Malnutrition – Deficiency
11 min read
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Lack and abundance – differentiated
Malnutrition in the first years of life has immediate health disadvantages
and impairs health and performance in the long term. Children
born too small and those who are malnourished at a young age a
re more susceptible to disease and have a higher risk of dying
prematurely.
Poor growth is associated with various physical and cognitive consequences and affects over 150 million children worldwide. More than 50 million children are atrophied, half of them live in South Asia. But 5.4 million of the 38.3 million overweight or obese children in the world also live there. There is growing evidence that being overweight at an early age is associated with the risk of noncommunicable, e.g. cardiovascular, diseases later in life.
Although the worldwide prevalence of growth retardation decreased from 32.6 % in 2000 to 22.2 % in 2017, this reduction varies considerably from region to region (Asia: 38.1–23.2 %; Africa: 38.3–30.3 %; Latin America: 15.9–9.6 %). In a few countries, such as Nepal (57.1-36.0%) and Lesotho (52.7–33.4%), dramatic progress has been made.
Similarly, the prevalence of childhood obesity varies widely by region, as does the prevalence of childhood obesity worldwide, which increased between 2000 and 2017. Here, the largest increases have been in Eastern Europe and Central Asia (8.2–14.8%). Only West and Central Africa recorded a decrease from 4.3% to 3.0%. If these trends continue, 70 million children will be overweight or obese by 2025. These global, national and regional statistics are crucial for tracking progress and informing policy and programme priorities.
However, the implementation of specific measures should be based on detailed data to better understand which population groups are most affected and the underlying causes. Analyses from India, India and Vietnam, for example, suggest that the determinants of growth inhibition vary across the geography of the countries. In India, for example, the prevalence of growth inhibition, broken down by district, is between 12.4% and 65.1%.
This variability should not be surprising, as all forms of early life malnutrition have a complex aetiology.
Taking India as an example, the variety of factors includes geography (higher in the north and in the middle), level factors (wealth, household size), maternal factors (care during pregnancy, BMI, age of marriage, education), and filial factors (adequacy of nutrition). These factors explain 71 % of the variance in the prevalence of malnutrition, but 29% remain unexplained.
For decades, anaemia was considered the only indicator of malnutrition worldwide. But anaemia also has a complex aetiology and numerous nonnutritional causes. Unfortunately, such causes are rarely recorded on a larger scale. However, this would be necessary for targeted measures to achieve improvements for all forms of malnutrition.
Neufeld LM et al., 93rd Nestlé Nutrition Institute Workshop, Kalkutta, 2019
Malnutrition in the intensive care unit
Adequate food intake is essential during the stay in the paediatric intensive care unit. It was investigated whether the achievement of energy intake targets on day 4 after ingestion and the form of food intake were associated with an improved outcome.
Inadequate nutrition leads to energy and protein deficits, which result in insufficient weight and growth. In addition, malnutrition is associated with increased morbidity and mortality in seriously ill children. The prevalence of acute malnutrition, defined as weight-for-age < -2 SD, affects almost a quarter of all patients in the paediatric intensive care unit (PICU) and has hardly improved in recent decades.
Nutrition and outcome in 325 patients at the PICU, enteral and/or parenteral nutrition was included. The goal of energy intake the day after admission was 90–110% of the energy requirement at rest.
An observational study with prospectively obtained data reviewed acute malnutrition was defined as weight-for-age <-2 SD. The duration of stay, the days on the ventilator, the duration of antibiotic administration and the number of new infections were recorded.
Of the subjects (age 0.14 (0.0–18.0 years), 19% were acutely malnourished at admission.
In the median, 86% of the energy targets were administered enteral. With enteral energy delivery, 7% of patients were fed within the target frame, 50% below and 43% above the target frame. Acute malnutrition was observed very frequently at admission and discharge. In a subgroup (n=223) the acute malnutrition rate at discharge (26%) did not differ significantly from that at admission (22%).
However, there was no correlation between the amount of energy intake or the type of food intake and the clinical outcome.
de Betue CTI et al., Clinical Nutrition 2015
Iron supplementation in the first years of life
The first 1,000 days in a child‘s life are crucial for the developing brain. During this
time, iron deficiency has far-reaching consequences, especially affecting cognitive development.
There is therefore great interest in preventing or treating anaemia in pregnancy and during the first 2 years of life. However, there is a lack of meaningful data from high-quality randomised studies investigating the effects of various iron interventions during pregnancy, infancy and early childhood on cognitive development. Despite decades
of research, there is a lack of conclusive evidence for the optimal strategy for treating iron deficiency in infants and children. The varying results from different studies may be due to variations in dosage, duration and timing of iron treatment and basic characteristics of the study population.
