Hunger and Nutrition Facts
What is the relationship between hunger and nutrition?
This seems an obvious question — if one doesn’t eat enough food to fill current physiological needs — they feel hunger. Hunger can be temporary, such as not having enough to eat for a meal or a day, or can be long lasting when the person does not get enough to eat to maintain his or her physical needs over many days, weeks, months or years. When a person has hunger for a sustained period of time, he or she can develop malnutrition, either mild or severe, depending on one’s body needs and food intake.
Consequences of malnutrition
Malnutrition is defined as any disorder of nutrition. It may result from an unbalanced, insufficient or excessive diet or from impaired absorption, assimilation or use of foods. Overnutrition, a condition of excess nutrient and energy intake over time, may be regarded as a form of malnutrition when it leads to morbid obesity. Undernutrition is a condition of malnutrition caused by an inadequate food supply or an inability to use the nutrients in food. Undernutrition and its consequences is the focus of this article. (Definitions from Mosby Medical Dictionary 2009)
The term ‘Chronic malnutrition’ refers to lower intake of nutrients than the body needs over a long period of time. This type of undernutrition can cause young children to be
- stunted in height,
- delayed in developmental capacities such as brain function, and
- more prone to disease.
Additionally, undernutrition can cause:
- swollen and bleeding gums,
- diaainess and fatigue,
- decaying teeth, among other symptoms.
It is not as visible as severe malnutrition, hence receives less media attention than famines or outright starvation, for instance, nevertheless it is a much larger and chronic problem. Severe malnutrition, particularly in young children and infants, can lead to death.
Extent of the Problem
Hunger is the world’s number one health risk, greater than HIV and AIDS, tuberculosis and malaria combined (World Food Programme 2012). Statistics from the 2014 State of Food Insecurity in the World from the Food and Agriculture Organization (FAO) estimate that 805 million people in the world are chronically malnourished, down more than 200 million over the last decade, indicating progress.
Undernutrition can begin in the womb. If undernutrition carries on in the first 1,000 days of a child’s life it can also lead to stunted growth, which is irreversible at that point and associated with impaired cognitive ability and reduced performance in school and later in life at work. Undernourished children that are chronically malnourished are more likely to become short adults that birth smaller infants who have lower educational achievement and economic status in adulthood (Lancet 2008). This cycle carries on from mother to child when chronic undernutrition continues generation to generation. Stunting and its effects typically become permanent because reversal usually means changing the basic and underlying causes of malnutrition.
Who is most at risk for undernutrition?
The most vulnerable are:
- children under five, pregnant and lactating women, and the elderly and disabled;
- poor people;
- people who live in developing countries in Asia and the Pacific;
- people in Africa.
The World Health Organization (WHO) estimates that 98 million children under five years of age are underweight, or about one in every six children. Most underweight children live in Southern Asia (WHO 2013).
Vitamins and minerals (micronutrients)
If a specific essential nutrient is not consumed in adequate quantities, a nutritional deficiency can develop, such as the most common form of nutritional deficiency from lack of iron that may result in anemia. This kind of malnutrition does not cause obvious hunger per se, yet the body silently ‘hungers’ for the right nutrients. Vitamin A deficiency, which impacts eyesight among other physiological effects, is a common deficiency. WHO estimates that as many as 2 billion people worldwide, or about 30% of the world’s population, are not getting enough nutrients such as vitamin A, iron, or zinc in their diets. For a more detailed discussion of micronutrients, see the 2015 World Hunger and Poverty Facts and Statistics.
UNICEF’s model of malnutrition
To understand how hunger and malnutrition relate to each other, UNICEF developed a widely recognized model of the underlying causes of malnutrition (Figure 1). Hunger is a result of the immediate causes of malnutrition.
The ultimate manifestation of poor nutrition is malnutrition, due to basic, underlying and immediate factors that contribute to this condition.
