Abstract
Malnutrition is one of the gravest and most formidable challenges of the 21st century. It is one of the underlying causes of majority of the acute and chronic healthcare conditions, and one of the major contributors to prolonged hospitalization and negative outcomes of healthcare processes and medication. There are different factors and contributors that come into play to increase the trend of malnutrition across the world, and while some trends remain constant in both developing and developed countries, some trends tend to vary.
For instance, most developing, and third-world countries struggle with poverty-driven malnutrition, hunger and starvation, as the people have limited access to food supplies and essential nutrients. Poverty is a consistent factor that drives malnutrition amongst the low socioeconomic classes in developed countries, but lack of nutrition literacy, limited access to nutritious foods, malnutrition amongst the elderly and disease-associated malnutrition is a more common across industrialized and developed nations.
This paper will attempt to launch an inquiry into the dynamics and multifaceted nature of malnutrition and how it exists and expands across populations and communities across the world. The paper will examine the various forms of malnutrition in developed and developing countries, and attempt to understand the consequences of malnutrition on the healthcare system. It will attempt to launch an inquiry into the impact of malnutrition on the economy, on lifestyles across various socioeconomic classes, and the overall burden on the healthcare system.
Keywords: Malnutrition, Undernutrition, Overnutrition, Obesity, Starvation.
Malnutrition in the 21st Century
Introduction
Nutrition is significant for the health and wellbeing of individuals of all ages. Poor quality diets and lack of adequate nutrition consumption can lead towards malnutrition. Despite the advancements and innovations across healthcare industries worldwide, malnutrition continues to be a underrecognized and widely undertreated ailment, while its consequences are far-reaching and devastating for the global healthcare system. It is important to understand that malnutrition is a multifaceted global challenge, and its far-reaching consequences and impacts are experienced by the healthcare systems and communities in both, developed and developing countries. Indeed, combatting malnutrition is one of the greatest challenges of the 21st century, and it requires healthcare systems and governments to adopt immediate and effective solutions.
Malnutrition is a shrouded challenge faced by modern-day healthcare systems and the statistical figures are alarming. Even in developed countries with the most innovative healthcare facilities across the world, around 50% of the patients are either suffering from malnutrition or at risk of being malnourished. This is a massive burden for the healthcare infrastructure as patients who are malnourished have a slower healing process and have a greater chance of being readmitted to the hospital. Adequate nutrition is often overlooked, even though it is instrumental for effective healing and recovery. Research reveals that providing patients adequate nourishment, and nutrient supplements can bring about marked reductions in readmissions, healthcare complications, mortality rates and the duration of hospital stays, and the frequency of hospital visits.
It is important to note that the risk of malnutrition exists throughout the lifespan of an individual, and it begins even before a baby is born, therefore, nutrition or malnourishment has a detrimental impact on the development of a child. Amongst infants and children, nutrition is instrumental in allowing a healthy mental and physical development and growth. Amongst adults, nutrition creates a healthy, well-balanced diet and an active lifestyle. Amongst the elderly, nutrition supports a longer and healthier lifespan by supporting mental and physical health, and improving life quality to allow the elderly to enjoy greater independence. However, malnutrition can deny the fundamental elements of healthy growth and development amongst infants, children, adults and the elderly. The effects of malnutrition can be felt across regions, countries, economies, communities and healthcare systems.
For instance, as seen in the case of China, a country that boosts the largest population in the world, and with projections of population growth by another 300 million people by 2040, malnutrition is one of the major challenges faced by the Chinese healthcare system. The rapid growth of China and increases in the overall aging of its population has given birth to countless challenges in healthy lifestyles and healthcare systems that were not witnessed before, and urgently require effective solutions. It is important to note that malnutrition, as complex as it is, can be prevented and treated in communities and healthcare settings.
Malnutrition is a complex and multifaceted subject that impacts various populations, regions and communities in a diverse array of ways. Malnutrition has many facets and elements, and it has been a challenge to put forward an exact definition to define this challenge in its entirety. Healthcare experts and researchers agree that malnutrition is a critical challenge across the world in the 21st century. In many cases, people tend to confuse between starvation and malnourishment. It is crucial to understand that malnutrition is not entirely a challenge that stems from severe poverty, and it is certainly not limited to the young. In fact, malnutrition impacts people of all ages and from all communities across the globe.
