1/5/2021 7:28 AM MALNUTRITION Malnutrition status in Pakistan Assigned by: Dr Rubina Gull Abstract On 1 April 2016, the United Nations General Assembly adopted a resolution proclaiming a United Nations Decade of Action on Nutrition from 2016 to 2025. This Decade of Action aims to trigger intensified action to end hunger and eradicate all forms of malnutrition worldwide, and ensure universal access to healthier and more sustainable diets for all people, whoever they are and wherever they live, as the double burden of malnutrition now facing many countries worldwide characterized by the coexistence of undernutrition along with overweight, obesity or diet-related noncommunicable diseases (NCDs) Tauqeer Haya Tauqeerhaya8@gmail.com 1|Page 1. Epidemiology of malnutrition: Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization. Malnutrition consists of both undernutrition and overweight and obesity, as well as diet-related noncommunicable diseases. Undernutrition manifests in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies. Wasting is defined as low weight-for-height. It often indicates recent and severe weight loss, although it can also persist for a long time. Stunting is defined as low height-for-age. It is the result of chronic or recurrent undernutrition, usually associated with poverty, poor maternal health and nutrition, frequent illness and/or inappropriate feeding and care in early life. Underweight is defined as low weight-for-age. A child who is underweight may be stunted, wasted or both. Micronutrient deficiencies are a lack of vitamins and minerals that are essential for body functions such as producing enzymes, hormones and other substances needed for growth and development. Malnutrition is a pathological condition resulting from deficiency of one or more nutrients and has a wide range of clinical manifestations. 2|Page 2. The situation in Pakistan: Pakistan is on course to meet the global targets for under-five overweight and infant exclusive breastfeeding but is of course to meet the targets for all other indicators analyzed with adequate data. There is insufficient target data to assess Pakistan’s progress for low birth weight. According to UNICEF, nearly 10 million Pakistani children suffer from stunting. ▪ ▪ ▪ Only38% of children are exclusively breastfed for the first six months of life. As a result, more than half the children under five years of age are deficient in vitamin A. 40 %are deficient in both zinc and vitamin D, and nearly 62 % are anemic. 8 out of 10children in Pakistan do not eat the right type and quantity of food. As of 2018, the national prevalence of under-five overweight is 2.5%, which has decreased slightly from 4.8% in 2013. The national prevalence of under-five stunting is 37.6%, which is greater than the developing country average of 25%. Conversely, Pakistan’s under-five wasting prevalence of 7.1% is less than the developing country average of 8.9%. ▪ ▪ ▪ In Pakistan, 5%of infants under 6 months are exclusively breastfed, this is well below the Southern Asia average of 54.2%. There is insufficient data on low birth weight. Pakistan’s adult population also faces a malnutrition burden. 1%of women of reproductive age have anemia, and 12.6% of adult men have diabetes, compared to 12.1% of women. Meanwhile, 11.3% of women and 6% of men have obesity. 3|Page 3. Causes of malnutrition: Primery cause: Inadiquate feeding practices • • Food insecurity maternal undernutrition Secondary cause: Recurrunt infections. • • • • • • • Repeated infections Chronic diseases Genetic causes Cieliec diseases Diabeties melites Metabolic disorder Inadequate health services and lack of awareness about feeding and healthcare practices 4|Page 5|Page 6|Page 4. Nutrition transition: It is the shift in dietary consumption and energy expenditure that coincides with economic, demographic, and epidemiological changes. Specifically the term is used for the transition of developing countries from traditional diets high in cereal and fiber to more Western pattern diets high in sugars, fat, and animal-source food. Human diet, activity patterns, and nutritional status have undergone a sequence of major shifts, defined as broad patterns of food use and their corresponding nutrition-related diseases. Obesity emerges early in these shifts, as does the age and level of morbidity and mortality. We can think of five broad nutrition patterns. a. Pattern 1: Collecting Food: This diet, which characterizes hunter-gatherer populations, is high in carbohydrates and fiber and low in fat, especially saturated fat. The proportion of polyunsaturated fat in meat from wild animals is significantly higher than that from modern domesticated animals. Activity patterns are very high and obesity among societies is rare. b. Pattern 2: Famine: Variety of food becomes much less diverse, changes in diet varies across cultures and periods