Malnutrition: When is it a cause for concern? |01 December 2023

This seems like a very heavy topic but we promise we will not make it too technical. In fact, we will begin by defining what the term malnutrition means and what we will be limiting ourselves to today.

When we hear the term ‘malnutrition’ the first thing that comes to mind is someone thin and frail who is not eating properly. And although that is not entirely wrong, it is only part of the story.

Malnutrition is defined in several ways and there is no universal definition for it but in the word malnutrition, you get ‘mal’ which implies wrong or improper and ‘nutrition’ which refers to providing the body with food. To put it simply therefore, it means that it is an imbalance between the nutrients that the body needs and the nutrients it actually gets. It includes any condition whereby there may be deficiencies or excesses of specific nutrients from the diet.

Malnutrition therefore includes undernutrition, overnutrition (overweight and obesity) and micronutrient deficiencies (lack of specific vitamins/minerals) such as anaemia. In Seychelles the biggest health problem that is commonly talked about is obesity. Nevertheless, there are some children and adults who suffer from undernutrition.

Our focus for today therefore is on undernutrition as it is something that we seldom talk about although it poses many health risks if undiagnosed and untreated. It is noteworthy at this stage that the term malnutrition and undernutrition are often used synonymously despite malnutrition being more than just undernutrition. To avoid any confusion though we will use the term undernutrition as this is the topic of interest.

An overview of undernutrition

There are three main forms of undernutrition, namely stunting, wasting and underweight. Stunting and wasting are common in the early years of a child’s life, whereas underweight can usually happen at any age.

A person is said to be stunted when they are of shorter than normal stature for their age, known as low-height-for-age as a result of chronic poor nutrition especially in the early years. When stunting is unresolved in early childhood it can have irreversible damage on a child’s physical and intellectual development which then persists in adulthood.

Wasting is another form of undernutrition which is characterised by the person being too thin for their height or having low weight-for-height. Wasting usually occurs as a result of inadequate quality and quantity of food and recurrent or prolonged illness due to infection.

A person who is underweight is too thin for their age or what is known as low weight-for-age. If you are underweight, it is usually because of poor food intake or your body having difficulty in absorbing important nutrients. A child who is underweight is at risk of being wasted or stunted or both.

How do you know if you are undernourished?

The signs and symptoms of undernutrition may vary but the most common symptom is unintentional weight loss. You may also experience loss of muscle and fat (loose skin), hollow cheeks and sunken eyes, difficulty for a cut or wound to heal, lethargy and difficulty concentrating. Some people may also fall sick more easily due to reduced immunity, or may have weak bones as well as hair and skin changes. In addition, children may experience hindered growth and impaired brain development.

Causes of undernutrition

The most obvious answer here would be ‘not eating enough’. Sometimes however you might be eating enough but you are not choosing the right types of food. This is where the quality of food eaten is of immense importance.

But when we explore inadequate food intake or low quantity of food further we find that there are many factors that can lead to that. It might be that you don’t have enough money to buy food or to be able to buy the right types of food or it might be that you don’t have access to healthy foods or perhaps you are following a restrictive diet commonly known as crash diets.

It can also happen sometimes however that you are having your usual food intake but your demand for certain nutrients is more. This is typical in childhood and adolescence as well as pregnancy and lactation. If the quantity and quality of food remains unchanged, this therefore increases your risk of undernutrition.

Undernutrition can also happen as a result of certain medical conditions that prevent you from eating enough or from absorbing the nutrients in your food. Certain conditions can make eating difficult such as dementia, depression, nausea, vomiting as well as eating disorders like anorexia nervosa. Certain medications, alcohol or illicit drugs can also affect your appetite and therefore your food intake.

Some medical conditions deplete nutrients from the body such as chronic diarrhoea or cancer. Some people also have malabsorption as a result of diseases like inflammatory bowel disease, coeliac disease or pancreatic insufficiency. Others still may not be able to get enough in the body because they are on long-term tube feeding which may not fully meet their increased needs. 

Treatment of undernutrition

The treatment of undernutrition will vary depending on the severity and its cause. If you have an infection or illness then it will make sense to treat the underlying illness or infection at the same time as addressing the nutritional insufficiency.

Most of the time, if a person is able to eat then the aim is to slowly and gradually increase the amount of energy and nutrients like protein that they are getting. Eating small, nutritious meals several times a day instead of large meals is more appropriate. For those who have difficulty in chewing food, a liquid diet is a better option. There is a lot of focus on quality rather than quantity in the early stages so as not to overload the body.

You want to include foods like wholegrains, local starches like breadfruit and sweet potatoes, fish, eggs, lean meat, lentils, beans, vegetables, milk products and healthy fats like olive oil and avocado. It is important to gradually increase food intake especially in severe undernutrition because you may otherwise experience complications like diarrhoea or imbalances in body water and glucose.

Sometimes when food intake is not enough an oral nutritional supplement such as Ensure may be given to guarantee that the body gets the energy and nutrients that it needs. If feeding by mouth is not an option then tube feeding is considered until normal feeding can resume. In the end, the goal remains to improve your nutritional intake so as to improve your health outcome.

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Yours in health

The E4OH Team