Severe Malnutrition in 2020


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          Malnutrition refers to deficiencies, excesses or imbalance in a person’s intake

          Of energy or nutrients. It mostly happens when the body does not take enough of

          The nutrients that are required for normal growth and development.The term 

          Malnutrition covers two broad groups of conditions that are overweight and



                            The cellular imbalance between the supply of nutrients and energy and body’s demand for them to ensure growth, maintenance and other functions

  • Malnutrition limits a person’s ability to function and diminishes the quality of life by:
  • Impairing muscle functions
  • Decreasing bone mass
  • Limiting immune defences
  • Reduce cognitive abilities
  • Delaying wound healing
  • Slowing recovery from illness and surgery
  • Increasing hospitalizations


  • reduced appetite.
  • lack of interest in food and drink.
  • feeling tired all the time.
  • feeling weaker.
  • getting ill again and again and taking a long time to recover.
  • wounds taking a long time to heal.
  • poor concentration.
  • feeling cold most of the time.

                                              Malnutrition In Pakistan:

One hundred and fifty mothers of under-5 kids clinically recognized as malnourished in katchi abadis (vagrant settlements) of Karachi. In Karachi, 45 of the 150 mothers met had kids with third-degree lack of healthy sustenance as indicated by weight-for-age models, 15 of whom passed on throughout the study. Tharparkar in 2014 taking the circumstance of ailing health from terrible to more awful. The issue of ailing health was additionally intensified by helpless access to clean drinking water and disinfection and inaccessibility of staff and medication at social insurance offices. The major healthful issues in Pakistan incorporate low birth weight because of poor maternal sustenance, protein vitality hunger, paleness, iodine inadequacy issues and other micro-nutrient deficiencies.                       


  • Protein-Energy Malnutrition
  • Micro-nutrient deficiency Malnutrition

                                       protein energy malnutrition

Under-nutrition is sometimes called as a synonym of Protein-energy malnutrition (PEM). The term “severe malnutrition” or “severe under-nutrition” is frequently used to cite specifically to (PEM). PEM is often associated with micronutrient deficiency. Two types of PEM are Kwashiorkor and Marasmus, and they commonly exist side by side.


Kwashiorkor is a nutritional issue, regular in provincial zones of creating nations like Pakistan, and it fundamentally influences kids in the second year of life. Kwashiorkor is a type of lack of healthy sustenance coming about because of over the top dietary admission of sugars. Kwashiorkor happens in youngsters weaned from breastfeeding due to the mother’s new pregnancy and took care of rather sugar beverages or starch abstains from food with insignificant admission of proteins, nutrients and micro-nutrients, for example, folic acid, vitamin C, iron, iodine, and Selenium.kwashiorkor


This typical disease is associated with a diet based on:

  • Starches 
  • Low-protein staple foods such as sweet potatoes, and bananas.


  • Diarrhoea 
  • Malaria 
  • Pneumonia  
  • Apathy
  • Anorexia
  • Soft oedema of feet, legs, hands, arms, and face caused by Hypoalbumenia
  • Hepatomegaly with fatty liver commonly occurs.
  • Skin lesions are typical and include pellagroid desquamative dermatitis with hyper-pigmentation and sometimes Skin ulceration.   
  • The hair becomes thin and fragile with bands of loss of pigmentation.

 Children with kwashiorkor have low levels of albumin, polyunsaturated fatty acids and antioxidants such as glutathione and vitamin E.


Marasmus (‘to waste away’) is caused by improper intake of protein-rich food and energy. Marasmus can result from a continued eating regimen of lacking vitality and protein, and the digestion adjusts to draw out endurance. It is traditionally seen in famine, significant food restriction, or more severe cases of Anorexia. Conditions are characterized by extreme wasting of the muscles and a gaunt expression. The primary signs and symptoms of marasmus is an acute loss of body fat and muscle tissues, leading to an unusually low body mass index BMI. Marasmus is a type of wasting.



Nutrient deficiency is the main cause of marasmus. It occurs in children that do not ingest enough protein, calories, carbohydrates, and other important nutrients. This is usually due to poverty and a scarcity of food.


 The main symptoms are:

  • Severe wasting 
  • leaving little or no oedema 
  • Minimal subcutaneous fat
  • Severe muscle wasting 
  • Non-normal serum albumin levels.
  • Stunted growth
  • Anorexia
  • Eyes may appear sunken

Marasmic kwashiorkor:

It is the third type of protein-energy malnutrition that combines features and symptoms of both marasmus and kwashiorkor.A person with marasmic kwashiorkor may be extremely thin, show signs of wasting in areas of the body and have excessive fluid buildup in other parts

In kids with marasmus kwashiorkor, the weight will be under 60 per cent of the standard load for their age. Immediate clinical treatment is fundamental. As the condition advances, recuperation turns out to be more troublesome, and the odds of endurance diminish.


  • reduced appetite.
  • lack of interest in food and drink.
  • feeling tired all the time.
  • feeling weaker.
  • getting ill again and again and taking a long time to recover.
  • wounds taking a long time to heal.
  • poor concentration.
  • feeling cold most of the time.



The micro-nutrient deficiency malnutrition is also linked with Protein-energy malnutrition. Deficiencies of Fat-soluble vitamins, Iron are most common but the deficiencies of other micro-nutrients are also found. (See “Malnutrition in children in resource-limited countries: Clinical assessment”.). Micro-nutrient malnutrition can occur if the person is getting enough energy and not thin or short but there is a deficiency of specific nutrients in the diet. There are a number of disorder that occurs due to micro-nutrients deficiencies such as:

  • Anaemia
  • Pellagra
  • Scurvy
  • Xerophthalmia
  • Beriberi
  • Ariboflavinosis
  • Rickets

Many people suffer from these diseases but anaemia is the most common.

                    deficiency disease


etiology of malnutrition

Different combinations of many etiological factors can lead to malnutrition such as

  • Social and Economic Factors
  • Biological Factors
  • Environmental Factors
  • Role of free radicals and Antitoxin
  • Age of the Host

                                                preventions from malnutrition

  • A variety of strategies have been developed to help prevent and treat malnutrition. 
  • These commonly involve diet, nutrition supplementation, meal delivery programs, and nutrition education or counselling.
  • Formulation of nutrition policy and overall long term planning to improve production and supplies of food
  • Land reforms, proper guidance in agriculture to help farmers to get better yields from their lands.
  • By controlling the growth of the population and providing family planning guidance can be helpful and lead to more food availability.
  • Targeted Supplementary Feeding Programme (TTSFP) is also useful for children with malnutrition and pregnant and lactating women with acute malnutrition. They are given dry take-home rations every two weeks or every month. 
  • Interventions involve a focus on a healthy and Balanced diet and including sources of iron. Good sources of iron include fruits, vegetables, whole grains etc.
  • Babies should be breastfed for at least a year and when the diet is started, it should contain iron-rich cereal or pureed meat. 
  • Iron fortification of food can be an appropriate measure. Promotion of foods rich in iron as well as micronutrients (folic acid, Vitamin A, C, B-12, and Zinc) help in iron absorption.

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