Many healthcare experts and researchers tend to overlook the four most significant sides of malnutrition. Firstly, the lack of adequate nutrition in the diets of the elderly, which has emerged as a significant challenge across Asian countries and other developing regions of the world. Recently obtained evidence reveals an alarming awareness gaps amongst healthcare experts and the wider community in understanding the severity and consequences of malnutrition amongst the elderly and senior citizens. In majority of the cases, senior citizens in hospitals are not adequately examined for malnutrition during their stay or upon their admission, which causes severe complications in their treatment, thereby, prolonging their stay in the hospital.
Disease-associated malnutrition (DAM) is another widely burgeoning issue and a formidable challenge, which places immense economic burden on countries and their economies. Many chronic health ailments and conditions amongst aging populations can trigger the symptoms of disease-associated malnutrition. It is interesting to note that the impacts of disease-associated malnutrition are felt across all countries, developing and underdeveloped. China is increasingly combatting against the challenges of disease-associated malnutrition as its aging population is rapidly rising, incurring a burden of billions of dollars on the Chinese economy each year.
Overnutrition or obesity is another concealed and underrated aspect of malnutrition, and it is widely increasing across developed countries. It is important to note that adequate nutrition is a harmonious balance between the consumption and absorption of macro and micronutrients. Overnutrition or obesity can also give birth to nutritional insufficiencies and lack of essential nutrients, which in turn give birth to adverse health complications and chronic ailments, such as cancer, diabetes, heart diseases, cardiovascular complications and others. Lastly, maternal malnutrition is another underrecognized issue of malnutrition that leads to lifelong nutritional complications, which is formally referred to as fetal programming. (SCIENCE, 2014, p.3-4)
Research Aim
This research papers aim to launch an inquiry into the challenges posed by malnutrition in the 21st century. The paper will attempt to understand the definition of malnutrition and its many facets. This paper will attempt to understand the gravity of the impact and consequences of malnutrition across developed and developing countries in the world. The, causes and statistics of malnutrition from across various regions and countries will be examined in order to understand the gravity of the challenge posed by lack of adequate nutrition.
This will prove instrumental in understanding the causes and multifaceted dynamics that contribute to the rise in malnutrition. This paper will attempt to identify the challenges malnutrition creates for healthcare systems, and communities across the world.
Malnutrition in Developed & Developing Countries
Clinical practitioners and researchers have coined various definitions to understand the effects of malnutrition. According to the World Health Organization International Classification of Diseases 10 (ICD-10), malnutrition is defined by reductions in body mass index or unintentional weight loss, which evidence of reduced nutritional consumption leading to muscle wasting or fat loss. The American Society of Parenteral and Enteral Nutrition defines malnutrition in light of an imbalanced nutrition intake and based on starvation, and in relation to acute conditions and chronic diseases. The European Society for Parental and Enteral Nutrition takes into account both lack of sufficient nutrition and overnutrition while defining the symptoms and scope of malnutrition. (White et al., 2012, p. 275)
Malnutrition incorporates a wide array of diseases that include complex patho-physiological conditions, which poses a formidable challenge for public health infrastructure. This challenge is complex and multifaceted for both, developed and developing countries. For instance, a country with a population as large as China, the consequences of malnutrition prove immensely burdensome for the healthcare sector, society, communities and households. As the aging population continues to grow, the challenges of malnutrition continue to rise. For instance, in China, over 178 million people are above the age of 60, and this figure is expected to rise to 20% by 2050. There is also an increase in the number of elderly patients in admitted to hospitals in China, and malnutrition amongst the elderly and senior citizens leads to prolonged hospitalizations, reduced mortality and ineffective surgical outcomes. (Chen et al., 2014, p.6)
Lifestyles in the 21st century are characterized by widespread challenges of starvation, hunger and malnutrition. In recent years, researchers have witnessed the old-age trend or reduced hunger and the reemergence of famine. Evidence reveals that the most significant response to eradicate malnutrition, starvation and hunger is to ensure an adequate and nutritious food supply. It is important to understand that malnutrition exists in all forms and facets and is not limited to hunger or starvation. In fact, majority of the cases of malnutrition exist in the form of micronutrient deficiencies, overnutrition and obesity, which have emerged as formidable challenges in developed and developing countries. In order to effectively combat malnutrition, it is important to grasp a clear understanding of the factors and processes that impact diets across the world.
