasises that while international donor agencies should increase spending to achieve global nutrition goals, national governments and citizens themselves need to increase spending and act appropriately. The role of individuals and families comes largely in the form of preferences and constraints. 52 People make choices that shape dietary patterns and physical activity but also the uptake of healthcare services, spending on smoking and hygiene, as well as investments in schooling for their children and agricultural productivity (if farmers).

The value of such large investments to future human and economic development has long been understood in high income countries, such as Europe and the United States. European countries deploy a wide range of policies to combat residual hunger. These include promoting more diverse local food production and diversified diets, the latter “encouraged through nutrition education targeting school children and mothers of young children.” 38 The United States also supports large state food provisioning through nutrition programmes aimed at women and children. For example, spending on the federal food stamp programme in 2017 reached $68bn ($126 per person). 53 Similarly, spending on the Women Infants and Children programme, which targets low income families nutritionally at risk with food supplements, nutrition education, and health system referrals, reached $6.5bn in 2017. 54

Conclusions

The sustainable development goals require all countries and their citizens to act together to end hunger and all forms of malnutrition by 2030. 13 Setting targets is a good first step, but actions need to follow quickly. Urgent attention to achieve such goals is seriously overdue. Policy action must be designed to reduce malnutrition in all its forms, and be adequately funded. Measures must be evidence based, implemented at scale, and include both broad based and targeted actions aimed at the most nutritionally vulnerable people. The evidence to support such actions is growing, but it is already plentiful and compelling; there is no need for delay. The rapidly escalating threats posed by malnutrition represent a planetary challenge on a par with poverty and climate change. An appropriate response at the required scale is top priority for decision makers globally. It cannot wait.

Key messages

Despite record levels of food production globally, hunger and many forms of malnutrition still affect billions of people

While traditionally associated with a lack of food, hunger, and malnutrition (which includes overweight and obesity as well as undernutrition) are associated with low quality diets

Poor diet quality is a problem in every country—high and low income alike. A high quality diet meets most key nutrient needs, mainly through nutrient rich foods

Securing high quality diets for all, comprising sufficiency, diversity, balance, and safety, is necessary to resolve hunger and malnutrition in all its forms

Policy makers must urgently implement evidence based, cost effective actions that have a triple purpose: eradicate hunger, resolve all forms of undernutrition, and tackle obesity

Governments must consider how policies across multiple sectors influence the functioning of food systems from farm to fork. They must identify changes that will help all consumers to have healthy diets

The challenge is huge, but the urgency has never been so great

Contributors and sources: The authors have diverse subject expertise and policy experience relating to hunger, food insecurity, diets and nutrition. Some authors have a medical or agriculture background, while others have training and experience in policy analysis, nutrition and humanitarian action. PW and GAS were both members of the Global Futures Council on Food Security and Agriculture of the World Economic Forum. PW and AL advise the Global Panel on Agriculture and Food Systems for Nutrition. SS is a contributing author to the upcoming EAT Lancet Commission on Healthy Diets from Sustainable Food Systems. Data used are all in the public domain, and are derived from nationally representative surveys, United Nations agency analyses, or peer reviewed publications. PW, GAS and AL were involved in manuscript concept and design. All authors were involved in drafting and editing the manuscript; critically revised the manuscript for important intellectual content and approved the final manuscript and the authorship list. PW is the guarantor.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is one of a series commissioned by The BMJ . Open access fees for the series were funded by Swiss Re, which had no input into the commissioning or peer review of the articles. The BMJ thanks the series advisers, Nita Forouhi and Dariush Mozaffarian, for valuable advice and guiding selection of topics in the series.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

• ↵ High Level Panel of Experts. Second note on critical and emerging issues for food security and nutrition. High level panel of experts on food security and nutrition of the Committee on World Food Security. Rome, Italy. 2017. http://www.fao.org/fileadmin/user_upload/hlpe/hlpe_documents/Critical-Emerging-Issues-2016/HLPE_Note-to-CFS_Critical-and-Emerging-Issues-2nd-Edition__27-April-2017_.pdf
• ↵ Food and Agriculture Organization of the United Nations/International Fund for Agricultural Development/World Food Programme. State of food insecurity in the world 2017. Rome, Italy, 2017. https://www.wfp.org/content/2017-state-food-security-and-nutrition-world-sofi-report
• ↵ Pangaribowo EM, Gerber N, Torero M. 2013. Food and nutrition security indicators: a review. FOODSECURE working paper 04. Report for the European Union's Seventh Framework Programme FP7/2007-2011 under grant agreement n° 290693. http://www3.lei.wur.nl/WECRGeneral/FoodSecurePublications/05_Pangaribowo%20Gerber%20Torero_FNS%20Indicators.pdf
• ↵ International Food Policy Research Institute. Global nutrition report 2016: from promise to impact: ending malnutrition by 2030. Washington, DC, USA; 2016. http://www.ifpri.org/publication/global-nutrition-report-2016-promise-impact-ending-malnutrition-2030
• Sutherland J ,
• Dangour AD ,
• Shankar B ,
• Global panel
• ↵ World Health Organization. Healthy diet. WHO Fact Sheet N°394. Geneva, Switzerland; 2015. http://www.who.int/en/news-room/fact-sheets/detail/healthy-diet
• Flaxman AD ,
• GBD 2015 Risk Factors Collaborators.
• WHO Multicentre Growth Reference Study Group
• ↵ Roser M, Ortiz-Ospina E. Global extreme poverty. 2017. http://ourworldindata.org/extreme-poverty
• ↵ World Bank. Understanding poverty; 2016. http://www.worldbank.org/en/understanding-poverty
• ↵ International Food Policy Research Institute. Global Nutrition Report 2017: Nourishing the SDGs . Washington, DC, USA, 2017. http://165.227.233.32/wp-content/uploads/2017/11/Report_2017-2.pdf
• ↵ UNICEF, World Health Organization and World Bank. Joint child malnutrition estimates: levels and trends (2018 edition). New York, NY, 2018. http://www.who.int/nutgrowthdb/estimates/en/
• de Onís M ,
• Monteiro C ,
• de Onis M ,
• ↵ International Food Policy Research Institute. Global nutrition report 2014: Actions and accountability to advance nutrition and sustainable development . 2017. http://globalnutritionreport.org/the-report/
• Gillespie S ,
• van den Bold M ,
• Stories of Change Study Team
• ↵ Headey D. Nutrition in Ethiopia: an emerging success story? Ethiopia strategic support program. Research Note 40. Ethiopian Development Research Institute, International Food Policy Research Institute, 2015. http://ebrary.ifpri.org/utils/getfile/collection/p15738coll2/id/129266/filename/129477.pdf
• Alderman H ,
• Maternal and Child Nutrition Study Group
• ↵ Nisbett N, Davis P, Yosef S, Akhtar N. Bangladesh’s story of change in nutrition: strong improvements in basic and underlying determinants with an unfinished agenda for direct community level support. Glob Food Secur 2017;13:21-9. doi: 10.1016/j.gfs.2017.01.005 .
• Griffiths M
• ↵ Famine Early Warning Systems Network. Acute food insecurity: near term (February-May 2017). Washington, DC, USA, 2017. http://fews.net/east-africa/somalia/alert/may-9-2017
• von Braun J ,
• ↵ Hasell J, Roser M. Our world in data. Famines, 2015. https://ourworldindata.org/famines
• ↵ United Nations Office for the Coordination of Humanitarian Affairs. Famine response and prevention North-East Nigeria, South Sudan, Somalia and Yemen. New York, NY, 2017. https://docs.unocha.org/sites/dms/Documents/FAMINE_press_handout_Final.pdf
• Victora CG ,
• Walker SP ,
• Dasgupta R ,
• Prendergast AJ ,
• Humphrey JH
• Hoddinott J ,
• Tesfaye R ,
• McDonald CM ,
• Flaxman S ,
• Nutrition Impact Model Study
• Massiot E ,
• Arsenault JE ,
• Stevens GA ,
• Finucane MM ,
• De-Regil LM ,
• Nutrition Impact Model Study Group (Anaemia)
• Andersson M ,
• Karumbunathan V ,
• Zimmermann MB
• Wessells KR ,
• ↵ Food and Agriculture Organization of the United Nations. Europe and Central Asia regional overview of food insecurity: the food insecurity transition. Budapest, Hungary, 2017. http://www.fao.org/3/a-i6877e.pdf
• Shariff ZM ,
• Francis D ,
• Burnier D ,
• Dorosty AR ,
• Eshraghian M
• ↵ Greenberg H, Deckelbaum RJ. Diet and non-communicable diseases: an urgent need for new paradigms. In: Eggersdorfer M, Kraemer K, Cordaro JB, et al, eds. Good nutrition: perspectives for the 21st century . Karger, 2016. https://www.karger.com/Article/Pdf/452379
• Fleming T ,
• Robinson M ,
• Franklin B ,
• Puckett S ,
• Macklin J ,
• White-Means S
• Vedovato GM ,
• Surkan PJ ,
• Jones-Smith J ,
• García OP ,
• Ronquillo D ,
• del Carmen Caamaño M ,
• Bhutta ZA ,
• Lancet Nutrition Interventions Review Group, the Maternal and Child Nutrition Study Group
• Saravia-Matus S ,
• Gomez y Paloma S
• Jaacks LM ,
• Slining MM ,
• ↵ Food and Agriculture Organization of the United Nations. Food outlook: biannual report on global food markets. Rome, Italy, 2016. http://www.fao.org/3/a-I5703E.pdf
• Kakietek J ,
• Eberwein JD ,
• ↵ Hoddinot J, Rosegrant M, Torero M. 2012. Investments to reduce hunger and undernutrition. Copenhagen Consensus 2012 challenge paper: hunger and malnutrition. http://www.copenhagenconsensus.com/sites/default/files/hungerandmalnutrition.pdf
• ↵ United States Department of Agriculture. Supplemental nutrition assistance program participation and costs (as of 4 May 2018). https://fns-prod.azureedge.net/sites/default/files/pd/SNAPsummary.pdf
• ↵ United States Department of Agriculture. Women, infants and children (WIC): WIC funding and program data. https://www.fns.usda.gov/wic/wic-funding-and-program-data

