Classification of Malnutrition

Our bodies need nutrients to grow, to work and to fight disease. Getting too little of them harms the body, and so does getting too much. In simple words, malnutrition means the body having less of the nutrients it needs, or more than it needs. So a thin, weak child is malnourished, and so is a person who carries far more body fat than is healthy.

Doctors say that malnutrition is the main cause of illness among children in Nepal. Because of it, the physical and mental growth of many Nepali children has been held back. The largest number of its victims are children under two years of age.

Malnutrition does not only affect a child's body. It also affects how the child thinks and how they get along with others. Its effects fall into three groups.

Malnutrition rarely has a single cause. Many things, from the food in a home to the poverty of a whole society, work together to bring it about. The main causes are:

• Not enough food and not enough nutrients
• Disease and infection
• Lack of knowledge about nutrition
• Unhealthy food
• Babies not being breastfed
• Lack of food for children, pregnant women and mothers who have just given birth
• Population growth and pollution of the environment
• Social exploitation and inequality
• Low wages

Malnutrition is studied in four classes, depending on which nutrient is missing or which is in excess:

• Protein energy malnutrition
• Vitamin deficiency malnutrition
• Mineral deficiency malnutrition
• Obesity

The first three are caused by too little of something. The fourth, obesity, is caused by too much.

Carbohydrate and fat give the body energy, while protein builds and grows the body's cells. When the diet is short of these, the body has neither the fuel to work nor the material to grow. Two serious diseases come under this class: marasmus and kwashiorkor.

In marasmus the child's body wastes away. It is seen most often in children under 5 years of age. Once it takes hold, the child's weight drops sharply, the muscles shrink away, and the skin becomes thin and wrinkled.

Marasmus is caused by:

• A lack of carbohydrate and protein in food
• Worms and attacks of various infectious diseases
• Poverty and hunger
• Ignorance
• Being a victim of conflict
• Lack of education

The signs of marasmus are:

• The child is irritable and keeps crying out
• The face looks like an old person's
• The skin becomes wrinkled
• When the skin is pinched and let go, it goes back into place only slowly
• The eyes are sunken
• The child is fretful and startles easily
• The child is very hungry
• The body weight is very low

Kwashiorkor is a form of malnutrition just as serious as marasmus. A child with it cries and whines so much that it is also known as the crying disease.

Once a baby is 6 months old, breast milk alone is no longer enough for its body. If the baby does not then get extra food, such as soft cereal porridge and a mash of rice and lentils, it runs short of protein and this disease follows. This is why it is seen especially in children who depend on mother's milk alone. It usually appears in children aged 3 to 5 years, but older children and even adults can get it.

Kwashiorkor is caused by:

• Lack of protein in food
• Worms and attacks of various infectious diseases
• Poverty or hunger
• Ignorance
• No balanced diet, together with unhealthy eating habits and behaviour
• Lack of education

The signs of kwashiorkor are:

• First the feet swell, and as the condition gets worse the swelling spreads to the lower legs, the hands and the face
• The face looks round like the moon
• The weight is low
• The child's body, arms, legs, belly and face swell up
• The child has anaemia, a shortage of blood
• Teeth and bones develop poorly

Both diseases are forms of protein energy malnutrition. In both, the child loses weight and is irritable or tearful. These differences tell them apart:

The ways to prevent marasmus and kwashiorkor are of two kinds: immediate measures, taken straight away, and long-term measures, kept up over time. The immediate measures are:

• Pregnant women and new mothers eat more food rich in protein and carbohydrate, and of better quality
• As soon as a baby is born, it is given the mother's thick yellow first milk, called colostrum
• The child is vaccinated against infectious diseases
• Complementary food is arranged for the child after 6 months
• After 6 months the child is fed nourishing foods such as cereal porridge, rice and lentil mash, rice pudding, rice, flatbread, vegetables, fish, meat, eggs, cow or buffalo milk and fruit
• Different nourishing foods are given morning, afternoon and evening, and because a child's stomach is small, it is fed small amounts many times a day
• The child is kept warm
• Depending on how ill the child is, the child is treated in hospital
• Food is never allowed to run short of protein and calories
• The child is not fed milk from a bottle

The long-term measures are:

• First find out which type of malnutrition it is, and if it is severe, admit the child to hospital for treatment
• Find out whether the child also has diarrhoea or another infection
• Give medicine against worms from time to time
• Restore the child's nutrition to a healthy level
• Take a doctor's advice from time to time

A lack of vitamins causes diseases such as rickets, pellagra, scurvy and night blindness. Of these, night blindness is the one seen most often.

