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Malnutrition essentially comes in various forms, which include undernutrition, inadequate vitamins or minerals, and overweight to mention a few, however, most people only see malnutrition from the aspect of undernutrition. Notwithstanding research has shown that not only does malnutrition involve inadequate food supply, but also can be present in people with enough food supply but who lack the appropriate nutrients.
To begin it would be interesting to note that:
- It is estimated half of anaemia cases are due to iron deficiency. Almost half of children in low and middle income countries 47% of under fives are affected by anaemia, impairing cognitive and physical development Iron is a key component of micronutrient blends which are used in large-scale and targeted fortification programs;
- Iodine deficiency is the greatest single cause of mental retardation and brain damage. It can easily be prevented by adding iodine to salt. Between 1990 and 2009, the number of households consuming iodized salt rose from 20% to 70%. Coincidently, the number of countries in which iodine-deficiency disorders were considered a public health concern reduced by 43% between 1993 and 2007;
- Vitamin A deficiency causes early childhood blindness and increases the severity of infections and anaemia. It affects an estimated 190 million pre-school aged children, and 19 million pregnant and breastfeeding women globally. Vitamin A can be added to cooking oil as well as wheat and maize flour. It is also included in micronutrient powders;
- Zinc deficiency affects childrens health and physical growth; it is also essential for mothers during pregnancy. It is estimated to cause 4% of deaths in pre-school aged children in lower-income countries. Zinc supplementation improves growth in stunted children and can be included in wheat flour, maize flour, or rice.
Notwithstanding the facts listed above, the main causes of malnutrition are not recognized. Therefore it is necessary to have a glimpse through the foundation of malnutrition in the human body.
In the early 1950s, the understanding of the immunity of the body system was undeveloped. However malnutrition can be dated back to the dark ages, where animals were deprived of certain nutrients essential for their daily living, this seemed like a step towards the acquisition of knowledge, Unfortunately, the animal models represented, at best, only moderately faithful simulations of the human situation. This was because animals were fed a defined diet deficient in the specific nutrients of interest, with everything else in sufficient amounts, because the diet was provided by a defined schedule, because the animals were maintained on a strict cycle of light and dark, and because they were generally protected from external infectious diseases. In each of these features, the animal models differed totally from the human situation. From the perspective of human nutrition, it was considered that protein-energy malnutrition or protein-calorie malnutrition as it was called was attributable principally to dietary deficiency and therefore it could be prevented or treated by dietary measures alone. There was also little or no contact between immunologists or infectious diseases specialists who studied host susceptibility to infection and those interested in nutrition. Without a doubt, the best immunology of the day was not being applied to nutritional diseases which explains the limited conclusion made by the individuals in that time concerning the outcome of malnutrition in humans at that time.
The awareness of Malnutrition
In the 16th century, various discoveries were made which described the link between malnutrition and infections, unique reviews were made on the American Journal of medical sciences article by Taylor and Gordon in 1959. The authors made the case that malnutrition resulted in increased susceptibility to infection and that infection caused deterioration of nutritional status, ushering in a cycle of malnutrition-infection that would ultimately lead to kwashiorkor, which is a major symptom of malnutrition and, if untreated, to death. The interactions were described as generally synergistic, occasionally antagonistic. Synergistic interactions, the most common, were those in which the combined effects of malnutrition and infection were more profound than the sum of the individual effects of either one alone. Antagonistic interactions were occasionally documented in which the presence of malnutrition lessened the impact of an infectious disease. This article explains the malnutrition cycle, which leads to infection, more nutritional deterioration, and finally more infections. The article implies that improving nutritional intake with exposure to infection isnt necessarily the best way to reverse the cycle, rather more attention should be given to the infections in order to reduce death rates resulting from malnutrition. This was because infection itself caused a loss of critical body stores of protein, energy, minerals, and vitamins. The article explains common occurrences usually observed in children who were improving during the initial phase of nutritional treatment for acute kwashiorkor suddenly worsen when they developed an infection such as measles or bacterial pneumonia, often with a fatal termination, or to see children fail to respond to nutritional therapy until an in apparent ongoing infection, such as in the urinary tract, was detected and treated. Experiences such as these suggested that a dual attack on nutrition and infection was needed for an optimal response.
The finding recorded in the article made a significant impact on the study of malnutrition, which served as a stepping stone for research in the later years, such as that of William Beisel, who first suggested a role for leukocyte-derived mediators in initiating the catabolic changes and loss of nutrient stores characteristic of the infected host. These studies employed partially purified mixtures of the growth medium in which leukocytes were incubated and stimulated.As well as discoveries made within a ten-year period in the 20th century. The endogenous pyrogen derived from activated leukocytes and responsible for the febrile response during infection was cleansed, sequenced and the gene identified. With this information, this protein was renamed interleukin the first of a number of peptide mediators with different functions found to be clearly characterized. Identification of other interleukins soon followed, including tumor necrosis factor-alpha. These critical mediators of cell function and host response are now known as cytokines. When it was appreciated that many of these same cytokines were involved in the activation of the immune response, it became clear that the immune and metabolic responses to infection were intimately entwined, with common pathways of activation and regulation, suggesting that both responses had survival value and that attempts to manipulate the metabolic response to diminishing the deterioration of nutritional status during infection might have potential downsides. These discoveries began to draw the attention of immunologists to study the effects of nutrition on immune function, and the beginning of greater collaborations between experts in different fields, especially in nutrition and immunology. There was an increase in the number of studies conducted in humans during this period, as the approach towards malnutrition continued to improve and new methods to obtain relevant cell types from human blood and other tissues were developed. Some of this was ascribed to the full realization that malnutrition of a degree sufficient to impair immune function was not just confined to children in developing countries without access to nutritionally complete diets, but occurred in up to half of the adult patients hospitalized on medical or surgical services around the world.
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