Introduction to Malnutrition

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. The term malnutrition includes obesity, however BAPEN is focused on the problem of “undernutrition”. The term “malnutrition” is used on this website to mean “undernutrition”. For further information on obesity please go to  NHS Choices website .

What are the signs and symptoms of malnutrition?

Malnutrition can be difficult to recognise, particularly in patients who are overweight or obese to start with. Malnutrition may happen gradually, making it difficult to detect in the early stages. Some of the signs and symptoms include:

• Loss of appetite
• Weight loss – clothes, rings, jewellery, dentures may become loose
• Tiredness, loss of energy
• 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 is associated with lethargy and depression
• Poor concentration
• Poor growth in children
• Who is at risk of malnutrition?

In this section

• What are the consequences of malnutrition?
• How is malnutrition recognised?
• What is the scale of malnutrition in the UK?
• How much does malnutrition cost the UK?
• How is malnutrition prevented and treated?
• Malnutrition Videos
• How Good is Your Nutritional Care?
• UK Malnutrition Awareness Week
• BAPEN Actions to Combat Malnutrition
• What have others done to combat malnutrition?
• Examples of Good Practice in Nutritional Care

Malnutrition

'MUST' & Self-Screening

Member Area

'MUST' Calculator

Introducing 'MUST'

The 'MUST' Toolkit

BIFA Guidelines

Decision Trees

Nutrition Support

Self-Screening Tool

e-Learning Portal

BAPEN Partners

Policies & Procedures

The BAPEN Office

Constitution of BAPEN

Cookies & Privacy

© 2024 BAPEN. All rights reserved

By visiting bapen.org.uk you accept our use of cookies and agree to our privacy policy Accept

Introductory Chapter: Malnutrition

• November 2020
• In book: Malnutrition

• Government College University Faisalabad

• Jiangsu University

Discover the world's research

• 25+ million members
• 160+ million publication pages
• 2.3+ billion citations

• Ratnasari Dyah
• Arianto Arianto
• Muliadi Muliadi

• PUBLIC HEALTH NUTR

• Zulfiqar A Bhutta

• Gretchen A Stevens
• Mariel M Finucane
• Christopher J. Paciorek
• Majid Ezzati
• J Pakistan Med Assoc
• Ammara Mushtaq
• J Paediatr Child Health

• J C Waterlow
• Recruit researchers
• Join for free
• Login Email Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google Welcome back! Please log in. Email · Hint Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google No account? Sign up

• Entertainment
• Environment
• Information Science and Technology
• Social Issues

Home Essay Samples Health

Essay Samples on Malnutrition

Malnutrition as a treatable condition, its types and how to overcome it.

Introduction The term malnutrition describes as a deficiency excess or imbalanced of wide range of nutrients resulting adverse effects on body which leads to poor health which increase the risk of malnutrition. In most cases malnutrition is a treatable condition that can be managed by...

• Healthy Lifestyle
• Malnutrition

What Is Double Burden of Malnutrition

The definition of double burden of malnutrition is coexistence of undernutrition along with overweight and obesity, or diet-related non-communicable diseases across the life course. There are multiple forms of malnutrition including: stunting, wasting, micronutrient deficiencies (vitamins and minerals), overweight or obesity, and non-communicable diseases (NCDs)....

Kwashiorkor as a Edematous Malnutrition and Its Effect on Mental Health

Kwashiorkor, also known as “edematous malnutrition, is caused by an unbalanced diet to very low protein intake, or marasmus. Kwashiorkor is most often apparent in poverish regions experiencing food deprivation. “The diseases usually strikes after weaning, between 1 and 3 years of age. It is...

• Mental Illness

Hungry in Hospital: An Examination of a Nutritional Report in England and Wales

In this essay I will critically examine a nutritional report by the Association of Community Health Councils for England and Wales (ACHCEW) (1997) ‘Hungry in Hospital?”. The Hungry in Hospital report looks at the importance of food in relation to nutrition, and how nutrition is...

• Importance of Food

Best topics on Malnutrition

1. Malnutrition as a Treatable Condition, Its Types and How to Overcome It

2. What Is Double Burden of Malnutrition

3. Kwashiorkor as a Edematous Malnutrition and Its Effect on Mental Health

4. Hungry in Hospital: An Examination of a Nutritional Report in England and Wales

Stressed out with your paper?

Consider using writing assistance:

• 100% unique papers
• 3 hrs deadline option
• Chronic Pain
• Blood Donation
• Childhood Obesity
• Stem Cell Research
• Universal Health Care
• Breastfeeding

Need writing help?

You can always rely on us no matter what type of paper you need

*No hidden charges

100% Unique Essays

Absolutely Confidential

Money Back Guarantee

By clicking “Send Essay”, you agree to our Terms of service and Privacy statement. We will occasionally send you account related emails

You can also get a UNIQUE essay on this or any other topic

Thank you! We’ll contact you as soon as possible.

REVIEW article

The intertwined relationship between malnutrition and poverty.

• 1 Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
• 2 Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia

Despite social and economic development, the burden of malnutrition across the globe remains unacceptably high. A vital relationship exists between nutritional status, human capital, and economic standing. Malnutrition adversely affects the physiological and mental capacity of individuals; which in turn hampers productivity levels, making them and their respective countries more susceptible to poverty. A two-way link exists between malnutrition and poverty, creating a vicious cycle with each fueling the other. Malnutrition produces conditions of poverty by reducing the economic potential of the population and likewise, poverty reinforces malnutrition by increasing the risk of food insecurity. The aim of the paper is to describe the interconnection between malnutrition and poverty, and to highlight how both serve as the cause and consequence of each other. The paper also discusses ways to move ahead to tackle these issues in a parallel manner rather than in separate silos.

