Malnutrition

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Classification according to ICD-10
E43 Unspecified significant energy and protein malnutrition
E44.0 Moderate energy and protein malnutrition
E44.1 Slight energy and protein malnutrition
E45 Delayed development due to energy and protein malnutrition
E46 Unspecified energy and protein malnutrition
ICD-10 online (WHO version 2019)

Malnutrition , also known as quantitative malnutrition , is the form of malnutrition that leads to a negative energy balance and lower body weight . Basically, there is a reduction in weight when the body receives less energy or substances in the form of food during metabolism than is consumed by basal metabolic rate and physical activity , or when the nutrients are excreted faster than they can be replaced.

Malnutrition, especially in childhood, can lead to lagging behind in physical and mental development ( underweight , short stature , cognitive retardation ), serious illnesses and, in extreme cases, death. As a result, those affected usually suffer from a protein , fat , vitamin and mineral deficiency ; this state of lagging development is also referred to by the English term stunting .

Causes of hunger and related malnutrition

The globalization critic Jean Ziegler (2000–2008 UN Special Rapporteur on the Right to Food ) names the causes of malnutrition

  • Principle poverty
  • Staple food prices that are unaffordable for the poor
  • General lack of food
    • Shortage due to the uneven distribution of arable land
    • Self-cultivation is unprofitable because food imports are made of food whose market prices have been reduced by export subsidies from the producer countries
    • Cultivation of biofuel raw materials ( sugar cane , oil palms ) instead of food
    • Use of foods like wheat and corn as raw materials for biofuel production
    • Feeding of food to pets and reservation of food-growing space for the production of animal feed.

Overpopulation or population growth is only a problem in the family context, according to Ziegler, the annual harvest yields could feed everyone with plant-based foods.

Climate change as the cause

According to the WHO, the number of malnourished women and children in developing countries threatens to increase by 20 percent by 2020, among other things as a result of constantly inadequate food availability. Rising food prices and climate change, which are closely related, are seen as the cause. The extremely cold winter in Europe caused a huge increase in wheat prices, drought and intense heat caused the price of sugar, corn and soy to rise, for example in South America. Increases in food prices hurt the poorer population more. While families in industrialized countries spend ten percent of their income on food, in developing countries it is 50 to 80 percent. As a result, the poor eat less, less often, with poorer quality and less variety in food.

It is assumed that by 2050 - if climate change is not halted - the number of hungry people worldwide will rise by an additional 10–20 percent and that by 2050 an additional 24 million children will suffer from malnutrition. Almost half, around 10 million children, will live in sub-Saharan Africa. Between 1980 and 2006, the annual number of climate-related weather disasters quadrupled. By 2015, the number of people directly affected by weather disasters will rise to 375 million annually. In 2010, 300 million people fell victim to climate-related natural disasters and disasters - often in countries that have few resources to absorb the consequences. According to FAO experts, by 2025 two thirds of the currently available arable land will become unusable due to climate change. As a report by Oxfam predicts, climate change will cause food prices to rise 50–90 percent more by 2030 than they would already be.

proof

There are several ways to determine if a person is malnourished. The WHO takes the Body Mass Index (BMI) as a measure and defines malnutrition as if the BMI is below 18.5; However, the WHO sometimes uses the terms malnutrition and undernourishment as synonyms. In addition, the MUST developed in Great Britain or the STAMP, which is also used in children, are also used.

MUST can be used to determine if an adult is underweight and at risk of malnutrition in five steps, including obese adults. The 5 steps of the MUST are:

  • Step 1 and 2 - recording the nutritional parameters (height, weight, BMI, recent unwanted weight loss)
  • Step 3 - Assess the Impact of Acute Illness
  • Step 4 - Calculate the overall risk of malnutrition or the degree of malnutrition
  • Step 5 - Develop an appropriate care plan based on therapy guidelines and / or local guidelines.

Occurrence

Proportion of malnourished people in total population by state

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 .

Malnutrition in Developing Countries

In developing countries, people are often malnourished due to a lack of food or malnourished due to ignorance of the optimal composition of the food. Even when people have enough to eat, they can suffer from malnutrition if their food does not contain enough micronutrients, such as minerals and vitamins, to meet their daily needs. And the remains of food, urine and feces , are "deposited" outdoors by around 1.1 billion people worldwide. As a result, every ninth inhabitant of the earth only has contaminated water, which can make you sick, available as daily drinking water.

In addition, the majority of the population in developing countries does not have needs-based access to health care and, if so, often cannot afford a doctor's visit and medication . At the same time, the drainage of talent , the migration of specialist staff to areas where higher earnings await, lead to a thinning of medical care, especially in structurally weak regions. The few medical wards only provide curative care without being able to go into the necessary cause- related prevention of diseases.