of acute scarcity. Dietary changes are hypothesized to be associated with nutritional stress and a reduction in stature. The pattern of famine has varied over time and space. Some civilizations are more successful than others in alleviating famine and chronic hunger. Physical activities change but there is little change in activity levels during this period. c. Pattern 3: Receding Famine: The consumption of fruits, vegetables, and animal protein increases, and starchy staples become less important in the diet. Many earlier civilizations made great progress in reducing chronic hunger and famine, but only in the last third of the last millennium have these changes become widespread, leading to marked shifts in diet. However, famines continued well into the 7|Page 18th century in portions of Europe, and today they remain common in some regions of the world. Activity patterns start to shift and inactivity and leisure become part of the lives of more people. d. Pattern 4: Nutrition-Related Noncommunicable Disease: In most high-income societies a diet high in total fat, cholesterol, sugar, and other refined carbohydrates and low in polyunsaturated fatty acids and fiber is often accompanied by an increasingly sedentary life. The result is an increased prevalence of obesity that leads to the degenerative diseases. e. Pattern 5: Behavioral Change: A new dietary pattern appears to be emerging as a result of changes in diet, evidently associated with the desire to prevent or delay degenerative diseases and prolong health. These changes, which are instituted in some countries by consumers and in others by government policy, may be found to constitute a large-scale transition in dietary structure and body composition. 8|Page 5. Double burden of malnutrition The double burden of malnutrition is characterized by the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases, within individuals, households and populations, and across the life course. 9|Page 6. THE DRIVERS AND DETERMINANTS OF THE DOUBLE BURDEN OF MALNUTRITION: The causes of the double burden of malnutrition relate to a sequence of epidemiological changes known as the a. nutrition transition b. the epidemiological transition c. the demographic transition. a. The nutrition transition: It describes the shift in dietary patterns, consumption and energy expenditure associated with economic development over time, often in the context of globalization and urbanization. This change is associated with a shift from a predominance of undernutrition in populations to higher rates of overweight, obesity and non-communicable diseases NCDs. b. The epidemiological transition: It describes the changes in overall population disease burden associated with the increase in economic prosperity – with a shift from a predominance of infection and diseases related to undernutrition to rising rates of NCDs. c. the demographic transition It describes the shift in population structure and lengthening lifespans. This sees a transformation from populations with high birth rates and death rates (related to the above transitions), with relatively high proportions of younger people, to populations with increasing proportions of older people (with age also being a risk factor for many NCDs). 10 | P a g e 7. AN INTEGRATED RESPONSE DOUBLE DUTY ACTIONS: The double burden of malnutrition can be seen as a dual nutrition challenge, or an opportunity for double returns. Programmes and policies that aim to address this nutrition burden through double-duty or “win–win”, common, evidence-based actions are likely to be both efficacious and cost-effective. Double-duty actions include interventions, programmes and policies that have the potential to simultaneously reduce the risk or burden of both undernutrition (including wasting, stunting and micronutrient deficiency or insufficiency) and overweight, obesity or diet-related NCDs (including type 2 diabetes, cardiovascular disease and some cancers). Some examples may include policies to ensure access to optimal maternal and antenatal nutrition and care; the protection, promotion and supporting of breastfeeding, including exclusive breastfeeding during the first 6 months, and appropriate complementary feeding in the first 2 years of life; programmes that foster healthy diets in preschools, schools, public institutions and workplaces; measures and policies that improve food security and ensure access to healthy foods by all individuals and families; and initiatives that ensure access to healthy and sustainable diets from appropriate and resilient food systems. 8. References: https://apps.who.int/iris/bitstream/handle/10665/255413/WHO-NMH-NHD-17.3-eng.pdf?ua=1 https://jpma.org.pk/article-details/3324 https://globalnutritionreport.org/resources/nutrition-profiles/asia/southern-asia/pakistan/ https://www.who.int/news-room/fact-sheets/detail/malnutrition 11 | P a g e