Introduction

Malnutrition relates to a deficiency, excess, or imbalance of energy and other macro and micro-nutrients. It comprises of varying degrees of under- or over- nutrition, which leads to changes in body composition, body function, and clinical outcomes. In other words, malnutrition is an all-inclusive term that represents all manifestations of poor nutrition and ranges from extreme hunger and undernutrition to obesity ( 1 , 2 ). Despite social and economic development, the burden of malnutrition across the globe remains unacceptably high ( 2 ), recent data suggests that ~800 million people are undernourished, out of which 780 million reside in low-to-middle income countries, especially in Sub-Saharan Africa and South Asia ( 2 ). In 2015, inadequate food intake and poor dietary quality were responsible directly or indirectly for causing ill-health with six of the top 11 global risk factors being associated with dietary imbalances ( 2 ) and in 2017, 11 million deaths and 255 million disability-adjusted life years (DALYs) were attributable to dietary risk factors ( 3 ). Children under the age of 5 years are highly vulnerable to malnutrition with estimates suggesting that in 2019, globally 144 million children under the age of five were stunted (short for his/her age), 47 million wasted (thin for his/her height) and 38 million overweight (abnormal or excess bodyweight) ( 4 ). In adults, obesity is becoming more prevalent worldwide with ~38.9% of the adult population being either overweight or obese ( 5 ). Paradoxically, even though women have a higher prevalence (15.1%) of obesity than men (11%) ( 5 ); millions of women around the world are still underweight and one-third of women of reproductive age are estimated to have anemia ( 5 ).

Malnutrition has long been linked to poverty as higher rates of malnutrition are found in areas with chronic poverty ( 6 ). The impact of poverty on individuals can be seen through multiple manifestations and includes poor nutritional status, food insecurity, vulnerability to disease, reduced productivity levels, and compromised physical and intellectual development. Additionally, people living in poverty are unable to access necessities including nutritious food, hygienic environment, appropriate shelter, and adequate health care ( 7 ). Therefore, it would not be incorrect to suggest that even though malnutrition is a global phenomenon, those living in poverty face a higher burden. The question that now arises is whether malnutrition is a cause or consequence of poverty. The relationship between the nutritional status and economic standing has been further explored through the course of this paper.

The World Bank has set the International Poverty Line at $1.90 per person per day using 2011 Purchasing Power Parity (PPP) conversion factors ( 8 ). Therefore, households with a per capita income or expenditure less than the standard poverty line are defined as being poor ( 9 ). This makes income level the prime indicator for poverty, however with the passage of time, the need for re-conceptualizing poverty is becoming more evident as poverty is complex and multifaceted. Therefore, the conceptualization of poverty should not be limited to average income and wealth only but should encompass various other deprivations that are often experienced by people living in poverty. The global Multidimensional Poverty Index (MPI) is an international measure of acute poverty covering over 100 developing countries; created by the Oxford Poverty and Human Development Initiative (OPHI) and the United Nations Development Programme (UNDP) in 2010 ( 10 ). The global MPI steps away from the traditional view of poverty being solely limited to average income and wealth; to a more holistic view that highlights the need for using multiple indicators to account for various issues faced by people as a consequence of poverty ( 10 ). Through this index, poverty is portrayed to be a deprivation of basic amenities that restricts individuals from leading a good and healthy life ( 11 ) and takes into account the systemic disparities within a country and stretches the boundaries of poverty beyond the shortage of material assets to a concept that encompasses multiple deprivations, including but not limited to: assets, living standards, education, sanitation and hygiene, health and nutrition ( 10 ).

Since the 1990s, it is estimated that the proportion of the world's population living in extreme poverty has declined by more than a half ( 8 ). In 2015, 10% of the world's population lived under the poverty line; compared to nearly 36% in 1990 ( 8 ). Unfortunately, despite the overall decline in global poverty, progress has been uneven and disproportionate with the majority of the world's poor residing predominantly in Sub-Saharan Africa and South Asia ( 8 ). In 2015, 736 million people lived in extreme conditions of poverty with half of them i.e., 368 million residing only in five countries of India, Nigeria, Democratic Republic of Congo, Ethiopia, and Bangladesh ( 8 ). This illustrates that certain countries especially those afflicted by conflict, poor governance, and natural disasters continue to experience a skewed burden of poverty.

To analyze the vital linkages between poverty and malnutrition; it is important to highlight the growing evidence that health outcomes including malnutrition are driven by social determinants of health i.e., the conditions and circumstances in which people live, learn, work, and even play have a significant impact on their health ( 12 ). This interconnection between people's conditions and circumstances and their health can be displayed using the concept of poverty and food insecurity. The term “food insecurity” refers to a situation in which people do not have adequate physical, social or economic access to sufficient and nutritious food ( 13 ). Broadly, food insecurity is assessed using four dimensions i.e., food availability, access to food, stability of supply and safe, and healthy food utilization ( 14 ). Food insecurity may occur at various levels including regional, national, household, or individual. Poverty and food insecurity are deeply related, as poverty may adversely affect the social determinants of health and may create unfavorable conditions in which people might experience unreliable food supply ( 13 ). Food is a major household expenditure for the poor households ( 15 ). Data from African countries indicate that close to half of household income is spent on food: Nigeria (56.4%) ( 16 ); Kenya (46.7%), Cameroon (45.6%), Algeria (42.5%) ( 17 ). Similarly, within high-income countries, low-income households spend a significant proportion of their income on food: Ireland (14–33%), USA (28.8–42.6%) ( 17 , 18 ). In comparison, the wealthiest households in the USA spend a much lower 6.5–9.2% of household income on food ( 17 ). Despite spending a large proportion of their household income on food, many poor households continue to remain food insecure because of their insufficient, irregular, and fluctuating incomes ( 2 , 13 ).

Poverty, Food Insecurity and Double Burden of Malnutrition

A vital relationship exists between malnutrition and poverty. Poverty creates unstable and unfavorable conditions that may contribute to fueling the problem of malnutrition ( 7 ). People living in poverty often face financial limitations, which hinders their ability to access safe, sufficient, and nutritious food ( 7 ). Food insecurity compromises people's ability to acquire the amount of food needed to fulfill the bodily requirement of calories and without sufficient calorie intake, an individual may not be able to build up energy or strength to carry out everyday life activities and this also hampers the capacity and productivity to earn ( 19 ). While people living in poverty may require a greater quantity of food than they cursrently have, it is important to take into consideration that appropriate intake of nutrients and quality of food is equally important ( 19 ). Poverty can contribute to worsening malnutrition by compromising the quality of food intake and bolstering hidden hunger which is the deficiency of essential vitamins and minerals. The burden of obesity has extended beyond wealthier, developed nations and has now also become a feature of the developing world ( 16 ). Poverty leads to financial constraints that in turn lead to the consumption of cheap, high-energy staple foods, primarily carbohydrates, and fats rather than nutritionally dense food. Through the consumption of carbohydrates and fats, energy levels spike; but nutritional quality becomes compromised. The consequence of this is reduced nutritional quality and nutrient deficiencies. Poverty plays a significant role in regulating access and preference of foods ( 13 , 16 ), and this is evident in studies that showcase that when people living in poverty get a chance to spend relatively more on food; they often prefer to buy better tasting food, rather than good quality food ( 19 ).

