INTRODUCTION

Malnutrition is a condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess, or in the wrong proportions (Sullivan and Sheffin, 2003). Malnutrition is technically a category of diseases that include: undernutrition, obesity and overweight, and micronutrient deficiency among others (WHO, 2012). However, it is frequently used to mean just undernutrition from either inadequate calories or inadequate specific dietary components for whatever reason. People who are malnourished may: Not consume adequate calories and protein for growth and maintenance (undernutrition or protein energy malnutrition) (WHO, 2001). Consume too many calories (overnutrition) (WHO, 2001). Have abnormal nutrient loss (due to diarrhoea or chronic illness) or increased energy expenditure (secondary malnutrition) (Grover and Looi, 2009). Undernutrition occurs when an individual does not consume enough food. It encompasses stunting, wasting, and deficiencies of essential vitamins and minerals. In developing countries, undernutrition does not occur, especially in people who are very poor, such as the homeless, and in those who have psychiatric disorders. Also, people who are very ill may be unable to eat enough food because they have lost their appetite or because their bodys need for nutrient is greatly increase (Nube and Van Den Boom, 2003). Infants, children and adolescent are at risk of undernutrition because they are growing and thus need a lot of calories and nutrients (WHO, 2012). When not enough calories are consumed, the body breaks down its own fat and uses it for calories. After fat stores are used up, the body may breakdown its other tissues, such as muscles and tissues in internal organs, leading to serious problems, including death (Sue Horton et al, 2008). A severe deficiency of protein and calories called Protein-Energy Malnutrition results
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when people do not consume enough protein and calories for a long time. Two forms of Protein-Energy Malnutrition are Kwashiorkor and Marasmus, and they commonly coexist (Katsi Lambros, 2011).

CAUSES OF MALNUTRITION Major causes of malnutrition include diseases, poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors. Clinical malnutrition is a major burden also in developed countries. Various scales of analysis also have to be considered in order to determine the socio-political causes of malnutrition. For example, the population of a community may be at risk if the area lacks health related services (Fotso, 2005). DISEASES AND INFECTION Certain illness and infections, such as tuberculosis, measles, and diarrhea are directly linked to acute malnutrition. A combination of diseases and malnutrition weakens the metabolism creating a vicious cycle of infection and undernourishment, leading to vulnerability to illness (Baro and Deubel, 2006). HIV and AIDS have become a leading cause of acute malnutrition in developing countries. A child infected with HIV is more vulnerable to acute malnutrition than a healthy child. Anti-retroviral drugs are more effective when combined with adequate, regular food intake. So ensuring a healthy diet is an important aspect of HIV control and treatment (Dolin, 2010). DIETARY PRACTICES Lack of breastfeeding can lead to malnutrition in infants and children. Possible reason for the lack in the developing world may be that the average family thinks bottle feeding is better. The world health organization says mothers abandon breastfeeding because they do not know how to get their baby to latch on properly or suffer pain and discomfort (Reuters, 2009).