The immediate cause of undernutrition is a result of a lack of dietary intake, or disease. This can be caused by consuming too few nutrients or to an infection, which can increase requirements and prevent the body from absorbing those nutrients consumed.
At this level, infection and malnutrition are actually a vicious cycle where inadequate diet can cause weight loss and growth faltering as well as lowered immunity. This in turn can lead to increase incidence, severity and duration of disease. Disease, in turn leads to loss of appetite, mal-absorption of nutrients and an increased need for nutritional requirements, leading back to an inadequate diet. The primary diseases that contribute to this cycle in the developing word are diarrhea, acute respiratory infections, measles and malaria. Both treating the disease and efforts to improve their nutritional status can break the cycle.
At the next level are the underlying causes of malnutrition. Whether or not an individual gets enough food to eat or whether s/he is at risk of infection is mainly the result of factors operating at the household and community level.
Within the UNICEF framework described these are classified as underlying causes. They can be grouped into three broad categories:
–household food insecurity
–unhealthy household environment and lack of health services.
Household food insecurity can be defined as the household having access to foods that are needed to sustain life; or the inability to obtain enough affordable food for the nutritional needs of the family and for the intake of food with the right balance of protein, fat and carbohydrates. Inadequate care includes practices such as inadequate breast-feeding or poor dietary intake. Sometimes cultural taboos play a negative role in food security, such as withholding nutrition foods during pregnancy or illness. Lastly, lack of public health services, poor sanitation and access to clean water can contribute to food insecurity.
The basic causes of malnutrition arise from a variety of complex social, economic and political factors. These factors can defeat household food security: for instance, social and food safety nets are not available for families who may suffer economic hardships; or women and girls are not protected by countries’ laws and customs; and governments’ political and ideological practices may impact income and resource distribution.
Poverty is one of the underlying causes. If a family doesn’t earn enough income through consistent and sufficient work to buy food and other needs for a family, that resulting poverty can lead to inadequate food security, and inability to access health care services.
The basic causes of malnutrition are very difficult and expensive to address, often requiring changes in government programming, protection of vulnerable ethnic groups, and the building up of health, water and sanitary infrastructures, among other infrastructures such as roads, that allow people easier access to the services and foods they need. Until these are adequately addressed, malnutrition will remain the large-scale problem that it is.
There are promising signs of progress. Since the early 1990s, 11 of the 63 developing countries had reached the undernourishment levels of below 5% and demonstrate that meeting the Millennium Development Goal’s target of halving the proportion of undernourished people by 2015 is within reach. (FAO State of Food Insecurity 2014). Despite overall progress, there has been only modest improvements in reducing the food insecure in parts of the world plagued by natural disasters and conflict, particularly sub-Saharan Africa and Western Asia.
True today as when the Presidential Commission on World Hunger was established: “ he eventual alleviation of world hunger will require many long-range programs of hard work which officer no promises of quick and dramatic results”
Bibliography and Resources
Food and Agriculture Organization. State of Food Insecurity 2014
Food and Agriculture Organization– http://www.fao.org/3/a-i4030e.pdf
The Lancet. http://www.indianpediatrics.net/apr2008/298.pdf
Mosby’s Medical Dictionary 2009
Report of the Presidential Commission on World Hunger (early 1980’s). Washington, DC
UNICEF Nutrition Training Module http://www.unicef.org/nutrition/training/
World Food Program 2013 Hunger Stats
World Health Organization 2015 http://www.who.int/gho/mdg/poverty_hunger/underweight_text/en/
World Health Organization 2011 http://www.who.int/gho/mdg/poverty_hunger/underweight_text/en/
World Health Organization 2012. Micronutrient Deficiencies
World Health Organization 2013. Obesity and Overweight Fact Sheet http://www.who.int/mediacentre/factsheets/fs311/en/
World Food Program. 2012. Two minutes to learn about school meals
World Health Organization. 2011. Global Health Observatory. Underweight in Children