Malnutrition

Classification according to ICD-10
R63.3	Nutritional problems and improper nutrition
ICD-10 online (WHO version 2019)

Of malnutrition is when the components of the food are composed so that it permanently to a deviation from a defined target value is (requirement or expectation). Such set values would, for example, and optionally, well-being , health stability, regeneration , body growth , survival , religion sbedingte feed or fasting commandments, beauty ideal , ideal weight, target weight , fighting weight and more.

Based on the minimum law of plants, every organism needs a balanced supply of water, nutrients (e.g. starch , sugar , fats ) and other vital substances (which the body cannot synthesize itself) as well as an absence of toxins and radioactivity in order to survive in food. Constant or regular malnutrition is usually associated with a deficiency or an oversupply of these nutritional components and can lead to health problems or premature death .

Some special forms are derived from this generic term and occasionally equated with it, although mixed forms are of course also possible:

Malnutrition (= malnutrition) as malnutrition due to deficiencies in individual or all essential food components or the diet does not meet the physical needs according to the activity and development of the organism , for example deficiency in protein , vitamins or certain essential trace elements .
Malnutrition (= undernutrition) than those malnutrition, leading to a negative energy balance leading, so that (apart from the mass of the food and excretion sprodukte) a reduction in the body weight of the organism and to food deprivation leads; The result can be normal weight or underweight , depending on the initial situation. Basically, there is a reduction in weight when the body issuppliedwithless energy or substances in the form of foodduring metabolism than is consumedby basal metabolic rate and physical activity or when the nutrients are excreted faster than they can be replaced, resulting in a negative energy balance.

Overeating as malnutrition that leads to a positive energy balance or an increase in body weight or obesity ;

a false diet requires that a "right" diet is known generally or individually, and these "proper diet" is not reached knowingly or unknowingly as a nominal value from a single individual.

Undersupply , when the body cannot absorb or utilize the necessary nutritional components, or this occurs as a result of food intolerance . This also includes dehydration as a type of malnutrition , i.e. the inadequate balance of fluids in the event of a disease-related loss of fluid or a loss of fluids caused by body vapors (e.g. when sweating). Dehydration can lead to stroke or anemia, and thus death.

On the contrary, the oversupply affects not only normal food components but also toxins that can lead to acute or chronic poisoning .

According to a definition in medical literature, malnutrition is “a nutritional condition in which deficiency or excess of energy, proteins or other nutrients have measurable undesirable effects on the shape of the tissues and the organism (...), on their function and on the clinical course . ”In addition, a distinction is made between exogenous malnutrition through the diet and endogenous malnutrition of individual cells.

Specific malnutrition

A vitamin deficiency is very rare in Germany today, but iron deficiency is more common. Iodine deficiency can lead to a goiter .

Older people are at higher risk of malnutrition, especially if they live alone as singles, in social isolation , or in old people's or nursing homes . In the case of malnourished groups in particular, it is not always clear whether it is malnutrition or malnutrition. These grievances can be counteracted by training and informing those affected or the nursing staff / the home management about the imbalance between nutrient intake and nutrient requirement.

Even poor or homeless people sometimes suffer from malnutrition and vitamin deficiency . A study by the University of Bonn in 2007 found an increased incidence of obesity due to incorrect and unbalanced food in children whose parents receive ALG II (Hartz IV), and estimates the cost of a balanced diet for an adolescent to be around twice as high as that in the ALG II rate provided daily amount for nutrition.

A problem not limited to the homeless is excessive consumption of prepared meals , junk food , fast food and street food . Most fast food dishes contain few vitamins anyway due to their composition, and they are prepared with great heat, which also destroys vitamins. One problem with ready-made meals is that they are optimized for a long shelf life and vitamins are naturally destroyed over this period or lost during production.

Consumption of large amounts of husked and polished rice can trigger the vitamin B ₁ deficiency disease beri-beri . This often affects people in third world countries and in Asia, whose diet consists mainly of such rice, but it can also be caused by a one-sided diet with heavily ground flour ("white flour"). Eating raw fish can cause thiamine deficiency because it may contain an enzyme that destroys this vitamin. This is also a problem for people in Asia, as raw fish is part of the menu there.