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Deriving too much of ones diet from a single source, such as eating almost exclusively corn or rice, can cause malnutrition. This may be either from a lack of education about proper nutrition, or from only having access to a single food source. Overeating is also a form of malnutrition. It is much more common in developed countries, where for the majority of people, access to food is not an issue; the issue in these developed countries is choosing the right kind of food (Gardner and Halweil, 2000). Overeating leads to many diseases, such as heart diseases and diabetes that may result in death. POVERTY AND FOOD PRICES In Bangladesh, poor socio-economic position was associated with chronic malnutrition since it inhibits purchase of nutritious food such as milk, meat, poultry, and fruits (Khan and Kraemer, 2009). Poverty alone does not lead to malnutrition, but it seriously affects the availability of adequate amounts of nutritious food for the most vulnerable populations. Over 90 percent of malnourished people live in developing countries (Khan and Kraemer, 2009). Food prices is also a factor contributing to malnutrition, due to insufficient financial resources, the vulnerable populations are malnourished because of the fluctuations in prices of food which they can hardly afford (WHO, 2010). AGRICULTURAL PRODUCTIVITY Local food shortages can be caused by a lack of arable land, adverse weather, lower farming skills such as crop rotation, or by a lack of technology or resources needed for a higher yields found in modern agriculture, such as fertilizers, pesticides, irrigation, machinery and storage facilities. As a result of widespread poverty, farmers cannot afford or government cannot provide the resources necessary to improve local yields. The World Bank and some wealthy donor countries also press nations that depend on aid to cut or eliminate
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subsidized agricultural inputs such as fertilizer, in the name of free market policies (Dugger, 2007). Many, if not most, farmers cannot afford fertilizer at market prices, leading to low agricultural production and wages and high, unaffordable food prices. CLIMATE CHANGE The effects of climate change are also dramatic, devastating areas which are already vulnerable. Infrastructure is damaged or destroyed; diseases spread quickly; people can no longer grow crops or raise livestock (Dugger, 2007). According to studies in over 40 developing countries, the decline in agricultural production caused either directly or indirectly by climate change could dramatically increase the number of people suffering from hunger in the coming years (Gardner and Halweil, 2000). Climate change is of great important to food security. With 95 percent of all malnourished peoples living in the relatively stable climate region of the subtopics and topics. According to the latest IPCC reports temperature increases in these regions are very likely (IPCC, 2007). Even small changes in temperatures can lead to increase in extreme weather conditions (IPCC, 2007). Many of these have great impact on agricultural production and hence nutrition. An increase in extreme weather such as drought in regions such as sub-Saharan would have even greater consequences in terms of malnutrition (Black, 2010). LACK OF SAFE DRINKING WATER Water is synonymous with life. Lack of portable water, poor sanitation, and dangerous hygiene practices increase vulnerability to infectious and waterborne diseases, which are direct causes of acute malnutrition (Sue Horton et al, 2008).