The deficiency of micronutrients or “hidden hunger” is an important component of malnutrition ( 13 ). Micronutrient deficiencies can exists in all age groups and in any socioeconomic bracket. Iron, folate, vitamin A, iodine, and zinc deficiencies are among the most common and widespread micronutrient deficiencies among women and children in low- and middle- income countries and many of these micronutrient deficiencies co-exist. Assessing the relationship between malnutrition and poverty, requires consideration of micronutrient deficiencies. While macro- and micro- nutrient deficiencies may cause suboptimal mental and physical development, recurrent infections and growth retardation ( 20 , 21 ); micro-nutrient deficiencies may also result in adverse birth outcomes including low birth weight babies ( 22 , 23 ). To date, ~20 million babies are born with low birth weight each year and there is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life ( 5 , 24 ). Low birth weight in babies can contribute to the vicious cycle of malnutrition since maternal nutrition status especially maternal stature has been reported to be inversely associated with offspring mortality, underweight, and stunting in infancy and childhood ( 22 , 23 ). Moreover, the importance of adequate intake of micronutrients can be noted in children born to mothers with sufficient amounts of iodine during pregnancy ( 19 ), as these children tend to complete one-third or one-half a year more schooling than children born to mothers with inadequate amount of iodine during pregnancy ( 19 ). It has been suggested that if every mother took iodine capsules during pregnancy then this could improve educational attainment among children in Central and Southern Africa ( 19 ).

Briefly put, the double burden of malnutrition and the importance of micro-nutrients should be recognized when analyzing the malnutrition-poverty cycle. There is a growing need to reimagine the concept of malnutrition and development experts and policy makers should make strides to account for the inherent complexities of both concepts in order to develop successful and sustainable nutritional strategies ( 19 ).

Malnutrition: Cause or Consequence of Poverty?

The question that now arises is whether malnutrition is a cause or consequence of poverty and vice versa? To elaborate upon this, it is important to highlight the relationship of human capital with nutrition and poverty.

Human capital is an integral asset of any country and the process of developing human capital begins from infancy and continues throughout the course of an individual's life ( 25 ). Nutritional status has a profound impact on human capital. The reasoning is simple, improved nutritional status is vital for escaping poverty, as good health is needed to increase productivity levels, contribute to economic growth, and improve a country's overall welfare ( 6 ). Without adequate nutrition, human capital starts to decline. This is because malnutrition negatively impacts physical and mental development, intellectual capacity, productivity, and the economic potential of an individual ( 25 ). As a consequence, economic stability is threatened, making a country more vulnerable to poverty. Poverty contributes to the problem of food insecurity which is referred to as a “resourced-constrained” or “poverty related” condition. Although the populations affected by poverty and food insecurity overlap; it is important to note that not all people living in poverty are food insecure and that this problem also exists in people living above the poverty line. Moreover, poverty also contributes in creating conditions of micro-nutrient deficiencies and hidden hunger. These factors exacerbate the issue of malnutrition and makes individuals more vulnerable to other health concerns. Irregular and unstable food supply along with low quality of food due to insufficient or inadequate nutrient intake can compromise immunity and make individuals more susceptible to infections. Additionally, if infected, matters tend to become worse because infections may further reduce nutritional and health status, thereby aggravating malnutrition and reinforcing its cycle with poverty ( 25 , 26 ).

A vicious cycle exists through which both poverty and malnutrition fuel and reinforce each other ( 25 ). Globally, the poorest countries are the countries bearing the highest burden of malnutrition. Nutritional imbalances reduce work capacity and human capital; and this makes countries more susceptible to poverty. Furthermore, malnutrition is also a consequence of poverty, as poverty increases food insecurity and hidden hunger; which contributes to the problem of malnutrition. This makes both these elements a cause and a consequence of each other. Establishing a linear relationship between the two would overlook the complexities and nuances that exist within the framework of this topic.

What Will be the Next Steps?

In order to progress socially and economically, there is an urgent need to recognize the burden of poverty and malnutrition and to take immediate steps to break the ongoing cycle. To achieve this target, it is important to understand what factors feed and reinforce it.

The cycle of poverty and malnutrition appears to be intergenerational. Evidence suggests that malnourished women are at a higher risk of having malnourished children and this creates an intergenerational effect ( 6 ). It is imperative to intervene early in life in order to maximize the effectiveness of interventions and break the cycle. The Lancet Nutrition Series ( 27 ) modeled the effect of 10 evidence based nutrition specific interventions on lives saved in the 34 countries that have 90% of the world's children with stunted growth. The series also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behavior change, access to and uptake of these interventions. Findings suggest that the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access these 10 evidence-based nutrition interventions at 90% coverage. These nutrition specific interventions included salt iodization, multiple micronutrient supplementation in pregnancy (includes iron-folate), calcium supplementation in pregnancy, energy-protein supplementation in pregnancy, vitamin A supplementation in childhood, zinc supplementation in childhood, breastfeeding promotion, complementary feeding education, complementary food supplementation, and management of severe acute malnutrition in children. The findings also support the use of various community engagement and delivery strategies that can help reach poor segments of the population at greatest risk in order to make a difference ( 27 ). In other words, the interventions need to reach the poorest of the poor to break the cycle of malnutrition and poverty and should also incorporate disease and infection prevention as a part of their strategy ( 25 ).

Considering the inter-linkages described above between malnutrition and poverty, nutrition specific interventions need to be augmented with nutrition sensitive interventions in order to accelerate the progress of reducing malnutrition. Nutrition sensitive interventions are those that address intermediate and underlying causes of malnutrition and help to improve access to nutritious food, clean water and sanitation, education and employment, and health care etc. Large scale nutrition programs focusing on evidence based nutrition interventions should also target key underlying determinants of nutrition including poverty in order to enhance the coverage and effectiveness of nutrition-specific interventions. These include interventions in the sectors of agriculture, social safety nets, early child development, education, and women's empowerment. Women's empowerment is instrumental in not only improving malnutrition but general well-being ( 28 ). Hence, a parallel focus on nutrition sensitive and nutrition specific interventions has the potential to greatly accelerate progress in not only the areas of nutrition but also break the intergenerational cycle of malnutrition and poverty ( 29 ). More recently, bio-fortification and agricultural biodiversity are also considered to have the potential to cater to the issues of poverty and malnutrition in a parallel manner ( 30 ). In developing countries, bio-fortification could focus on improving quality of coarse cereals, as well as fodders along with community participatory approaches to enhance agricultural biodiversity. This approach not only could contribute to a reduction in malnutrition and poverty, but reduce food insecurity and improve sustainability ( 31 , 32 ), though further research is needed in the domain ( 30 , 31 ). Income disparity is also a factor that allows the malnutrition-poverty cycle to persist. In fact, a country may experience economic growth, but still have widespread poverty and high levels of malnutrition. This is because income inequality translates as health inequality; as the income gap grows, so does health disparity ( 7 , 13 , 25 ). Furthermore, gender inequities have also been associated with both poverty and malnutrition as a result of lower opportunities for women in the fields of education and employment. A recent analysis based on data from 49 low- and middle-income countries assessing the relationship between gender equity and malnutrition and health suggests that gender equity in education and employment decreases child malnutrition and is an important determinant in nutrition and access to health care ( 33 ). Therefore, any attempt to improve global nutritional status and to achieve the targets set by the “2030 Agenda for Sustainable Development” requires a focus on alleviating poverty and simultaneously focusing on agriculture, social safety nets, early child development, education, and strengthening women's position in society ( 34 – 37 ).

Nutritional interventions should be designed in an all-rounded, holistic manner. It would be fruitful to involve multiple stakeholders including health, education, agriculture, water, sanitation and hygiene, gender and economics. To ensure sustainability, nutritional interventions should be context-specific and should also be cost-effective since these issues concern low and middle income countries.