An example of widespread malnutrition is dieting without a doctor's prescription or supervision, supposedly promoting health or weight loss. The variety of diets is very large, the vegan raw food or 80/10/10 diet are strict examples. The clinical picture that people suffer from is called orthorexia . Depending on the type of diet, different hypovitaminoses also occur with different intensities.

Malnutrition (qualitative malnutrition) also means an undersupply of vitamins and minerals . In children there is a delay in physical and mental development that can be irreparable. Often malnutrition eats too little fruit and vegetables (contains vitamins), dairy products (contain calcium ), sea fish (contains iodine ) and whole grain bread, legumes and potatoes (contain fiber ).

Particularly comfortable people or those under time pressure tend to malnutrition with canned or ready-to-eat meals, avoiding raw vegetables and fruit and unconsciously foregoing a balanced diet if they do not compensate for missing nutritional components in some other way. Malnutrition can lead to frequent infections (runny nose, colds , etc.), constipation, iodine deficiency and bone decalcification ( osteoporosis ).

General malnutrition or malnutrition

Child with a hybrid of kwashiorkor and marasmus

Adolescent after a noma disease

The WHO defines malnutrition from a body mass index below 18.5. However, the WHO sometimes uses the terms malnutrition and undernourishment as synonyms. In the case of malnutrition, people's energy needs are not met by food. Many factors can accelerate nutrient loss, such as: B. diarrhea , severe bowel disorders, burns, excessive sweating, heavy bleeding ( haemorrhage ) or a kidney malfunction. Illness, excessive diets, serious injuries, lengthy hospital stays, or drug and alcohol abuse can also limit nutrient intake.

Common symptoms of malnutrition include tiredness, dizziness, and unwanted weight loss.

Hunger was so widespread in the Middle Ages that it was considered one of the " four horsemen of the apocalyptic " alongside war , pestilence and death . Famine is practically non- existent in industrialized countries today, but it still occurs in developing countries . There people are often malnourished due to a lack of food or malnourished due to lack of knowledge about the optimal food composition. According to estimates by the World Health Organization , around a quarter of all children under five are malnourished. Malnutrition, especially in childhood, can lead to retardation in physical and mental development (retardation), to serious diseases such as dystrophy , kwashiorkor (hunger edema, starvation stomach), marasmus (emaciation after all energy and protein reserves have been depleted), noma (tissue decomposition) and subsequently usually lead to death. As a result, those affected usually suffer from a protein , fat, vitamin and mineral deficiency .

The body mass index and the guidelines of the German Society for Nutritional Medicine (DGEM) are the rule of thumb for malnutrition . The following guidelines can be used for hydration: The normal daily requirement of a person is 25 ml / kg. In southern countries, heavy physical work or for competitive athletes, an additional 5 ml / kg should be estimated.

In addition, malnutrition tends to occur in the industrialized countries as a result of mental eating disorders such as ( anorexia nervosa or bulimia nervosa ).

During a period of fasting or starvation, there is a certain adjustment to the lack of nutrients. This process is called hunger adaptation . The metabolic rate can be reduced to around 50 percent. Heart rate, blood pressure and body temperature drop; an extreme example is hibernation in animals. The rest of the energy requirement is covered by ketone bodies . The insulin level drops. The metabolism changes to catabolism due to the lack of food or nutrients . After about eight to ten days, the basal metabolic rate is reduced and the metabolic process slows down. In the case of food deprivation, the body must obtain the energy it needs to maintain important body functions from its energy stores. One after the other, energy supplies in the form of carbohydrates (e.g. glycogen ), fats (e.g. subcutaneous adipose tissue ) and, ultimately, proteins (e.g. muscles) are attacked to cover the energy requirement . The consequence of prolonged lack of food is emaciation or inanition . It can lead to a complete loss of strength, which is also called cachexia .

Eating earth against hunger

Eating earth to satisfy hunger is a particularly blatant form of nutrition and part of malnutrition (which can lead to iron deficiency , for example ). The incomprehensibility of this hunger phenomenon often led to its interpretation and classification as a health disorder , as it is described as pica syndrome . To be classified as pica syndrome, it is necessary that the eating behavior does not correspond to any culture-related norm. Eating earth is also interpreted to mean that minerals are supposed to be absorbed, but as an apparently effective remedy against hunger, eating earth is widespread among poor sections of the population:

“ “ Hunger also drives many to eat earth. Across Alabama , Mississippi , and North Carolina , many black women often eat up to 50 percent - clay. This apathetic and anemia- exhausted woman led me to the slope where she used to dig for "food" that she shared with her son. “Do you eat earth?” “Sometimes…” “Does it taste good?” “Yes.” (Surprised) “Have you never eaten any?” […] “Who else eats earth here?” “My mother and my aunt there up in the white house. I think all of them. " "

- Jacob Holdt : American Pictures. Pictures from America. Personal experiences in America's lower classes, S. Fischer Verlag, Frankfurt am Main, 1984, ISBN 3-10-034102-3 , page 95, with pictures

Filthy biscuits made from yellow plateau clay, salt and vegetable fat have become a regular meal in the slums of Haiti since the 2010 earthquake . Originally they were offered as cosmetics (for peeling ) and as a remedy to bind stomach acid and as a source of calcium for children and pregnant women. Various video reports also show people who eat earth patties against hunger. Relevant press releases, photo reports and film reports were contradicted by the filmmaker Claudette Coulanges , who lives in Germany and Haiti and a native Haitian. “I can remember some women, especially pregnant women, who occasionally nibbled or sucked dried clay. But that had nothing to do with hunger. ” And “ Total nonsense, because who can afford butter in a slum - not to mention the hot and humid climate? ”

Anonymous, quoted by Mizaél Poggioli: Poverty in the world. The different forms of poverty. Retrieved on February 1, 2013 (written in 1652 by a missionary priest from Saint Quentin to Vincent de Paul ): “ “ Here the hunger is so great that you can see people eating the earth, chewing grass, removing the bark from trees and removing the miserable rags Tear body to devour them. And, if you hadn't seen it, you wouldn't dare to say it because it's so horrific: they devour their own arms and hands and die in this wretched state " "

Stone soup

In times of famine cooked people in the room of the Dalmatian Adriatic islands stone soup ; in addition, stones from the sea overgrown with algae and mussels were boiled into soup.

Eat leather

During the 841 day siege of Leningrad in World War II, people boiled leather into glue, which they ate. In addition, more than 1,000 cases of cannibalism have been recorded.

Extender for bread flour

In times of starvation (or because of fraud) bread flour was stretched with sawdust , tree bark, turnips, straw, bran or flour made from chestnuts or acorns .

Overeating

Gluttony and medical food addiction as bulimia nervosa and binge eating can lead to overeating.

Chronic poisoning

Often in the vicinity of Erzaufbereitungs - or smelting plants are pollutants discharged into the environment and absorbed by the food. Well-known results of large-scale soiling are, for example, Minamata disease , Itai-Itai disease or Gressenich disease . An estimated 2.6 million people are affected by the poisoning with chromium salts in surface and drinking water in the Sukinda Valley of the Indian region of Orissa (see also the main article Blacksmith Institute ).

The biological importance of arsenic for humans is not yet fully understood. It is considered a trace element in humans, but deficiency symptoms have so far only been demonstrated in animals. The necessary requirement, if it should exist, is between 5 and 50 µg per day. This is offset by a daily intake of arsenic - depending on the choice of food - of up to 1 milligram, which is considered harmless. Anionic arsenic occurs as arsenite ([AsO ₃ ] ³⁻ ) and arsenate ([AsO ₄ ] ³⁻ ) in high concentrations in groundwater in many countries . Over 100 million people around the world drink contaminated water due to leaching from ores containing arsenic in the form of trivalent and pentavalent ions . Especially in India , Bangladesh and Thailand , where numerous wells were dug with international support in the 20th century in order to be able to escape from surface water contaminated with pathogens to groundwater, this undetected pollution of the drinking water led to chronic arsenic poisoning in large parts of the affected population.

Arsenic in groundwater: risk areas worldwide

Up until the 19th century, ergot mass poisoning was part of everyday life, caused by a harmful fungus on bread and feed grain. There were still isolated cases of poisoning in the 20th century. In the years 1926 and 1927 there was mass poisoning in the Soviet Union - officially there were over 11,000 deaths from bread containing mother-grain. The last, albeit controversial, poisoning incident is said to have occurred in Pont-Saint-Esprit (France) in 1951 , with 200 sick people and 7 dead.

Around three billion people have no access to clean drinking water. Inadequate supply of safe drinking water is the leading cause of most illnesses and deaths in developing countries , especially the high child mortality rate. Numerous development projects are devoted to solving this problem, but none of these projects will reach 2-3 billion people.

Percentage distribution of the population with access to safe drinking water (2000)
country	%	country	%	country	%	country	%	country	%
Albania	97	Algeria	89	Azerbaijan	78	Brazil	87	Chile	93
China	75	Cuba	91	Egypt	97	India	84	Indonesia	78
Iran	92	Iraq	85	Kenya	57	North Korea	100	South Korea	92
Mexico	88	Moldova	92	Morocco	80	Mozambique	57	Pakistan	90
Peru	80	Philippines	86	Singapore	100	South Africa	86	Sudan	67
Syria	80	Turkey	82	Uganda	52	Venezuela	83	Zimbabwe	83
Note: All industrialized countries (listed in UNICEF 2000 ) with available data have 100% access

Around 1.5 million people die every year from contaminated water. One reason for this is the garbage that is not disposed of in developing countries, but ends up untreated in lakes and rivers. In addition, there is a lack of sanitary facilities and agricultural waste, which unclearedly contaminates the water cycle. Water pipes, sewage treatment plants and sewer systems are often not available in third world countries. If this infrastructure exists, it is usually ailing or cannot withstand the increasing population growth. Nevertheless, a positive trend can be seen: in 1990 77% of the world population were connected to safe drinking water sources. Twelve years later it was 83%. In South Asia the connection rate rose from 71 to 84%. In the area south of the Sahara, progress is not so rapid: 49% of the people had access to clean water in 1990, compared with 58% in 2002. Precisely because the population is growing rapidly in these regions, these growth rates are a success. In the East African state of Tanzania , the proportion of the population with access to clean drinking water rose from 38% to 73%.

Malnutrition in animals and plants

Animal malnutrition also leads to deficiency symptoms ; in dogs , for example, a lackluster coat is a sign of a lack of protein .

The term can also be used for plant-based nutrition through soil nutrients, with the crop yield being based on the minimum of nutrients available . The findings on this formed a basis for quantitative agricultural chemistry since the middle of the 19th century. At that time, many soils in Central Europe were depleted in numerous nutrients due to heavy use. The introduction of mineral fertilization brought about considerable increases in yield. Today five to six times higher yields are common. However, if the crops are over-fertilized, the yields can decrease again.

In addition to the core nutritional elements carbon , hydrogen , oxygen , nitrogen , phosphorus and other main nutritional elements such as potassium , sulfur , calcium and magnesium, there are a number of micronutrient elements whose optimum effect is often very narrow, i.e. H. only small differences in the amount of these trace nutrients or micronutrients cause deficiency symptoms or over-fertilization.

Over-fertilization is one of the "malnutrition" of plants . In particular, high levels of nitrogen give rise to a high nitrate concentration in the soil and also in the plants. These nitrates are reduced to nitrites that are harmful to health in the intestines of humans and animals . If bodies of water are “over-fed” with nutrients, one speaks of eutrophication , and in the case of soils, also of salinization .

literature

Maximilian Ledochowski: Clinical Nutritional Medicine. Springer, Vienna / New York 2010, ISBN 978-3-211-88899-5 .
Maria Magdalena Schreier, Sabine Bartholomeyczik: Malnutrition in the elderly and in need of care: Causes and prevention from a care perspective. , Schlütersche, 1st edition 2004