Malnutrition includes extreme hunger, lack of adequate nutrition, starvation and obesity. More importantly, malnutrition is prevalent across all countries and regions across the globe, regardless of their healthcare and economic development, and the major cause behind malnutrition is poor quality diets. Therefore, all solutions devised to eliminate malnutrition and hunger need to be focused on ensuring an adequate supply of nutritious and high-quality diets. Malnutrition is a significant contributor to the global burden of disease, and poor quality and under nourishing diets are widely associated with the risk factors of acute conditions and chronic diseases. Poor quality diets lack essential nutrients, micronutrients, minerals, vitamins, and fiber and contain an access off saturated fats, sugar, salt, and calories. In 2010, lack of physical activity and dietary risk factors made up 10% of the global burden of diseases, accounting for early deaths, chronic ailments and disabilities. (Lim et al., 2012, p.380)
In 2015, malnutrition and dietary risk factors accounted for six of the top 11 global health risk factors, including high cholesterol and obesity. (GBD 2015 Risk Factors Collaborators, 2015, p.1672)
Table 1. Source: Web et al., 2018, p.2.
It is important to understand that malnutrition is a broader term that takes into account multiple health and nutrition impacts in various forms and ways. As seen in the table above, the period between 1990-2002 witnessed an 18.6& reduced in the proportion of individuals classified as hungry throughout the world. In 2014-2016, this proportion was further decreased by 11%. As the population of the world increased by 2 billion, there was a reduction of hunger amongst 211 million. Many developed and developing nations, including Ethiopia, China, Bangladesh, and Brazil made significant improvements in fighting malnutrition arising from hunger and starvation. South America made significant gains in decreasing the trends of malnourishment, and in 25 years, it achieved a 25% reduction in undernourishment. These improvements were brought about by the rapid efforts to promote literacy, eradicate poverty, and bring about healthcare innovations. (Web et al., 2018, p.2-3)
Malnutrition continues to postoperative morbidity and prolongs hospitalization, creating a burden for the healthcare system. In developed countries with higher aging populations, such as China, malnutrition is widely witnessed across elderly patients and senior citizens. Research reveals that in China, around 60% of the hospitalized patients also suffer from malnutrition. This reveals that patients who are admitted to hospitals are not screened for malnutrition, which leads to an obvious absence of adequate diagnosis.
As seen in Table 2, around 50% of the hospitalized elderly patients, which amount to 17 million, suffer from malnutrition on a yearly basis. This indicates that malnutrition is one of the foremost challenges and burden on public healthcare, and it demands a dynamic and multifaceted response from healthcare providers, scientists and medical researchers. (Sun, 2011, p.24-27)
Table 2. Source: Sun, 2011, p.24-27
Consequences & Burdens of Malnutrition
Figure 1: Phillipson et al., 2014, p.18-19
A survey conducted by the Food and Agriculture Organization of the United Nations reveals that in 2009, 1.02 billion people across the world were undernourished. This makes up one in every six individuals. As seen in figure 1, malnutrition places a heavy burden on countries across the world, developing and developed alike. Malnutrition leads to the development of deteriorating health conditions, which not only impact individuals and societies, but also leave a burdensome impact on the healthcare system and economy.