Man and Child in India Suffering from Marasmus (1972)

60 percent of the starving are women; In Asia and South America in particular, more women than men suffer from hunger. The reasons are that women tend to earn less and usually do not have the same access to resources as men. In addition, girls in developing countries often have a poorer education than boys. For example, in Yemen far more than twice as many girls do not go to school as boys; in India only a quarter as many girls attend school as boys.

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.

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 sewage systems are often not available in third world countries. If this infrastructure exists, it is usually ailing or cannot withstand 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%.


This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.
The statement in the following paragraph that more than ten million people die every year as a result of hunger and malnutrition is not supported by the source given at the end of the paragraph (BpB with reference to BMZ).

According to the Federal Ministry for Economic Cooperation and Development (BMZ), of all global problems, the biggest social problem is malnutrition or hunger. More than ten million people die each year as a result of hunger and malnutrition - mathematically that is about one death every 3.5 seconds. More than half of them are children under the age of five. More people suffer from hunger or malnutrition than from AIDS , malaria and tuberculosis combined.

In addition to better nutrition with a sufficient supply of energy (see: physiological calorific value ), vitamins and minerals , a study on children in Malawi showed that additional antibiotic therapy improves weight gain and reduces mortality .

Malnutrition in the European Union

Extensive studies in the UK and the Netherlands have shown that one in four patients is at risk of malnutrition upon admission to hospital.

Across Europe, malnutrition has been linked to increased mortality , length of stay and higher health care costs. It is estimated that malnutrition costs € 120 billion a year in the EU alone.

In addition, malnutrition due to eating disorders ( anorexia nervosa , bulimia nervosa ) occurs in industrialized countries . Older people living alone and patients in old people's and nursing homes as well as the homeless are also at risk.

Malnutrition in the US

In the US, 10.8 million US citizens went hungry in 2005. In total there were even 35 million, that is one in eight Americans, who “had difficulties to eat”. Officially, however, there are no “starving people”, since since November 2006 the US government has been talking about people with “very low food security ” instead . The aid organization New York Food Bank announced in June 2008 that three million New Yorkers , more than one in three, did not have enough money for food. In 2007, 1.3 million New Yorkers enlisted the help of soup kitchens . In the USA, the CDC estimates that 30% of the population have a BMI of over 30 kg / m² and are therefore considered obese. Economically disadvantaged (less educated, poorer) as well as discriminated minorities ( Indians , blacks ) are much more affected by overweight and obesity .

In January 2010, Feeding America (FA), formerly called America's Second Harvest , published its report “ Hunger in America 2010. ”. The Chicago-based organization serves 37 million people annually. According to their survey results, 37 million people in the US, including 14 million children and 3 million seniors, are not getting enough to eat.

Situation 2012

The World Food Program (English UN World Food Program , WFP) is the largest humanitarian organization in the world. According to this organization and research by the FAO , 870 million people did not have enough to eat in 2012, 98 percent of whom live in developing countries. 35 percent of the global grain harvest is fed to livestock .

While the proportion of people starving in the world has decreased in recent years, the actual number of undernourished people has increased steadily over the past decade. This discrepancy is mainly due to increasing population growth and the increasing demand for food in developing countries.

Effects

Malnourished children weakened by hunger

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 metabolism 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 result of the prolonged lack of food is the wasting or inanition (wasting). It can lead to a complete loss of strength, which is also called cachexia .

In guinea pigs it was found that the thyroid gland no longer works when there is malnutrition , and research has shown that growth stops in rats even when sufficient growth hormones are circulating in the body. Studies of the population in Mexico have shown that malnutrition leads to general insufficiency of the pituitary gland and, as a consequence, to insufficiency of the gonads and adrenal glands .

Consequences of malnutrition and malnutrition on the body
Area Impact (incomplete list)
General condition increasing weakness and frailty
skin delayed wound healing,
heart reduced cardiac output
immune system Reduced immune
competence, delayed wound and infection healing and recovery
lung increased susceptibility to pneumonia
Musculature reduced muscle mass and muscle strength,
kidney increased infection rate
psyche Irritability, weakness, apathy , depressive mood, poor concentration
skeleton decreased bone density
Digestive tract diarrhea

Impact of malnutrition on women

Malnutrition (such as that caused by a lack of food or anorexia ) can lead to amenorrhea (failure to menstruate ). The monthly cycle function requires a minimum body fat percentage of 22 percent. In terms of developmental physiology, the effect can be derived as natural contraception in the case of poor nutrition and unfavorable conditions for the offspring.

Impact of malnutrition on children

Adolescent after a noma disease

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 .

Malnutrition contributes to 53% of the 10.6 million deaths of children under 5 years of age in developing countries each year. Converted this means that every 5 seconds a child dies (2012) from the effects of hunger.