Ending poverty in all its forms is the first of the 17 Sustainable Development Goals and ending hunger, reducing food insecurity and improved nutrition and agriculture is the second goal. Furthermore, at least 12 of the 17 goals contain indicators that are highly relevant to nutrition. Poverty and malnutrition are deeply interrelated, with each fuelling the other and hence it is imperative to tackle both issues simultaneously rather than in parallel silos. A two-way link exists, with both elements being the cause and consequence of each other. This vicious cycle remains a prime public health concern and immediate strides need to be made against it. For a sustainable improvement in nutritional outcomes, the battle against poverty and malnutrition has to be fought on all fronts, to achieve a healthier and more equitable society.

Author Contributions

All authors contributed to the study and the write-up.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

1. Soeters P, Bozzetti F, Cynober L, Forbes A, Shenkin A, Sobotka L. Defining malnutrition: a plea to rethink. Clin Nutr. (2017) 36:896–901. doi: 10.1016/j.clnu.2016.09.032

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Webb P, Stordalen GA, Singh S, Wijesinha-Bettoni R, Shetty P, Lartey A. Hunger and malnutrition in the 21st century. BMJ . (2018) 361:k2238. doi: 10.1136/bmj.k2238

3. Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet . (2019) 393:1958–72. doi: 10.1016/S0140-6736(19)30041-8

4. UNICEF WHO WBG. Levels and Trends in Child Malnutrition UNICEF-WHO-World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2020 Edition . Geneva (2020).

Google Scholar

5. Development Initiatives. Global Nutrition Report: Shining a Light to Spur Action on Nutrition . Bristol: Development Initiatives (2018).

6. Setboonsarng S. Child Malnutrition as a Poverty Indicator: An Evaluation in the Context of Different Development Interventions in Indonesia . Tokyo: ADB Institute Discussion Papers (2005).

7. Peña M, Bacallao J. Malnutrition and poverty. Annu Rev Nutr. (2002) 22:241–53. doi: 10.1146/annurev.nutr.22.120701.141104

8. The World Bank. Poverty . (2019). Available online at: https://www.worldbank.org/en/topic/poverty/overview (accessed January 3, 2019).

9. Heltberg R. Malnutrition, poverty, and economic growth. Health Econ. (2009) 18(S1):S77–88. doi: 10.1002/hec.1462

CrossRef Full Text | Google Scholar

10. Oxford Poverty and Human Development Initiative and UNDP. Global Multidimensional Poverty Index 2019: Illuminating Inequalities . Oxford (2019).

11. Knech A. Understanding and fighting poverty–Amartya Sen's capability approach and related theories. Soc Change Rev. (2012) 10:153–76. doi: 10.2478/scr-2013-0016

12. WHO. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Commission on Social Determinants of Health final report . Geneva: World Health Organization (2008).

13. Tanumihardjo SA, Anderson C, Kaufer-Horwitz M, Bode L, Emenaker NJ, Haqq AM, et al. Poverty, obesity, and malnutrition: an international perspective recognizing the paradox. J Am Diet Assoc. (2007) 107:1966–72. doi: 10.1016/j.jada.2007.08.007

14. Mundial B. Biofuels: Prospects, Risks and Opportunities . Washington, DC: The State of Food and Agriculture (2008).

15. Schanzenback D, Nunn R, Bauer L, Mumford M. Where Does All the Money Go: Shifts in Household Spending Over the Past 30 Years . Washington, DC: The Brookings Institute (2016).

16. Delisle H, Batal M. The double burden of malnutrition associated with poverty. Lancet. (2016) 387:2504–5. doi: 10.1016/S0140-6736(16)30795-4

17. World Economic Forum. Which Countries Spend the Most on Food? This Map Will Show You . Dublin (2016). Available online at: https://www.weforum.org/agenda/2016/12/this-map-shows-how-much-each-country-spends-on-food/ (accessed April 24, 2020).

18. Safefood. What Is the Cost of a Healthy Food Basket in the Republic of Ireland in 2018? Dublin (2019).

19. Banerjee A, Duflo E. More than 1 billion people are hungry in the world. Foreign Policy . (2011). p. 66–72.

20. WHO. Nutritional Landscape Information System: Country Profile Indicators - Interpretation Guide . Geneva: World Health Organization (2010).

21. World Health Organization. UNICEF-WHO-The World Bank: Joint Child Malnutrition Estimates: Levels and Trends . Geneva (2019).

PubMed Abstract | Google Scholar

22. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. (2013) 382:427–51. doi: 10.1016/S0140-6736(13)60937-X

23. Özaltin E, Hill K, Subramanian S. Association of maternal stature with offspring mortality, underweight, and stunting in low-to middle-income countries. JAMA . (2010) 303:1507–16. doi: 10.1001/jama.2010.450

24. Dewey KG, Begum K. Long-term consequences of stunting in early life. Maternal Child Nutr . (2011) 7:5–18. doi: 10.1111/j.1740-8709.2011.00349.x

25. Vorster HH. The link between poverty and malnutrition: a South African perspective. Health SA Gesondheid. (2010) 15:1–6. doi: 10.4102/hsag.v15i1.435

26. Thompson B, Cohen MJ, Meerman J. World food insecurity and malnutrition: scope, trends, causes and consequences. In: Thompson B, Cohen MJ, editors. The Impact of Climate Change and Bioenergy on Nutrition . Springer (2012). p. 21–41.

27. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet . (2013) 382:452–77. doi: 10.1016/S0140-6736(13)60996-4

28. Van den Bold M, Quisumbing AR, Gillespie S. Women's Empowerment and Nutrition: An Evidence Review . Washington, DC: International Food Policy Research Institute (2013).

29. Ruel MT, Alderman H, Maternal Group CNS. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet . (2013) 382:536–51. doi: 10.1016/S0140-6736(13)60843-0

30. Johns T, Eyzaguirre PB. Biofortification, biodiversity and diet: a search for complementary applications against poverty and malnutrition. Food Policy. (2007) 32:1–24. doi: 10.1016/j.foodpol.2006.03.014

31. Hunter D, Özkan I, Moura de Oliveira Beltrame D, Samarasinghe WLG, Wasike VW, Charrondière UR, et al. Enabled or disabled: is the environment right for using biodiversity to improve nutrition? Front Nutr. (2016) 3:14. doi: 10.3389/fnut.2016.00014

32. Kennedy G, Stoian D, Hunter D, Kikulwe E. Agricultural Biodiversity for Healthy, Diverse Diets . Rome: Bioversity International (2016).

33. Ekbrand H, Halleröd B. The more gender equity, the less child poverty? A multilevel analysis of malnutrition and health deprivation in 49 low-and middle-income countries. World Dev. (2018) 108:221–30. doi: 10.1016/j.worlddev.2018.01.028

34. Doss CR. Women and agricultural productivity: reframing the issues. Dev Policy Rev. (2018) 36:35–50. doi: 10.1111/dpr.12243

35. Fernandez RM. SDG3 good health and well-being: integration and connection with other SDGs. In: Leal Filho W, Wall T, Azul AM, Brandli L, Özuyar PG, editors. Good Health and Well-Being . Springer Nature (2020). p. 629–36.

36. Ishikawa M, Yokoyama T, Sagehashi M, Kunugita N, Miura H. Diagnosing the double burden of malnutrition using estimated deviation values in low-and lower-middle-income countries. PLoS ONE. (2018) 13:e0208525. doi: 10.1371/journal.pone.0208525

37. Leal Filho W, Tripathi SK, Andrade Guerra J, Giné-Garriga R, Orlovic Lovren V, Willats J. Using the sustainable development goals towards a better understanding of sustainability challenges. Int J Sustain Dev World Ecol. (2019) 26:179–90. doi: 10.1080/13504509.2018.1505674

Keywords: malnutrition, poverty, undernutrition, obesity, food insecurity

Citation: Siddiqui F, Salam RA, Lassi ZS and Das JK (2020) The Intertwined Relationship Between Malnutrition and Poverty. Front. Public Health 8:453. doi: 10.3389/fpubh.2020.00453

Received: 07 January 2020; Accepted: 21 July 2020; Published: 28 August 2020.