Malnutrition has a deteriorating impact on every system and organ within the body, which gives birth to the complications arising from stunted growth, lack of muscular strength and endurance, inadequate gut functioning, and impaired cognition throughout an individual’s lifespan, alongside undermining the functioning of the immune system. In developing nations, malnutrition is encouraged from various factors, including poverty and lack of sufficient food consumption. However, in developed nations, malnutrition is widely associated with chronic ailments, and noncommunicable ailments. Therefore, malnutrition creates a heavy burden for the economy, healthcare system, mortality and morbidity. (Phillipson et al., 2014, p.18-19)
In developing countries, malnutrition has given a rise to the development of bloating-related chronic ailments and body ulcers, triggered by protein deficiencies, and muscle wasting that stems from lack of sufficient energy consumption amongst men, women and children. Protein deficiencies and lack of energizing nutrients are the two most instrumental markers of malnutrition. It is important to understand that nutritional health relies upon a delicate balance of micronutrients and macronutrients. Unfortunately, there is no clinical test or diagnosis spectrum to identify and diagnose malnutrition. The Academy of Nutrition and Dietetics advocates that the definition of malnutrition encompasses all and any imbalance of essential nutrients, whether it is a lack of essential nutrients, or lack of sufficient calories to energize the body adequately. (White et al., 2012, p.276)
A recent report, published by the United Nations Food and Agriculture Organization, reveals that in 2014, more than 790 million people, which amount to 15% of the population in developing nations, suffer from an insufficient supply of food in order to address their bodily energy requirements. Across developed countries, around 15 million people suffer from an insufficient supply of food to adequately address their energy requirements. It is important to understand that hunger is just one dimension of the broader issue of malnutrition. It also encompasses the challenges of not obtaining sufficient calories, and the underlying micro and macronutrient density of these calories.
Therefore, a malnourished individual can be extremely obese or overweight, or thin and skinny, as seen in the pictures of starving children in third-world countries. Across western countries and emerging developing nations, obesity and overnutrition are major indicators of malnourishment. Nutrition insecurity is a rising global challenge that is undermining the success of the healthcare system worldwide, creating a severe economic burden for developing and developed nations. The definition of malnutrition encompasses both, the impact of excessively less calories to energize the body, and the impact of inadequate nutrients in the daily diets of people.
It is crucial to understand that fact that food insecurity is not the only obstacle that contributes to the development of malnutrition, in fact, nutrition insecurity is an equally formidable and burdensome challenge. In developed countries, there are instances of starvation, hunger and poverty giving birth to malnutrition, however, such instances are far greater across developing and third-world countries. However, nutrition insecurity, which refers to the lack of nutrient density in the calories we consume, is a challenge that contributes to malnutrition throughout the world.
For instance, in the American diet, there is a deficiency four essential nutrients: potassium, vitamin D, calcium and fiber. Similar nutrient deficiencies have also been observed in diets across Canada, and the European Union. The challenge stems from the inability of communities to access, buy and prepare nutrient-rich meals, and this inability poses severe short-term and long-term burdens for the global healthcare system, economy and society. Nutrition insecurities observed in fetuses, infants and children leads to developmental delays, academic and educational impairments and negative health impacts. As these children grow into adults, they face challenges in terms of productivity and earning a sustainable income to uphold living standards.
Adults who are suffering from nutrition insecurity experience heightened risk factors of suffering from acute diseases and chronic health conditions. This leads to an overall reduction in productivity, increases in absenteeism and thereby, it makes them less successful in their professions and jobs. Nutrition insecurity amongst seniors and the elderly leads to a faster decline in their cognitive abilities, and a heightened risk of suffering from chronic ailments, which creates a heavy burden on the healthcare system. Malnutrition, food insecurity, and nutrition insecurity are developed by poverty, resistance towards agricultural biotechnology, and nutrition illiteracy.
A survey conducted by the Pew Research Global Attitudes Center in 2013 revealed that despite being the richest country in the world, people in the United States of America continue to face challenges in enjoying access to and having the purchasing power for consuming high-quality diets. While there has been a significant improvement in the quality of diets across the US since 1999, there is still a significant divide between people from higher and lower socio-economic classes. People from higher socioeconomic classes enjoy healthier, nutrient-rich diets, while households from lower socioeconomic classes face an ability to access and purchase nutritious food.
More importantly, dietary quality remains the lowest amongst individuals who have less than 12 years of education. Nutrition illiteracy is one of the driving forces behind malnutrition, and consumers are largely unaware of the measures they can take to make their everyday meals more nutritious and well-balanced. People across developing and developed countries are largely unaware of their nutrient deficiencies, and do not understand the guidelines of a healthy, well-balanced diet. The constantly changing and evolving information on nutrition makes it even more challenging, even for the educated and higher-income classes, to understand and grasp the measures they can take to enjoy well-balanced and healthy diets.
