MALNUTRITION

Introduction on Malnutrition

Malnutrition is the cellular imbalance between the supply of nutrients and energy and the body’s demand for them
to ensure growth, maintenance, and specific functions. It includes both under- and over nutrition.

However, the term “malnutrition” commonly refers to undernutrition, and is used as such in these guidelines.

Although malnutrition can affect all ages, however, the early stages, including, foetus, infants and children, are most
vulnerable to the effects of undernutrition during the period of their most rapid physical growth and development during the first two years of life.

Malnutrition is a significant contributor to morbidity and mortality among children under 5 years in Uganda. It also
makes the prognosis of other diseases poor.

Note

  • Previously, malnutrition was classified into two types: 1) Protein-Energy Malnutrition (PEM) due to
    lack of adequate protein and energy in the diet and 2) Micronutrient malnutrition-due to deficiencies in specific micronutrients (vitamins and minerals).
  • These causal names are now avoided because protein and energy deficits are likely to be accompanied by deficiencies of other nutrients, and management of malnutrition takes this into consideration.

Causes/contributing factors to malnutrition

  • Immediate causes: diet and disease
    • Inadequate quantity and quality of food
    • Lack of knowledge on appropriate foods provided to children, poor food preparation, food taboos
    • Infections: reduce appetite, increase energy and nutrient utilisation, and limit the ability to absorb or retain nutrients e.g. in diarrhoea, intestinal parasites
  • Root causes: food insecurity, poor health services, poor environmental sanitation, natural disasters, excessive
    workload for women, poor weaning practices, culture, inadequate water supply, low literacy levels, low nutrition advocacy/education
  • Underlying causes: poverty, corruption, poor governance, poor infrastructure.

Consequences of malnutrition

  • Impaired growth, physical and mental and development
  • Impaired body resistance/immune system
  • Increased risk of adult chronic diseases
  • Increased risk of mortality
  • Increased risk for the cycle of inter-generational malnutrition
  • Poor economic well-being for the individual and country

Differential diagnosis

  • Nephrotic syndrome (nephritis)
  • Liver disease
  • Heart disease
  • Malabsorption syndrome
  • Malignancy (e.g., gastrointestinal tract cancer, liver cancer/hepatocellular carcinoma)