CONFLICTS Conflicts have a direct impact on food security, drastically compromising access to food. Often forced to flee as violence escalates, people uprooted by conflict lose access to their farms and businesses, or other means of local food production and markets. Abandoned fields and farms no longer provide food to broader distribution circuits. As a result, food supplies to distributors may be cut off, and the many populations dependent on them may be unable to obtain sufficient food (WHO, 2010). SIGNS AND SYMTOMS General malnutrition often develops slowly, over months or years, as the bodys store of nutrients is depleted, changes begin to happen at the cellular level affecting biochemical processes and decreasing the bodys ability to fight infections (Suskind, 2009). Over time, a variety of symptoms may begin to emerge, including: Anaemia Weight loss, decreased muscle mass, and weakness Dry scaly skins Oedema Hair that has lost its pigment Brittle and malformed (spooned) nails

Chronic diarrhoea

Slow wound healing Bone and joint pain Growth retardation (in children) Mental changes such as confusion and irritability Goitre (Suskind, 2009).

Specific nutrient deficiencies may cause characteristic symptoms. For instance, vitamin B12 deficiency can lead to tingling, numbness, and burning in the hands and feet.

EFFECTS/IMPLICATIONS OF MALNUTRITION
Malnutrition increases the risk of infection and infectious disease, and moderate malnutrition weakens every part of the immune system (Stillwaggon, 2008). Protein and energy malnutrition and deficiencies of specific micronutrients increases susceptibility to infection. Malnutrition affects HIV transmission by increasing the risk of transmission from mother to child and also increasing replication of the virus (Stillwaggon, 2008). In communities that lack access to safe drinking water, these additional health risks present a critical problem. Lower energy and impaired function of the brain also represent the downward spiral of malnutrition as victims are less able to perform the tasks they need to in order to acquire food, earn an income, or gain education. SHORT-TERM IMPLICATIONS Because so much development occurs in the first few years of life, nutrient deficiencies can have major short-term implications in young children. IMMUNE IMPLICATIONS Malnourishment can greatly compromise a childs immune system, making them more susceptible to infectious diseases (Suskind, 2009). Particularly in institutions where there are poor sanitary practices, children are vulnerable to infections from other children or caregivers. In particular, deficiencies of zinc, iron, and vitamin immune function (Balint, 1998). GROWTH IMPLICATIONS Nutrient deficiencies and gastrointestinal infections commonly co-occur in children. A child may contract infection due to poor nutritional status. In turn, a gastrointestinal infection places the child at even greater risk for nutrient
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deficiencies because nutrients are unable to be absorbed properly (Balint, 1998). Consequently, nutrient deficiency combined with infection can cause growth retardation. Additionally, a deficiency in one nutrient may lead to a deficiency in another nutrient, for example, deficiencies in iron, magnesium and zinc can cause anorexia and thereby result in reduced intake of other important nutrients such as protein (Suskind, 2009). Low lipid intake can also affect the absorption of important fat-soluble vitamins such as vitamin A and D. zinc and protein deficiencies can retard bone growth and development, putting a child at risk for long-term complications. LONG-TERM IMPLICATIONS The short-term implications of malnutrition eventually give way to longterm complications, such as growth and cognitive delays. GROWTH IMPLICATIONS Malnutrition not only impacts growth in the short term, but can also limit total bone growth. Children with stunted growth may never be able to regain lost growth potential if they continue to live in a nutritionally deprived situation (Balint, 1998). COGNITIVE IMPLICATIONS Malnutrition negatively affects brain development causing delays in motor and cognitive development. Psychologically, malnutrition in the form of iodine deficiency is the most common preventable cause of mental impairment worldwide (McNeil Jr, 2006). Even moderate iodine deficiency, especially in pregnant women, infants and children, lowers intelligence by 10 to 15 I.Q. points. The most visible effectsdisability goiters, cretinism, and dwarfism, affect a tiny minority. Iron deficiency anaemia in children under two years of age likely affects brain
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function acutely and probably also chronically. Folate deficiency has been linked to neural tube defects (Kenton, 2008). Research has shown over the years that better nourished children often perform significantly better in school mostly because of greater learning productivity per year of schooling (Kenton, 2008). Better nutrition has been shown to have an impact on both cognitive and spatial memorial performance; on study showed those with higher blood sugar levels performed better on certain memory tests (Benton, 1992). Nutritional deficiencies have also been shown to have a negative effect on learning behaviour. Other cognitive implications of malnutrition are: attention deficit disorder, reduced social skills, reduced language development, impaired school performance and reduced problem solving abilities (Suskind, 2009). CANCER Malnutrition can also result to cancer. According to a study by the International Agency for Research on Cancer, in the developing world, cancers of the liver, stomach and oesophagus were more common, often linked to consumption of carcinogenic preserved foods, such as smoked or salted food, and parasitic infections that attack organs. Developed countries tended to have cancer linked to affluence, such as cancers of the colon, rectum, breast and prostate, that can be cause by obesity, lack of exercise, diet and age (Coren, 2005). Weight loss in cancer patient of over 10 percent of pre-illness weight or weight in the preceding 3-6 months is often associated with a high risk of malnutrition (Coren, 2005). METABOLIC SYNDROME Malnutrition can lead to obesity and to metabolic syndrome, a set of risk factors characterized by abdominal obesity, a decreased ability process glucose (insulin resistance), and hypertension. Those with metabolic syndrome have been shown at a greater risk of developing type 2 diabetes and cardiovascular
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disease. Another form of malnutrition is vitamin or mineral toxicity. This is usually due to excessive supplementation, for instance, high doses of fat-soluble vitamins such as vitamin A rather than the ingestion of food. Toxicity symptoms depend on the substance(s) ingested, the severity of the overdose, and whether it is acute or chronic.