Reviewed by:

Copyright © 2020 Siddiqui, Salam, Lassi and Das. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jai K. Das, jai.das@aku.edu

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• PubMed/Medline
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Burden of childhood malnutrition: a roadmap of global and european policies promoting healthy nutrition for infants and young children.

1. Introduction

2. materials and methods.

• Word Health Organization (WHO) ( https://www.who.int/ ) (accessed on 26 March 2022)
• Centers for Disease Control and Prevention (CDC) ( https://www.cdc.gov/ ) (accessed on 26 March 2022)
• United Nations Children’s Fund (UNICEF) ( https://www.unicef.org/ ) (accessed on 26 March 2022)
• Word Health Organization Regional Office for Europe (WHO/Europe) ( https://www.euro.who.int/en ) (accessed on 26 March 2022)
• European Centre for Disease Prevention and Control (ECDC) ( https://www.ecdc.europa.eu/en ) (accessed on 26 March 2022)
• U. S. Department of Agriculture (USDA) ( https://www.usda.gov/ ) (accessed on 26 March 2022)

3.1. Breastfeeding, Complementary Feeding and Young Child Feeding Promotion

3.2. severe malnutrition prevention and management, 3.3. prevention of childhood overweight and obesity, 3.4. children’s healthy nutrition as a goal in broader plans, 3.5. strategies and action plans in the european region, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• Vassilakou, T. Childhood Malnutrition: Time for Action. Children 2021 , 8 , 103. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• World Health Organization. Malnutrition. Available online: https://www.who.int/en/news-room/fact-sheets/detail/malnutrition (accessed on 26 March 2022).
• Popkin, B.M.; Corvalan, C.; Grummer-Strawn, L.M. Dynamics of the double burden of malnutrition and the changing nutrition reality. Lancet 2020 , 395 , 65–74. [ Google Scholar ] [ CrossRef ]
• Biesalski, H.K.; O’Mealy, P. Hidden Hunger , 1st ed.; Springer: Berlin/Heidelberg, Germany, 2013. [ Google Scholar ]
• Food and Agriculture Organization. Hunger and Food Insecurity. Available online: https://www.fao.org/hunger/en/ (accessed on 26 March 2022).
• Economic Research Service; U.S. Department of Agriculture. Definitions of Food Security. Available online: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/ (accessed on 26 March 2022).
• Food and Agriculture Organization. The State of Food Security and Nutrition in the World: Safeguarding against Economic Slowdowns and Downturns ; Food and Agriculture Organization of the United Nations: Rome, Italy, 2019. [ Google Scholar ]
• Food Security Information Network. Global Report on Food Crises ; World Food Programme: Rome, Italy, 2019. [ Google Scholar ]
• World Health Organization. Levels and Trends in Child Malnutrition: UNICEF/WHO/The World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2020 Edition ; World Health Organization: Geneva, Switzerland, 2020. [ Google Scholar ]
• Cheryl, D.; Fryar, M.S.P.H.; Margaret, D.; Carroll, M.S.P.H.; Afful, J. Prevalence of Overweight, Obesity, and Severe Obesity among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 through 2017–2018 ; NCHS Health E-Stats: Atlanta, GA, USA, 2020. [ Google Scholar ]
• World Health Organization, Regional Office for Europe. WHO European Childhood Obesity Surveillance Initiative (COSI). Report on the Fourth Round of Data Collection 2015–2017 ; World Health Organization, Regional Office for Europe: Copenhagen, Denmark, 2021. [ Google Scholar ]
• Stavridou, A.; Kapsali, E.; Panagouli, E.; Thirios, A.; Polychronis, K.; Bacopoulou, F.; Psaltopoulou, T.; Tsolia, M.; Sergentanis, T.N.; Tsitsika, A. Obesity in Children and Adolescents during COVID-19 Pandemic. Children 2021 , 8 , 135. [ Google Scholar ] [ CrossRef ]
• Lange, S.J.; Kompaniyets, L.; Freedman, D.S.; Kraus, E.M.; Porter, R. Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2–19 years—United States, 2018–2020. Morb. Mortal. Wkly. Rep. 2021 , 70 , 1278. [ Google Scholar ] [ CrossRef ]
• International Food Policy Research Institute. 2014 Global Hunger Index: The Challenge of Hidden Hunger ; Welthungerhilfe, International Food Policy Research Institute: Bonn, Germany; Washington, DC, USA; Concern Worldwide: Dublin, Ireland, 2014. [ Google Scholar ]
• World Health Organization. Obesity and Overweight. Available online: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed on 26 March 2022).
• Nieman, P.; Leblanc, C.M. Psychosocial aspects of child and adolescent obesity. Paediatr. Child Health 2012 , 17 , 205–208. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Sahoo, K.; Sahoo, B.; Choudhury, A.K.; Sofi, N.Y.; Kumar, R.; Bhadoria, A.S. Childhood obesity: Causes and consequences. J. Family Med. Prim. Care 2015 , 4 , 187–192. [ Google Scholar ] [ PubMed ]
• Lifshitz, F. Obesity in children. J. Clin. Res. Pediatric Endocrinol. 2008 , 1 , 53–60. [ Google Scholar ] [ CrossRef ]
• Marshall, N.E.; Abrams, B.; Barbour, L.A.; Catalano, P.; Christian, P.; Friedman, J.E.; Hay, W.W., Jr.; Hernandez, T.L.; Krebs, N.F.; Oken, E.; et al. The importance of nutrition in pregnancy and lactation: Lifelong consequences. Am. J. Obstet. Gynecol. 2022 , 226 , 607–632. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Moore, B.F.; Harrall, K.K.; Sauder, K.A.; Glueck, D.H.; Dabelea, D. Neonatal Adiposity and Childhood Obesity. Pediatrics 2020 , 146 , e20200737. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Walters, E.; Edwards, R.G. Further thoughts regarding evidence offered in support of the ‘Barker hypothesis’. Reprod. Biomed. Online 2004 , 9 , 129–131. [ Google Scholar ] [ CrossRef ]
• Barker, D.J.; Eriksson, J.G.; Forsen, T.; Osmond, C. Fetal origins of adult disease: Strength of effects and biological basis. Int. J. Epidemiol. 2002 , 31 , 1235–1239. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
• Li, R.; Ware, J.; Chen, A.; Nelson, J.M.; Kmet, J.M.; Parks, S.E.; Morrow, A.L.; Chen, J.; Perrine, C.G. Breastfeeding and Post-perinatal Infant Deaths in the United States, A National Prospective Cohort Analysis. Lancet Reg. Health-Am. 2022 , 5 , 100094. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Victora, C.G.; Bahl, R.; Barros, A.J.; Franca, G.V.; Horton, S.; Krasevec, J.; Murch, S.; Sankar, M.J.; Walker, N.; Rollins, N.C. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet 2016 , 387 , 475–490. [ Google Scholar ] [ CrossRef ] [ Green Version ]
• World Health Organization. Breastfeeding. Available online: https://www.who.int/health-topics/breastfeeding#tab=tab_1 (accessed on 26 March 2022).
• World Health Organization; United Nations Children’s Fund (UNICEF). Protecting, Promoting and Supporting Breast-Feeding: The Special Role of Maternity Services ; 9241561300; World Health Organization: Geneva, Switzerland, 1989. [ Google Scholar ]
• World Health Organization; United Nations Children’s Fund (UNICEF). On the Protection, Promotion, and Support of Breastfeeding. Breastfeeding in the 1990s: Global Initiative ; Spedale degli Innocenti: Florence, Italy, 1990. [ Google Scholar ]
• UNICEF. World Declaration on the Survival, Protection and Development of Children and Plan of Action for Implementing the World Declaration on the Survival, Protection and Development of Children ; United Nations International Children’s Emergency Fund: New York, NY, USA, 1990. [ Google Scholar ]
• World Health Organization. Baby-Friendly Hospital Initiative. Available online: https://apps.who.int/nutrition/topics/bfhi/en/index.html (accessed on 26 March 2022).