Over 147 million preschool children around the world are affected by stunting, which means that they are too small compared to their peers.

Malnutrition has an impact on school performance and, according to studies, often results in lower incomes than adults.

Human right to food

The human right to food is considered to have been violated if human dignity is violated through permanent deprivation of food or basic nutritional requirements . Conversely, the United Nations Social Committee General Comment No. 12 states : “The right to adequate food is realized when every man, woman and child, individually or collectively, has physical and economic access at all times to adequate food or have the means to procure them. ”In view of the estimated 1,000,000,000 starving people worldwide and over 24,000 starvation deaths per day by the food and agriculture organization FAO, this is likely to be one of the most massively violated human rights over many decades. While the number of starving people is declining in China , according to the FAO, it is stagnating in India and growing in Africa . The Democratic Republic of the Congo has the highest proportion of undernourished people in its population at 70 percent. However, due to the lack of empirical information, all figures should be used with caution.

Control and countermeasures

Three out of four starving people live as small farmers, ranchers and farm laborers in the countryside. When the United Nations World Food Program buys food for the hungry, it does so largely through local and regional purchases (“Purchase for Progress” program) from smallholder cooperatives. Long-term contracts are also concluded in order to help farmers achieve surpluses and secure sales opportunities. The program also supports the local processing of food in order to expand the food supply in local markets.

Recently, about " cash for work " - and " food for work " programs ( to help themselves tried), no longer in need through food aid to support the needy instead get money or food for charitable work, such as the construction of irrigation canals, which secure the food and future of their village at the same time. Instead of money, vouchers issued for certain groceries are distributed, which people in need can redeem in local shops, which strengthens the local economy instead of ruining market prices through free food distribution.

In countries where children are not sent to school but are drawn to work or begging, school meals increase parents' willingness to send their child to school. The prospect of at least one nutritious meal a day promotes the number of school enrollments and also the regular attendance of the students.

Emigrants and migrants who remit their income bring about a reduction in poverty and have a positive effect on public health in the countries of origin.

See also

literature

  • Maximilian Ledochowski: Clinical Nutritional Medicine. Springer, Vienna / New York 2010, ISBN 978-3-211-88899-5 .
  • Christian Löser, Angela Jordan, Ellen Wegner: Malnutrition and malnutrition. Strategies and recipes to regain your strength. Trias-Verlag, Kassel 2012, ISBN 978-3-8304-6063-3 .
  • Jean Ziegler : We'll let them starve to death: mass destruction in the third world. C. Bertelsmann Verlag, 2012, ISBN 978-3-570-10126-1 .
  • Jean Ziegler : How does hunger come into the world? A conversation with my son. Bertelsmann, Munich 2002, ISBN 3-570-30059-5 .