CONCLUSION AND RECOMMENDATIONS

Malnutrition has been cited as the greatest single threat to the worlds public health. From the study, it was seen that malnutrition encompasses undernutrition, obesity and overweight and micronutrient deficiency amongst others, so malnutrition can be seen to not only be a threat to developing countries but also in developed countries. Management of this pandemic is being fought seriously by various organisations and donor agencies and countries. Emergencies measures have been put in place through fortifying foods to obtain micro-nutrients (Kristof, 2009), donating cash or cash vouchers instead of foods to deliver cheaper, faster and more efficient way of helping to the poor particularly in areas where food is available but unaffordable (UN, 2008). Also, an investment in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces the prices of food which was identified as one of the causes of malnutrition. Breastfeeding education has also not been left out as mothers are being educated on the importance of exclusive breastfeeding in the first six months and this could prevent infant mortality. It is therefore very important that people are educated on how to consume the right balance of nutrients from the major food groups such as carbohydrate, fruits and vegetable, protein, fats and dairy. Also they should ensure a proper hygiene and drink enough portable water daily to avoid diseases and infections that weaken the immune system.

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REFERENCES Balint, J. P. (1998). Physical Findings in Nutritional Deficiencies. Pediatr Clin North America: 45 (1). Pp 245-260. Baro, M. and Deubel, T. F.(2006). Persistent Hunger: Perspective on Vulnerability, Famine and Food Security in Sub-Saharan Africa. Annual review of Anthropology: 35. P 521 Benton, D. S. (1992). Breakfast, Blood Glucose and Memory. Biological Psychology: 33 (2). Pp. 207-208. Black, R. (2010). Rice Yields Falling Under Global Warming. Science and Environment: 61. Pp. 18-19. Coren, M. (2005). Study: Cancer no longer rare in poorer countries. www.cnn.com/2005/HEALTH/03/09. Dolin, G. L. (2010). Principles and Practice of Infectious Diseases. 7th Edition. Elsevier books, Philadelphia. Pp. 443. Dugger, C. W. (2007). Ending Famine, Simply by Ignoring the Experts. P. 273 Fotso, J. C. (2005). Measuring Socioeconomic Status in Health Research in Developing Countries. Social Indicators Research: 72(2): P. 189. Gardner, G. and Halweil, B. (2000). Escaping Hunger, Escaping Excess. World Watch 13(4): P. 24. Grover, Z. and Looi, C. (2009). Protein Energy Malnutrition. Pediatric clinics of North America 56(5): Pp 1055-1068. Intergovernmental Panel on Climate Change (2007). Climate Change: Synthesis Report. www.ipcc.ch/pdf/assessment-report. Katsi Lambros, N. (2011). Clinical Nutrition in Practice. John Wiley & sons, New York. P. 37

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Kenton, R. H.(2008). Neurologic Consequences of Malnutrition. Clinical Neurology 34: P. 33. Khan, M. M. and Kraemer, A. (2009). Factors associated with being underweight, overweight and obese among urban women in Bangladesh. Singapore Medical Journal 50(8): Pp 804-809. Kristof, N. D. (2009). The Hidden Hunger. www.nytimes.com/2009/05/24/opinion/24kristof.html. McNeil, D. G. (2009). In raising the worlds IQ the secret is in salt. www.nytimes.com/2006/12/16/health/16iodine.html. Nube, M. and Van Den Boom, G. J. (2003). Gender and Adult Undernutrition in Developing Countries. Annuals of Human Biology 30(5): Pp 520527. Reuters. (2009). Breastfeeding could save 1.3 million lives. www.reuters.com/article/healthNews. Stillwaggon, E. (2008). Race, Sex, and the Neglected Risks for Women and Girls in Sub-Saharan Africa. Feminist Economics 14 (4): Pp 67-68. Sue Horton, A.; Harold, A; and Rivera, A. J. (2008). The Challenge of Hunger and Malnutrition. Copenhagen Consensus Challenge Paper. 20: Pp 1619. Sullivan, A. and Sheffrin, M. S. (2003). Economics: Principles in Action. Pearson Prentice Hall, New Jersey. P 481. Suskind, D. L. (2009). Nutritional Deficiencies during Normal Growth. Pediatric clinic of North America 56(5): Pp 1035-1053. United Nations. (2008). UN aid debate: give cash not food. www.csmonitor.com/world/Africa/2008/06/04/woaf.html. World Health Organisation, (2010). The Global Picture. www.who.int/home-page. World Health Organisation. (2012). Nutrition Experts Take Action on Malnutrition WHO. www.who.int/nutrition.
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