• World Alliance for Breastfeeding Action. World Breastfeeding Week (WBW). Available online: https://waba.org.my/wbw/ (accessed on 26 March 2022).
• World Health Organization. The optimal duration of exclusive breastfeeding. In Report of an Expert Consultation ; World Health Organization: Geneva, Switzerland, 2001. [ Google Scholar ]
• World Health Organization. Global Strategy for Infant and Young Child Feeding ; 9241562218; World Health Organization: Geneva, Switzerland, 2003. [ Google Scholar ]
• Pan American Health Organization; WHO. Guiding Principles for Complementary Feeding of the Breastfed Child ; Division of Health Promotion and Protection/Food and Nutrition Program: Washington, DC, USA, 2003. [ Google Scholar ]
• UNICEF. 1990–2005 Celebrating the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding ; UNICEF: Florence, Italy, 2005. [ Google Scholar ]
• UNICEF. Innocenti Declaration on Infant and Young Child Feeding ; UNICEF: Florence, Italy, 2005. [ Google Scholar ]
• World Health Organization; United Nations Children’s Fund (UNICEF). Baby-friendly Hospital Initiative, revised, updated and expanded for integrated care, Section 2. Strengthening and sustaining the baby-friendly hospital initiative: A course for de-cision-makers; Section 3. In Breastfeeding Promotion and Support in a Baby-Friendly Hospital: A 20-Hour Course for Maternity Staff ; World Health Organization: Geneva, Switzerland, 2009. [ Google Scholar ]
• Nyqvist, K.H.; Maastrup, R.; Hansen, M.; Haggkvist, A.; Hannula, L.; Ezeonodo, A.; Kylberg, E.; Haiek, L. Neo-BFHI: The Baby-Friendly Hospital Initiative for Neonatal Wards ; Nordic and Quebec Working Group: Quebec, QC, Canada, 2015. [ Google Scholar ]
• World Health Organization. Guideline: Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services ; World Health Organization: Geneva, Switzerland, 2017. [ Google Scholar ]
• World Health Organization; United Nations Children’s Fund (UNICEF). Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services: Implementing the Revised Baby-Friendly Hospital Initiative 2018 ; World Health Organization: Geneva, Switzerland, 2018. [ Google Scholar ]
• World Health Organization; United Nations Children’s Fund (UNICEF). The Extension of the 2025 Maternal, Infant and Young Child Nutrition Targets to 2030 ; United Nations Children’s Fund (UNICEF): New York, NY, USA, 2019. [ Google Scholar ]
• World Health Organization. Indicators for Assessing Breast-Feeding Practices: Report of an Informal Meeting ; World Health Organization: Geneva, Switzerland, 1991. [ Google Scholar ]
• World Health Organization. Indicators for Assessing Infant and Young Child Feeding Practices ; World Health Organization: Geneva, Switzerland, 2008. [ Google Scholar ]
• World Health Organization; United Nations Children’s Fund (UNICEF). Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods ; 9240018387; World Health Organization: Geneva, Switzerland; United Nations Children’s Fund: New York, NY, USA, 2021. [ Google Scholar ]
• World Health Organization. Breastfeeding Counselling: A training Course ; World Health Organization: Geneva, Switzerland, 1993. [ Google Scholar ]
• World Health Organization. Infant and Young Child Feeding Counselling: An Integrated Course ; World Health Organization: Geneva, Switzerland, 2009. [ Google Scholar ]
• World Health Organization. WHO Recommendations on Postnatal Care of the Mother and Newborn ; World Health Organization: Geneva, Switzerland, 2014. [ Google Scholar ]
• World Health Organization. Early Essential Newborn Care: Clinical Practice Pocket Guide ; WHO Regional Office for the Western Pacific: Manila, Philippines, 2014. [ Google Scholar ]
• World Health Organization. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals ; World Health Organization: Geneva, Switzerland, 2009. [ Google Scholar ]
• World Health Organization. Essential Newborn Care Course ; World Health Organization: Geneva, Switzerland, 2010. [ Google Scholar ]
• World Health Organization. International Code of Marketing of Breast-Milk Substitutes ; World Health Organization: Geneva, Switzerland, 1981. [ Google Scholar ]
• World Health Organization. Country Implementation of the International Code of Marketing of Breast-Milk Substitutes: Status Report 2011 ; 9241505982; World Health Organization: Geneva, Switzerland, 2013. [ Google Scholar ]
• World Health Organization; United Nations Children’s Fund (UNICEF). WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children ; World Health Organization: Geneva, Switzerland, 2009. [ Google Scholar ]
• World Health Organization. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers ; World Health Organization: Geneva, Switzerland, 1999. [ Google Scholar ]
• World Health Organization. Management of the Child with a Serious Infection or Severe Malnutrition: Guidelines for Care at the First-Referral Level in Developing Countries ; World Health Organization: Geneva, Switzerland, 2000. [ Google Scholar ]
• World Health Organization. Guideline: Updates on the Management of Severe ACUTE malnutrition in Infants and Children ; World Health Organization: Geneva, Switzerland, 2013; pp. 6–54. [ Google Scholar ]
• WHO; UNICEF; WFP; UNSCN. Community-Based Management of Severe Acute Malnutrition: A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund ; 9280641476; WHO: Geneva, Switzerland; UNICEF: New York, NY, USA; WFP: Rome, Italy; UNSCN: Geneva, Switzerland, 2007. [ Google Scholar ]
• World Health Organization. Community-Based Strategies for Breastfeeding Promotion and Support in Developing Countries ; 9241591218; World Health Organization: Geneva, Switzerland, 2003. [ Google Scholar ]
• World Health Organization. Report of the Commission on Ending Childhood Obesity ; World Health Organization: Geneva, Switzerland, 2016. [ Google Scholar ]
• World Health Organization. Guideline: Assessing and Managing Children at Primary Health-Care Facilities to Prevent Overweight and Obesity in the Context of the Double Burden of Malnutrition ; World Health Organization: Geneva, Switzerland, 2017. [ Google Scholar ]
• United Nations. We Can End Poverty. Available online: https://www.un.org/millenniumgoals/poverty.shtml (accessed on 26 March 2022).
• United Nations. Goal 7: Ensure Environmental Sustainability. Available online: https://www.un.org/millenniumgoals/environ.shtml (accessed on 26 March 2022).
• United Nations. We Can End Poverty. Millennium Development Goals and beyond 2015 . Available online: https://www.un.org/millenniumgoals/ (accessed on 26 March 2022).
• Ban Ki-moon, B. Global Strategy for Women’s and Children’s Health ; United Nations: New York, NY, USA, 2010. [ Google Scholar ]
• United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development ; United Nations: San Francisco, CA, USA, 2015. [ Google Scholar ]
• Food and Agriculture Organization of the United Nations. Sustainable Development Goals. Available online: https://www.fao.org/sustainable-development-goals/goals/goal-2/en/ (accessed on 26 March 2022).
• World Health Organization. Every Woman Every Child—The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030): Survive, Thrive, Transform ; World Health Organization: Geneva, Switzerland, 2015. [ Google Scholar ]
• World Health Organization; United Nations Children’s Fund (UNICEF). Protect the Progress: Rise, Refocus and Recover: 2020 Progress Report on the “Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health” (2016–2030) ; 9240011994; UNICEF: New York, NY, USA, 2020. [ Google Scholar ]