Web links

Commons : Malnutrition  - Collection of pictures, videos and audio files

Individual evidence

  1. ↑ a b c d e Alphabetical directory for the ICD-10-WHO Version 2019, Volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 908.
  2. ↑ EUFIG: It is time to recognize malnutrition in Europe. ( Memento of the original from June 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . @1@ 2Template: Webachiv / IABot / www.eufic.org
  3. ↑ Thomas Wagner: Hidden Hunger - One-sided nutrition endangers health. dradio.de/dlf , Environment and Consumers , March 4, 2013 (March 9, 2013).
  4. ↑ Jean Ziegler: We Let Them Starve: The Mass Destruction in the Third World. C. Bertelsmann Verlag, 2012, ISBN 978-3-570-10126-1 .
  5. ↑ Carole Presern, Director of the “Partnership for Maternal, Newborn & Child Health” at WHO, quoted at mothers and children who suffer from malnutrition due to climate change at Sustainable Life.ch.
  6. ↑ a b 7 facts about climate change and hunger . wfp.org.
  7. ↑ Maximilian Ledochowski: Clinical nutritional medicine. P. 83.
  8. ↑ Malnutrition (E40-E46). ICD-10-WHO Version 2006 ( Memento from March 6, 2010 in the Internet Archive )
  9. ↑ It is time to recognize malnutrition in Europe. ( Memento of the original from June 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. at eucif.org @1@ 2Template: Webachiv / IABot / www.eufic.org
  10. ↑ United Nations World Water Report 2012, cited on urine and faeces outdoors. Millions have no toilets. at n-tv.de.
  11. ↑ Thomas Löscher, Gerd-Dieter Burchard (Ed.): Tropical medicine in clinic and practice. with travel and migration medicine. 4th edition. Thieme Verlag, Stuttgart 2010, ISBN 978-3-13-785804-1 .
  12. ↑ Women in focus . wfp.org.
  13. ↑ Women & Hunger - 10 Facts. ( Memento of January 28, 2013 in the Internet Archive ) wfp.org.
  14. ↑ Every sixth person has no access to clean drinking water. In: www.europarl.europa.eu. European Parliament , May 21, 2011, archived from the original on June 28, 2011 ; Retrieved June 28, 2011 .
  15. ↑ Uschi Eid : Water for Everyone: Best Practice Models - Experiences from the UN Water Board and German development cooperation. (PDF; 108 kB) p. 5 , archived from the original on June 28, 2011 ; Retrieved June 28, 2011 .
  16. ↑ Federal Agency for Civic Education: Malnutrition .
  17. ↑ I. Trehan, HS Goldbach, LN LaGrone, GJ Meuli, RJ Wang, KM Maleta, MJ Manary: Antibiotics as Part of the management of severe acute malnutrition. In: N Engl J Med. 2013, 368, pp. 425-435, doi: 10.1056 / NEJMoa1202851 .
  18. ↑ Rebecca J Stratton, Ceri J Green, Marinos Elia (Eds.): Disease-Related Malnutrition: An Evidence-Based Approach To Treatment. CABI Publishing, Wallingford, United Kingdom 2003; C. Russell, M. ELia: Nutrition Screening Survey in the UK in 2008: Hospitals, care homes and mental health units. Redditch, BAPEN 2009; HM Kruizenga u. a .: Screening of nutritional status in The Netherlands. In: Clin Nutr. 22 (2003), pp. 147-152; JM Meijers et al. a .: Malnutrition prevalence in The Netherlands: results of the annual Dutch national prevalence measurement of care problems. In: Br J Nutr. 101 (2009), pp. 417-423; quoted in It is time to recognize malnutrition in Europe. ( Memento of the original from June 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. at eufic.org. @1@ 2Template: Webachiv / IABot / www.eufic.org
  19. ↑ RJ Stratton, M. Elia: A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. In: Clin Nutr Suppl. 2 (1) 2007, pp. 5-23, cited in It is time to recognize malnutrition Europe. ( Memento of the original from June 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , at eufic.org. @1@ 2Template: Webachiv / IABot / www.eufic.org
  20. ↑ O. Ljungqvist et al. a .: The European fight against malnutrition. In: Clin Nutr. 29 (2) 2010, pp. 149-150. quoted in It is time to recognize malnutrition in Europe. ( Memento of the original from June 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , at eufic.org. @1@ 2Template: Webachiv / IABot / www.eufic.org
  21. ↑ Nursing researches: malnutrition in aging people ; German senior league .
  22. ↑ US government renames starving citizens. In: Der Tagesspiegel . November 22, 2006, p. 32, Weltspiegel.
  23. ^ Poverty - Hungry in New York . In: Süddeutsche Zeitung . June 14, 2008.
  24. ↑ CL Odgen, MD Carroll, LR Curtin, MA McDowell, CJ Tabak, KM Flegal: Prevalence of overweight and obesity in the United States. 1999-2004. In: JAMA. 295, No. 13, April 2006, pp. 1549-1555.
  25. ↑ Stephen Lendman: Growing Hunger in America . In: Baltimore Chronicle. February 9, 2010.
  26. ^ World Food Program: Statistics .
  27. ↑ World Food Program: Millennium Development Goals .
  28. ^ HE Voss: The influence of endocrine glands on the metabolism of mammals. In: Helmcke, Lengerken: Handbuch der Zoologie. Eighth volume. Verlag de Gruyter, Berlin 1956, DNB 456894365 .
  29. ^ Christian Löser, Angela Jordan, Ellen Wegner: Malnutrition and malnutrition. Trias-Verlag, Kassel 2012, ISBN 978-3-8304-6063-3 .
  30. ^ Walter Siegenthaler, Hubert E. Blum: Clinical Pathophysiology. 9th edition. Thieme Verlag, Stuttgart 2006, ISBN 3-13-449609-7 , p. 389.
  31. ↑ Welthungerhilfe ( Memento of the original dated December 22, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . @1@ 2Template: Webachiv / IABot / www.welthungerhilfe.de
  32. ↑ Hunger demands a high price. Consequences of malnutrition for women and children. (PDF; 68 kB) World Food Program, at wfp.org.
  33. ↑ SCN World Nutrition Report, quoted under malnutrition . World Food Program.
  34. ↑ Malnutrition . World Food Program.
  35. ↑ Purchase for Progress (P4P) - Opportunities for smallholders . wfp.org.
  36. ↑ Innovations in the fight against hunger. wfp.org.
  37. ↑ School meals . wfp.org
  38. ↑ Haiti: "When the school bell rings, the children stand in line" . wfp.org.
  39. ^ Richard H. Adams, Jr: Evaluating the Economic Impact of International Remittances On Developing Countries Using Household Surveys: A Literature Review. In: Journal of Development Studies. 47, (6) 2011, pp. 809-828.