Resisting agricultural biotechnology is another contributor that gives rise to malnutrition across developed and wealthier nations. There have been countless innovations in the realm of science that have empowered the agricultural communities across the world with newer opportunities and developments to make great strides in addressing the global demand for food and eliminating nutrition security, alongside addressing the challenges of environmental sustainability. Agricultural biotechnology, livestock vaccines, and genetically modified organisms have the potential to boost crop yields and productivity by reducing crop damage and animal harm. However, many of these innovations are also engulfed with controversies.
There is a greater need for governments, healthcare systems and communities to address the challenge of malnutrition by adequately addressing the challenges of nutrition insecurity. There is a great need for academic and educational discourse on food safety and nutrition security, particularly across vulnerable communities and populations, infants, children and the elderly. There is also a greater need for global and regional feeding programs, free and discounted school nutrition schemes for children and teenagers from low socioeconomic backgrounds. Senior feeding schemes and food distribution programs can also help developed and developing nations combat malnutrition by eradicating food and nutrition insecurity. (Finn, 2014, p.8-9)
Conclusion
The impact of poverty on the spread and rise of malnutrition has been observed in every country, developing and developed nations alike, as it compromises the access to healthy and nutritious food items. However, poverty-induced malnutrition is particularly higher in low-income and third-world countries. Populations who are living in poverty-stricken circumstances are also increasingly vulnerable to economic downfalls and environmental shocks, political conflicts, floods and droughts. This increases their risk for starvation and lack of sufficient food supply. Chronic malnutrition creates a significant burden on societies, economies and countries.
The impact of poverty induced malnutrition are observed across the world, and they tend to exhibit more deteriorating impacts amongst women and children. A recently conducted study reveals that malnutrition contributes to 3.1 million child deaths annually.
More alarmingly, malnutrition increases the burden of morbidity, and overwhelms the healthcare system by increasing chronic childhood malnutrition, which leads to stunted growth, delayed educational development, intellectual impairments and other lifelong chronic ailments. Around one in every three children in developing nations are either underweight or stunted, while micronutrient deficiencies are common across 30% of their populations. Childhood malnutrition is also associated with reduced academic success, intellectual impairment and therefore, reduced economic productivity amongst adults. Over the lifespan of an individual, malnutrition undermines the life quality of individuals by reducing their educational attainment, productivity levels, and therefore their lifetime earnings. (Blössner et al., 2005, p.11-13)
Malnutrition across the developing regions and countries has deteriorating impacts on the healthcare system and economy, and these economic and health effects thereby increase poverty and the resulting malnutrition. There is a greater need for micronutrient supplementation and food security programs to address malnutrition across the developing world. Micronutrient supplementation presents an effective and widely researched approach towards combatting the effects of malnutrition. There is a great need to identify deficiencies and to deliver deficient nutrients, such as zinc, potassium, iron and folate adequately. These micronutrient supplementation programs must be delivered with screening approaches, alongside providing nutrition education through community and primary care center. These programs must place a greater emphasis on infants, children, and gestating and lactating women.
There is a greater prevalence of poverty-induced malnutrition in countries across Africa, South Asia and Central Asia, as these regions are home to countless low-income communities faced with food shortages and nutrient insecurity. As the economies across the world continue to develop, there is a reduction in malnutrition induced by poverty. For instance, in the case of China, there was an 82% reduction in underweight children between the period 1987 and 2010. This reduction in underweight children was experienced during a period of rapid economic development.
However, as compared to poverty-induced malnutrition, disease-associated malnutrition (DAM) is more common across industrialized and developed countries, where malnutrition stems from chronic ailments and acute illnesses. Disease-associated malnutrition stems from various causes, such as reduced consumption of nutrients due to loss of appetite or malabsorption of micro and macronutrients due to intestinal diseases, and the increased nutritional requirements of the body due to chronic ailments. The elderly and senior citizens are at a greater risk for suffering from disease-associated malnutrition, particularly those with chronic ailments, such as cancer, diabetes, and heart diseases. (Philipson et al., 2014, p.18-19)
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