• United Nations System Standing Committee on Nutrition. United Nations Decade of Action on Nutrition 2016–2025 ; A/RES/70/259; United Nations System Standing Committee on Nutrition: Rome, Italy, 2016. [ Google Scholar ]
• World Health Organization. Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition ; No. WHO/NMH/NHD/14.1; World Health Organization: Geneva, Switzerland, 2014. [ Google Scholar ]
• World Health Organization. Health Promoting Schools. Available online: https://www.who.int/health-topics/health-promoting-schools#tab=tab_1 (accessed on 26 March 2022).
• World Health Organization Assembly. Fifty-Third World Health Assembly, Geneva, 15–20 May 2000: Resolutions and Decisions, Annex ; World Health Organization: Geneva, Switzerland, 2000. [ Google Scholar ]
• World Health Organization. Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases ; World Health Organization: Geneva, Switzerland, 2009. [ Google Scholar ]
• World Health Organization. Global Action Plan for the Prevention and Control of NCDs 2013–2020 ; World Health Organization: Geneva, Switzerland, 2013. [ Google Scholar ]
• Cattaneo, A. Protection, Promotion and Support of Breastfeeding in Europe: A Blueprint for Action ; EU Project Contract N. SPC; Unit for Health Services Research and International Health: Trieste, Italy, 2004; p. 2002359. [ Google Scholar ]
• World Health Organization Regional Office for Europe. European Strategy for Child and Adolescent Health and Development ; WHO Regional Office for Europe: Copenhagen, Denmark, 2005. [ Google Scholar ]
• European Commission. EU Action Plan on Childhood Obesity 2014–2020 ; European Commission: Brussels, Belgium, 2014. [ Google Scholar ]
• World Health Organization. European Food and Nutrition Action Plan 2015–2020 ; Health Organization: Geneva, Switzerland, 2015. [ Google Scholar ]
• World Health Organization Regional Office for Europe. WHO European Action Plan for Food and Nutrition Policy 2007–2012 ; World Health Organization Regional Office for Europe: Copenhagen, Denmark, 2008. [ Google Scholar ]
• World Health Organization Regional Office for Europe. The First Action Plan for Food and Nutrition Policy: WHO European Region 2000–2005 ; Regional Office for Europe: Copenhagen, Denmark, 2001. [ Google Scholar ]
• Barnekov, V.; Buijs, G.; Clift, S.; Jensen, B.; Paulus, P.; Rivett, D.; Young, I. The Health Promoting School: A Resource for Developing Indicators ; International Planning Committee of the European Network of Health Promoting Schools: Copenhagen, Denmark, 2006. [ Google Scholar ]
• The Schools for Health in Europe Network (SHE). Available online: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/the-schools-for-health-in-europe-network-she (accessed on 26 March 2022).
• Simovska, V.; Dadaczynski, K.; Viig, N.G.; Tjomsland, H.E.; Bowker, S.; Woynarowska, B.; de Ruiter, S.; Buijs, G. HEPS Tool for Schools: A Guide for School Policy Development on Healthy Eating and Physical Activity. HEPS: Woerden, The Netherlands, 2010. [ Google Scholar ]
• European Union. Healthy Food for a Healthy Future Best-ReMaP Joint Action of the European Union. Available online: https://bestremap.eu/ (accessed on 26 March 2022).
• WHO/Europe. Prevention and Control of Noncommunicable Diseases in the WHO European Region ; Resolution EUR/RC56/R2; WHO: Geneva, Switzerland, 2006. [ Google Scholar ]
• WHO/Europe. Gaining Health. The European Strategy for the Prevention and Control of Noncommunicable Diseases ; WHO: Geneva, Switzerland, 2006. [ Google Scholar ]
• World Health Organization. Action Plan for Implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016 ; 9289002689; Health Organization: Geneva, Switzerland, 2012. [ Google Scholar ]
• World Health Organization. Action Plan for the Prevention and Control of Noncommunicable Diseases in the WHO European Region ; World Health Organization Regional Office for Europe: Copenhagen, Denmark, 2016. [ Google Scholar ]
• Kuczmarski, R.J.; Ogden, C.L.; Guo, S.S.; Grummer-Strawn, L.M.; Flegal, K.M.; Mei, Z.; Wei, R.; Curtin, L.R.; Roche, A.F.; Johnson, C.L. 2000 CDC Growth Charts for the United States: Methods and development. Vital Health Stat. 2002 , 246 , 1–190. [ Google Scholar ]
• Gama, A.; Rosado-Marques, V.; Machado-Rodrigues, A.M.; Nogueira, H.; MourAo, I.; Padez, C. Prevalence of overweight and obesity in 3-to-10-year-old children: Assessment of different cut-off criteria WHO-IOTF. An. Acad. Bras. Cienc. 2020 , 92 , e20190449. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• International Association for the Study of Obesity. Available online: https://web.archive.org/web/20040824052003/http://www.iotf.org/ (accessed on 26 March 2022).
• UN General Assembly. Convention on the Rights of the Child. United Nations Treaty Ser. 1989 , 1577 , 1–23. [ Google Scholar ]
• World Health Assembly. Reducing Health Inequities through Action on the Social Determinants of Health ; World Health Organization: Geneva, Switzerland, 2009. [ Google Scholar ]
• United Nations. World Social Report 2020; Inequality in a Rapidly Changing World ; United Nations, Department of Economic and Social Affairs: New York, NY, USA, 2020. [ Google Scholar ]
• World Health Organization Europe. The Challenge of Obesity in the WHO European Region and the Strategies for Response ; World Health Organization Europe: Geneva, Switzerland, 2007. [ Google Scholar ]
• World Health Organization. Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey, 2018–2019: Summary Report ; World Health Organization: Geneva, Switzerland, 2020. [ Google Scholar ]
• Akseer, N.; Kandru, G.; Keats, E.C.; Bhutta, Z.A. COVID-19 pandemic and mitigation strategies: Implications for maternal and child health and nutrition. Am. J. Clin. Nutr. 2020 , 112 , 251–256. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Pérez-Escamilla, R.; Cunningham, K.; Moran, V.H. COVID-19 and maternal and child food and nutrition insecurity: A complex syndemic. Matern. Amp Child Nutr. 2020 , 16 , e13036. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ntambara, J.; Chu, M. The risk to child nutrition during and after COVID-19 pandemic: What to expect and how to respond. Public Health Nutr. 2021 , 24 , 3530–3536. [ Google Scholar ] [ CrossRef ] [ PubMed ]

Click here to enlarge figure

Share and Cite

Sotiraki, M.; Malliou, A.; Tachirai, N.; Kellari, N.; Grammatikopoulou, M.G.; Sergentanis, T.N.; Vassilakou, T. Burden of Childhood Malnutrition: A Roadmap of Global and European Policies Promoting Healthy Nutrition for Infants and Young Children. Children 2022 , 9 , 1179. https://doi.org/10.3390/children9081179

Sotiraki M, Malliou A, Tachirai N, Kellari N, Grammatikopoulou MG, Sergentanis TN, Vassilakou T. Burden of Childhood Malnutrition: A Roadmap of Global and European Policies Promoting Healthy Nutrition for Infants and Young Children. Children . 2022; 9(8):1179. https://doi.org/10.3390/children9081179

Sotiraki, Marianthi, Aggeliki Malliou, Ntaniela Tachirai, Nikoletta Kellari, Maria G. Grammatikopoulou, Theodoros N. Sergentanis, and Tonia Vassilakou. 2022. "Burden of Childhood Malnutrition: A Roadmap of Global and European Policies Promoting Healthy Nutrition for Infants and Young Children" Children 9, no. 8: 1179. https://doi.org/10.3390/children9081179

Article Metrics

Article access statistics, further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals