Malnutrition is one of the things that is greatly associated with developing countries today. In Nigeria it is one of the things that is secretly eating up the country which has led to an out-cry in the health sector with recent meetings, conferences and organizations looking for a way forward in reducing the risks and total reduction in the number of malnourished individuals in the country. In this post we shall look at malnutrition and how to possibly treat malnourished persons thereby reducing the level of malnourished persons in the country.
What Do We Know About Malnutrition…
Malnutrition is a state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue, body form and function.
According to UNICEF:
“Malnutrition is a broad term commonly used as an alternative to undernutrition but technically it also refers to overnutrition. People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness (undernutrition). They are also malnourished if they consume too many calories (overnutrition)“.
Malnutrition can be further classified as deficiency in protein energy or micronutrient deficiency which implies deficiency in one or more micronutrients, depending on the specific nature of the nutritional intake and expenditure imbalance. Regardless of the type, malnutrition may be a consequence of primary or secondary malnutrition.
Primary malnutrition refers to malnutrition which is caused by inadequate energy intake. This condition often occurs in relation to food insecurity or when adequate food is not available (in terms of total calories or specific micronutrients). It can also result from poor appetite due to illness or eating disorders such as anorexia nervosa.
Secondary malnutrition arises when an individual’s dietary intake is sufficient, but energy is not adequately absorbed by the body as a result of infectious conditions such as diarrhoea, measles or parasitic infections, or medical or surgical problems affecting the digestive system.
Malnutrition can also occur as a result of increased metabolic demands following illness or surgery. Malnutrition is strongly associated with ill health, as both a cause and consequence. Individuals who are malnourished are more susceptible to disease and infection due to impaired immune function, and tend to consult health practitioners more frequently and take longer to recover from episodes of illness or injuries. Illness, and particularly long episodes of illness, can also frequently result in malnutrition, as individuals tend to eat and drink less when they are ill.
Possible Symptoms Of Malnutrition
Malnutrition can often be very difficult to recognize, particularly in patients who are overweight or obese to start with. Malnutrition can happen very gradually, which can make it very difficult to spot in the early stages. Some of the symptoms and signs to watch out for include: loss of appetite, weight loss, tiredness, loss of energy, reduced ability to perform normal tasks, reduced physical performance, altered mood, poor concentration and poor growth in children.
Who Does Malnutrition Affect?
Mostly, malnutrition greatly affects the older people over the age of 65, particularly if they are living in a care home or nursing home or have been admitted to hospital, People with long-term conditions, such as diabetes, kidney disease, chronic lung disease, People with chronic progressive conditions for instance, dementia or cancer, People who abuse drugs. Also there are other social factors that can increase the risk of malnutrition and the include; Poverty, Social isolation Cultural norms for instance, hospitals and care homes may not always provide food that meets particular religious or cultural needs and so increase the risk of malnutrition whilst a person is away from their normal environment. Other Physical factors can also increase the risk of malnutrition. For example: Eating may be difficult because of a painful mouth or teeth, Swallowing may be more difficult (a stroke can affect swallowing) or painful, Losing your sense of smell or taste may affect your appetite, Being unable to cook for yourself may result in reduced food intake, Limited mobility or lack of transport may make it difficult to get food. It is also important to realize that if an older person is less able to feed themselves and becomes malnourished, this will make them more susceptible to disease, which in turn will make their nutritional state worse and impair recovery.
What Are The Possible Effects Of Malnutrition?
Malnutrition affects every system in the body and always results in increased vulnerability to illness, increased complications and in very extreme cases even death.It can also affect the Immune system by reducing the ability to fight infection and the affected areas include:
Muscles: Inactivity and reduced ability to work, shop, cook and self-care, Inactivity may also lead to pressure ulcers and blood clots, Falls, Reduced ability to cough may predispose to chest infections and pneumonia, Heart failure, Impaired wound healing
Kidneys: Inability to regulate salt and fluid can lead to over-hydration or dehydration
Brain: Malnutrition causes apathy, depression, introversion, self-neglect and deterioration in social interactions.
Reproduction: Malnutrition reduces fertility and if present during pregnancy can predispose to problems with diabetes, heart disease and stroke in the baby in later life.
Other effects of malnutrition among children and adolescents include: Growth failure and stunting, Delayed sexual development, Reduced muscle mass and strength, Impaired intellectual development, Rickets, Increased lifetime risk of osteoporosis.
How Can Malnutrition Be Reduced?
Recognizing the problem is the most important first step. Once individuals and those involved in their care are aware of the problem, often simple measures to increase food intake may be enough to reverse the downward cycle. We know for example that giving nutritional supplements to malnourished patients reduces complications such as wound breakdown by 70% and death by 40%.
The Deputy Representative, UNICEF Nigeria, Pernille Ironside made the call at the National Council on Nutrition (NCN) sub-committee meeting on Nutrition Awareness in Kano and she stressed the need for the state and federal governments to invest in nutrition through adequate funding and prompt release of funds allocated to the sector. She also said that:
“The reason why Nigeria should invest in nutrition is that early nutrition programmes increases school completion and we must also invest in nutrition because malnutrition is hampering survival and development of children”.
Once an individual has been assessed as being at risk of malnutrition it is always necessary to assess the problem in more detail and identify any other factors that are contributing to the problem. Treatment should always be tailored to the needs of the individual, but in general, if a person is able to eat and does not have a diminished appetite, then the first step would be to encourage this with a “Food first” approach. This may be in the form of advice on meals, snacks, nourishing drinks and food fortification, but should include setting goals of treatment and a plan for monitoring to ensure that these goals are met. If simple measures are not working or where the patient has a reduced appetite, then an assessment and support from a dietitian may be needed. In addition to fortifying food and increasing what to eat, there are many different oral nutritional supplements. These should usually only be used under the supervision of a dietitian or doctor. It is also possible that you may need to take a vitamin and mineral supplement but only if advised to do so by the professional treating them. For patients who are unable to eat, nutrition can be provided by tube feeding either into the gut or directly into the bloodstream via a vein.