Malnutrition is a health condition caused by an inadequate intake of nutrients, either due to

deficiency or due to excess. It may result from poor diet, diseases, or problems with nutrient
absorption. 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 non-communicable diseases (such as heart disease,
stroke, diabetes and some cancers).

Causes of Malnutrition
Malnutrition arises from a combination of dietary, health, and socioeconomic factors. Common
causes include:

 Inadequate Dietary Intake: A poor diet lacking essential nutrients, often due to limited
access to food, poverty, or food insecurity. This can stem from starvation or simply not
consuming a variety of nutritious foods.
 Health Conditions and Diseases: Illnesses that reduce appetite, impair digestion, or
increase nutrient needs, such as gastrointestinal disorders, cancer, or chronic infections.
For instance, disease-related malnutrition can result from malabsorption, increased
nutrient losses, or altered metabolic demands.
 Eating Disorders and Behavioral Factors: Conditions like anorexia nervosa or bulimia
that lead to intentional food restriction, as well as issues like alcoholism or mental health
problems affecting eating habits.
 Socioeconomic and Environmental Issues: Factors such as war, natural disasters, or
poor sanitation that disrupt food supply chains. In older adults, causes may include
difficulty chewing, social isolation, or medication side effects that reduce appetite.
 Absorption Problems: Medical issues like celiac disease, Crohn's disease, or surgeries
that affect the gut, preventing proper nutrient uptake from food.

Symptoms of Malnutrition
The main symptoms of malnutrition are:

Weight loss;

Frequent diarrhea;

Excessive fatigue;

Difficulty concentrating;

Lack of appetite;

Decreased body temperature;

Apathy;

Irritability;

Generalized swelling.

Malnutrition progresses in stages. It can come on slowly or very quickly, as can occur when
cancer is rapidly advancing. When the body doesn't get enough calories, it first consumes its own
fat and uses it as calories, similar to burning furniture to keep a house warm. After the stored fats
are used up, the body can break down its other tissues, such as muscle and internal organ tissue,
leading to serious problems, including death.

Protein-energy malnutrition
Protein-energy malnutrition (also known as protein-energy malnutrition) is a severe deficiency of
protein and calories that occurs when a person does not consume enough protein and calories
over a long period of time.

In countries with high rates of food insecurity, protein-energy malnutrition commonly occurs in
children. It contributes to more than half of all child deaths (for example, by increasing the risk
of developing life-threatening infections and, if infections do occur, increasing their severity).
However, this condition can affect anyone, regardless of age, if their dietary intake is inadequate.
Worldwide, the most important preventive strategy is to reduce poverty and improve nutritional
education and public health measures.

Protein-energy malnutrition has three main forms:

 Marasmus
 Kwashiorkor
 Kwashiorkor marasmático

Marasmus
Marasmus is a severe calorie and protein deficiency. The deficiency tends to occur in infants and
young children. It typically causes weight loss, muscle and fat loss, and dehydration.
Breastfeeding generally protects against marasmus.

Kwashiorkor
Kwashiorkor is a severe deficiency of protein rather than calories. Kwashiorkor is less common
than marasmus. The term derives from an African word meaning "first child-second child," as a
firstborn often develops kwashiorkor when a second child is born and weans them from
breastfeeding. Since children develop kwashiorkor after being weaned, they are usually older
than those who develop marasmus.

Kwashiorkor tends to occur in certain regions of the world where native foods and meals
intended for weaned babies are deficient in protein, yet sufficient in calories and carbohydrates.
Examples of such foods are yams, tapioca, rice, potatoes, and green bananas. However, anyone
can develop kwashiorkor if their diet consists primarily of carbohydrates. People with
kwashiorkor retain fluid, giving them a bloated appearance. If kwashiorkor is severe, the
abdomen may become distended.

Kwashiorkor marasmático
Marasmatic kwashiorkor occurs when a child with kwashiorkor does not consume enough
calories. The person with this disorder retains fluid, and muscle and adipose tissue waste away.
Starvation
Starvation is the most extreme manifestation of protein-energy malnutrition. It is caused by a
complete lack of nutrients over a long period of time. It usually occurs because food is
unavailable (e.g., during a famine), but occasionally, it occurs when food is available (e.g., when
a person is fasting or has anorexia nervosa ).

Consequences of Malnutrition
The main consequences of malnutrition are:
Delayed growth and development in children;
Severe weight loss;
Lowered immunity, which favors the onset of diseases;
Anemia;
Difficulty healing wounds;
Brittle skin, hair, and nails;
More visible wrinkles;
Intestinal dysfunction;
Delayed intellectual development in children;
Infertility.

Treatment

For most people, treating malnutrition involves gradually increasing the number of calories
consumed. The best way to achieve this is by consuming a large number of small, but nutritious,
meals per day. For example, people who have been starving are initially given small amounts of
food more frequently (6 to 12 times per day). Then, the amount of food is gradually increased. If
children have diarrhea, feeding should be delayed for a day or two to prevent the diarrhea from
worsening. During this interval, children should be given fluids.

People who have difficulty digesting solid foods may require liquid supplements or a liquid diet.
Lactose-free or low-lactose supplements (e.g., yogurt-based supplements) are often used because
many people have difficulty digesting lactose (a type of sugar found in dairy products), and
malnutrition can exacerbate this problem. Eating foods containing lactose often causes diarrhea.

As treatment progresses, the number of meals is reduced, while the amount of food at each meal
is increased, depending on the patient's adaptation.. In more severe cases, hospitalization may be
necessary to receive nutrients directly intravenously or through a gastric tube.

Prevention of Malnutrition

Preventing malnutrition focuses on addressing root causes through lifestyle, policy, and medical
interventions. Effective strategies include:

Promoting a Balanced Diet: Encourage consumption of diverse, nutrient-rich foods like

fruits, vegetables, whole grains, lean proteins, and dairy. The best prevention is a well-
balanced diet with a variety of nutritious whole foods. For at-risk groups, fortified foods
(e.g., iodized salt or vitamin-enriched cereals) can help fill gaps.

Improving Food Access and Education: Public health initiatives to combat poverty,
ensure food security, and educate on nutrition. Programs like school meals or community
gardens can reduce socioeconomic barriers.

Screening and Early Intervention: Regular health check-ups to identify risks,

especially in seniors or those with chronic diseases. Tools like body mass index (BMI)
monitoring or dietary assessments can detect issues early.

Managing Underlying Health Conditions: Treat digestive disorders, infections, or

eating disorders promptly to restore nutrient absorption and appetite. Supplementation
(e.g., vitamins or oral nutritional shakes) may be needed under medical guidance.

Global and Policy Measures: Efforts by organizations like the WHO to promote
breastfeeding, vaccination against infections, and hygiene to break the malnutrition-
infection cycle. In emergencies, humanitarian aid ensures nutrient-dense food
distribution.