World malnutrition

Sommer, A. 1987. Blinding Malnutrition. World Health. May Issne. pp. 20-24. 

An inadequate intake in the diet of those food chemicals that are essential nutrients results in health risks. Indeed these risks are by far the most important in terms of the world s population where malnutrition is a major public health problem. But, unlike the toxic chemicals, they would show a very different dose-response if they were subject to similar animal bioassays. At very low doses there would be a high risk of disease that would decrease as the dose was increased, the curve would then plateau until exposure was at such a level that toxicity could occur. Figure 11.2 shows this relationship which is U- or J-shaped rather than the essentially linear dose-response that is assumed for chemicals that are only toxic. The plateau region reflects what is commonly regarded as the homeostatic region where the cell is able to maintain its function and any excess nutrient is excreted, or mechanisms are induced that are completely reversible. 

It is generally accepted that malnutrition decreases the effectiveness of the immune system so that it increases the incidence of infections. Thus famine and infections are always considered together since it is assumed that the former exacerbate the latter. The influenza pandemic in 1918-19 in Europe led to the deaths of more than 20 million people. Poor nutrition caused by the First World War may well have impaired the immune system in many people, thus contributing to the large number of deaths. This topic is discussed in Chapter 18. 

Children dying from malnutrition have been first noted in 1937 to have had a profound depletion of the thymus gland (V2). This has now been confirmed in several parts of the world (T6, W5). 

The effectiveness of various therapeutical modalities of supplemental vitamin A has been examined in numerous studies using tablets or capsules. On the basis of these studies, increased consumption of dietary vitamin A has been advocated (World Health Organization, 1984,1992). In India and Indonesia, the provision of extra vitamin A resulted in considerable reduction of mortality (ca. 40%) in preschool children (Bhandari et al 1994 Humphrey et al, 1996). While the efficacy of excessive oral doses over more than 8-12 weeks has been questioned, it is evident that an insufficient, low dose given once per week is apparently of little effect on morbidity or mortality (Ramakrishnan et al, 1995a,b). Indeed, recurrent diarrheal episodes or the existence of malnutrition may explain the poor efficacy seen with oral supplementation with low doses (Ramakrishnan et al., 1995a). 

World Health Organization (1992). National strategies for overcoming micronutrient malnutrition. WHO 45th World Health Assembly, provisional agenda item 21.A45/17. 

Vitamin A deficiency can result from insufficient dietary intake, from malabsorption and it has been recognized that also malfunction of RAR-receptors can lead to symptoms of vitamin A deficiency. These symptoms include skin lesions, night blindness, corneal ulcerations and conjunctivitis and poor bone remodeling. Vitamin A deficiency associated with malnutrition is wide spread in large parts of the world and may be fatal in infants and young children suffering from kwashiorkor or marasmus. 

As pointed out by Anderson et al. (15), starvation, malnutrition, and protein deficiency may all cause differences in drug disposition and thereby differences of drug action. Even relatively minor food deficiencies as observed in Berlin after the second World War (16) caused some unusual reactions, e.g., death from injection of the old and generally safe local anesthetic drug procaine (17). 

WHO estimates that over 30% of the global burden of disease can be attributed to environmental factors and that 40% of this burden falls on children under five years of age, who account for only 10% of the world s population (WHO, 2004a). At least three million children under five years of age die annually due to environment-related illnesses. Environmental risk factors act in concert and are exacerbated by adverse social and economic conditions, particularly poverty and malnutrition. 

World Health Organization Management of Severe Malnutrition A Manual for Physicians and Senior Health Workers. WHO, Geneva, Switzerland, 1999. 

Wc cannot maintain our present high density of population in the developed world, nor deal with malnutrition in the developing world unless we preserve our food supply from attacks by insects and fungi and from competition by weeds. The world market for agrochemicals is over 10 000 000 000 per annum divided roughly equally between herbicides, fungicides, and insecticides,... 

People in many regions of the world suffer from protein-calorie malnutrition. If the world population continues to expand toward seven billion by the 21st century the need for more protein will become accentuated. As real demand for protein increases with a burgeoning population and as the emphasis changes from conventional agriculture (because of limitations of land and energy) to more direct consumption of plant and microbial proteins the necessity for new processes and new products will increase. 

In many cases it is impossible even to connect one study with another since the researcher is faced with a myriad of techniques used for measuring protein functionality. It is of great importance to gain an understanding of the relationship between structure and functionality so that the latter can be correctly predicted, manipulated and controlled, if only to insure better utilization of protein in a world where population and malnutrition are growing daily. 

There is also a big gap between real and perceived risk. In Europe and the United States the public is mainly concerned about residues and food safety. With proper precautions, however, this is not a real problem, as residues in food are low and do not contribute significantly to our total intake of chemicals. Actually, there are no cases confirmed in which residues of modem pesticides in food were the cause of poisoning of humans. As there is a large overproduction of agricultural commodities in western countries, people worry about minor risks, like pesticide residues, as they do not have to worry about supply of food in principle. The picture is strikingly different in other parts of the world, where food production does not match the growth of the population and where malnutrition and famine are well known. 

Kwashiorkor. The most common form of malnutrition in children in the world, kwashiorkor is caused by a diet having ample calories but little protein. The high levels of carbohydrate result in high levels of insulin. What is the effect of high levels of insulin on... 

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