Part 1: The Science of Nutrition and Malnutrition.

Today’s post is number three in the run-up to my International Reporting Project trip to India where I will be part of a team of 10 journalists covering the topic of child survival. First, I addressed Infectious Diseases, then Vaccinations. Today, we will look at Malnutrition. What is the state of malnutrition in India? How has scientific understanding of what good nourishment means helped us work on the malnourishment issue particularly in developing nations? Can science put an end to world hunger? How are sanitation and hygiene related to malnutrition?

Before we go on, let’s define a few terms so there is no confusion:

• Malnutrition is the condition that occurs when your body does not get enough nutrients.
• Starvation is a severe deficiency in caloric energy, nutrient, and  vitamin  intake.
• Famine is a widespread scarcity of food, usually accompanied or followed by regional malnutrition, starvation, epidemic, and increased mortality.
• Emaciation is abnormal thinness caused by lack of nutrition or by disease.
• Marasmus is chronic wasting of body tissues, especially in young children, commonly due to prolonged dietary deficiency of protein and calories.
• Kwashiorkor is a syndrome occurring in infants and young children soon after weaning. It is due to severe protein deficiency, and the symptoms include edema, pigmentation changes of skin and hair, impaired growth and development, distention of the abdomen, and pathologic liver changes.

We’ve all seen disturbing photos of children in the malnourished or starving so I’ll not replicate them here.

Facts about Malnutrition in India

Here are some facts about malnutrition in India from Child In Need India (CINI)

The World Bank conducted an analysis of the problem of malnutrition in India and introduced a long document, “Undernourished Children: A Call for Reform and Action” with this statement:

“The prevalence of underweight among children in India is amongst the highest in the world, and nearly double that of Sub-Saharan Africa. In 1998/99, 47 percent of children under three were underweight or severely underweight, and a further 26 percent were mildly underweight such that, in total, underweight afflicted almost three-quarters of Indian children. Levels of malnutrition have declined modestly, with the prevalence of underweight among children under three falling by 11 percent between 1992/93 and 1998/99. However, this lags far behind that achieved by countries with similar economic growth rates.  Undernutrition, both protein-energy malnutrition and  micronutrient deficiencies, directly affects many aspects of children’s development. In particular, it retards their physical and cognitive growth and increases susceptibility to infection, further increasing the probability of malnutrition. Child malnutrition is responsible for 22 percent of India’s burden of disease. Undernutrition also undermines educational attainment, and productivity, with adverse implications for income and economic growth.”

Across India, not all children are malnourished and some are more extremely malnourished than others. The numbers of those affected vary between remnants of the caste system, between Indian states, and gender where girls are more likely to be undernourished because of their lower status in society.

Malnutrition and Disease go Hand in Hand 

Malnourishment and emaciation can be caused by disease. As you can imagine, severe diarrhea (such as from cholera or rotavirus) will interrupt the absorption of nutrients while the feeling of deep malaise will leave a child not wanting to eat. Diseases and disorders associated with emaciation include malaria, cholera, tuberculosis, other infectious diseases with prolonged fever, and parasitic infections.

Malnutrition also increases the risk of infection and infectious disease, and weakens every part of the immune system. It is a major risk factor in the onset of active tuberculosis.  Protein and energy malnutrition and deficiencies of specific micronutrients (including iron, zinc, and vitamins) increase susceptibility to infection.

Providing adequate nutrition during the first 1000 days can ensure that children are less susceptible to disease.

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The Science of Nutrition and Malnutrition 

Clearly, malnutrition is a severe issue in India and has longterm implications for children and the future of the country. Let’s look at how scientific discovery helps us understand nutrition and good nutrition keeps us healthy.

Six Major Classes of Nutrients

carbohydrates           fats            minerals

protein                 vitamins            water

These nutrient classes can be categorized as either:

Macronutrients, which are needed in relatively large amounts, and include carbohydrates (including fiber), fats, protein, and water.

OR

Micronutrients, which are needed in smaller quantities, and are minerals and vitamins.

You probably remember the stories of how lack of vitamin C was discovered to be the cause of scurvy of men on ships or how the cause of Beriberi was the lack of thiamine (vitamin B1). The field of nutrition is full of scientific studies that have provided further understanding into what our bodies need to thrive. This list (modified from Wikipedia) shows us what may result from various nutrient deficiencies.

 Scientists Involved in Early Nutrition Research

Many Nobel prizes have been awarded for nutrition research, with heaviest emphasis on the discovery or synthesis of vitamins.

Take a look at this list from nobelprize.org. You will want to read this fascinating article from which this information is taken from, too, as it discusses in more detail how some of these scientists made their findings.

There was an interesting Nobel Prize awarded to a tireless researcher in the field of nutrition research. In 1949, Lord Boyd Orr from United Kingdom, who studied Biology, Medicine and Nutrition, won the Nobel Peace Prize (Yes, PEACE) “for his scientific research into nutrition and his work as the first Director-General of the United Nations Food and Agriculture Organization (FAO)”. He was passionate about understanding malnutrition and metabolism.

Part 2: Malnutrition and Sanitation