It mostly affects children between 3 and 5 years old, and it has become a common problem. Night blindness caused by a lack of vitamin A goes away once the child eats foods rich in vitamin A. Night blindness that is inherited in a family, however, cannot be cured. A lack of vitamin A also causes xerophthalmia, a disease in which the eyes become dry.

Night blindness is caused by:

• Too little vitamin A in daily food
• Disease of the retina of the eye
• Too few local sources of vitamin A, too few means and resources, and too little knowledge

The signs of night blindness are:

• In the evening and in the dark, the child sits quietly in one place
• The child keeps rubbing their eyes
• Adults, too, find it hard to walk about, ride a motorcycle or drive at night
• On coming from bright light into a room, the person cannot see

Night blindness is prevented and treated by:

• If it comes from a lack of vitamin A, eating foods rich in vitamin A cures it
• Young children should be given plenty of green leafy vegetables and yellow fruit
• The Government of Nepal gives out vitamin A capsules from time to time to children under 5 to control and wipe out night blindness, so children should be brought to this programme and given vitamin A
• Awareness of this disease should be spread among the public

The thyroid gland in the neck makes a hormone called thyroxin, and it needs iodine to make it. When there is too little iodine in the body or in food, the thyroid cannot release thyroxin, or releases too little. To make up the shortfall, the gland works harder. Working this hard, it swells until it looks like a lump hanging from the neck.

In Nepal this disease is seen more among people who live in the mountain and hill regions.

Goitre has one cause: too little iodine and minerals in food. Its signs are:

• A fleshy lump appears on the neck
• Children may suffer deafness and disability
• Tiring quickly
• The skin feels thick
• Memory becomes weaker
• The heart beats fast
• Blood pressure rises

Goitre is prevented by:

• Always using iodised salt
• Breastfeeding babies
• Eating food from the sea, because it contains iodine
• Seeing a doctor for advice and treatment as soon as the disease is suspected
• Making the community aware of this disease through health education

Malnutrition caused by too much of the nutrients is growing day by day. Obesity is one form of it.

Obesity harms the body in many ways. It leads to heart disease, diabetes, high blood pressure and kidney disease. It is not a problem of one age group only. People of any age can become obese.

Obesity is measured from a person's weight and height. A normal person's BMI is between 16 and 25. A BMI above 29 means obesity. The BMI chart divides the values into smaller groups:

To find BMI, weight is measured in kilograms and height in metres. The weight is then divided by the square of the height:

\[ \text{BMI} = \frac{W}{H^2} \]

Here \( W \) is the weight in kilograms and \( H \) is the height in metres, which is why BMI is written in kg/m².

Example: A student weighs 50 kg and is 1.6 m tall. Find her BMI and the group she belongs to.

Step 1: Putting the weight and height into the formula:

\[ \text{BMI} = \frac{50}{1.6^2} \]

Step 2: Squaring the height:

\[ 1.6 \times 1.6 = 2.56 \]

Step 3: Dividing the weight by the squared height:

\[ \frac{50}{2.56} \approx 19.5 \text{ kg/m}^2 \]

Step 4: Comparing the result with the BMI chart:

\[ 18 < 19.5 < 23 \]

A BMI of 19.5 kg/m² lies in the 18 to 23 group, so this student has an ideal body weight.

Obesity is caused by:

• Inherited causes that run in the family
• Not doing physical exercise, and living a life of too much ease
• A habit of overeating, and eating a lot of sweets, chocolate and ready-made food between meals
• Eating food with a lot of ghee, fat and carbohydrate
• Diseases of the endocrine, or hormone, glands

The signs of obesity are:

• A BMI above 29
• The hips grow larger
• Weight is more than it should be for the person's age and height

Obesity is prevented by:

• Doing about 30 minutes of physical exercise and yoga regularly to control weight
• Using less fat in food, and taking more water, green vegetables and fruit
• Not eating ready-made food
• Having the body checked from time to time as a doctor advises
• Raising public awareness of obesity and the health problems it brings