While there is clear evidence of the benefits of iron supplementation in cognitive performance in children who are anaemic, at school age. Studies in pre-school children have shown mixed results for visual, cognitive and psychomotor development.
The evidence for basic iron supplementation in children under 2 years of age remains
unclear. Some studies show small benefits, while others show no differences compared to placebo.
Caution should also be exercised when exceeding the recommended doses. This is because some studies report negative effects of high iron accumulation.
Larson LM et al., Ann Nutr Metab 2017
Iron deficiency has long-term effects
Iron deficiency is the most widespread deficiency of micronutrients worldwide. There is evidence that iron deficiency causes changes in the developing brain, which eventually lead to long-term effects on various cognitive functions.
A long-term Chilean research project investigated motor learning and its consolidation after sleep in adolescents who had persistent iron deficiency anaemia (IDA) in infancy.
53 adolescents (15–16 years) who had had proven anaemia as infants and 40 control adolescents practiced sequential motor finger tapping before and after a night‘s sleep. Performance was measured at the end of learning, 30 minutes later (boost effect) and the next morning.
It was shown that adolescents with iron deficiency anaemia learned more slowly in infancy than those in the control group, followed by a proportionally similar increase in performance after 30 minutes. Overnight performance remained stable in the control group but improved in the IDA adolescents. This suggests a positive effect of a post-training sleep to consolidate the incompletely learned motor skills. The overnight improvement in performance was observed mainly in the female IDA adolescents, but not in the male ones. This indicates a gender effect.
These results indicate long-lasting motor learning deficits, which sleep after training could compensate for to a certain extent.
Reyes S et al., Sleep Medicine 2019
Malnutrition in the first years of life has immediate health disadvantages
and impairs health and performance in the long term. Children
born too small and those who are malnourished at a young age a
re more susceptible to disease and have a higher risk of dying
prematurely.
Poor growth is associated with various physical and cognitive consequences and affects over 150 million children worldwide. More than 50 million children are atrophied, half of them live in South Asia. But 5.4 million of the 38.3 million overweight or obese children in the world also live there. There is growing evidence that being overweight at an early age is associated with the risk of noncommunicable, e.g. cardiovascular, diseases later in life.
Although the worldwide prevalence of growth retardation decreased from 32.6 % in 2000 to 22.2 % in 2017, this reduction varies considerably from region to region (Asia: 38.1–23.2 %; Africa: 38.3–30.3 %; Latin America: 15.9–9.6 %). In a few countries, such as Nepal (57.1-36.0%) and Lesotho (52.7–33.4%), dramatic progress has been made.
Similarly, the prevalence of childhood obesity varies widely by region, as does the prevalence of childhood obesity worldwide, which increased between 2000 and 2017. Here, the largest increases have been in Eastern Europe and Central Asia (8.2–14.8%). Only West and Central Africa recorded a decrease from 4.3% to 3.0%. If these trends continue, 70 million children will be overweight or obese by 2025. These global, national and regional statistics are crucial for tracking progress and informing policy and programme priorities.
However, the implementation of specific measures should be based on detailed data to better understand which population groups are most affected and the underlying causes. Analyses from India, India and Vietnam, for example, suggest that the determinants of growth inhibition vary across the geography of the countries. In India, for example, the prevalence of growth inhibition, broken down by district, is between 12.4% and 65.1%.
This variability should not be surprising, as all forms of early life malnutrition have a complex aetiology.
Taking India as an example, the variety of factors includes geography (higher in the north and in the middle), level factors (wealth, household size), maternal factors (care during pregnancy, BMI, age of marriage, education), and filial factors (adequacy of nutrition). These factors explain 71 % of the variance in the prevalence of malnutrition, but 29% remain unexplained.
For decades, anaemia was considered the only indicator of malnutrition worldwide. But anaemia also has a complex aetiology and numerous nonnutritional causes. Unfortunately, such causes are rarely recorded on a larger scale. However, this would be necessary for targeted measures to achieve improvements for all forms of malnutrition.
Neufeld LM et al., 93rd Nestlé Nutrition Institute Workshop, Kalkutta, 2019
Malnutrition in the intensive care unit
Adequate food intake is essential during the stay in the paediatric intensive care unit. It was investigated whether the achievement of energy intake targets on day 4 after ingestion and the form of food intake were associated with an improved outcome.
Inadequate nutrition leads to energy and protein deficits, which result in insufficient weight and growth. In addition, malnutrition is associated with increased morbidity and mortality in seriously ill children. The prevalence of acute malnutrition, defined as weight-for-age < -2 SD, affects almost a quarter of all patients in the paediatric intensive care unit (PICU) and has hardly improved in recent decades.
Nutrition and outcome in 325 patients at the PICU, enteral and/or parenteral nutrition was included. The goal of energy intake the day after admission was 90–110% of the energy requirement at rest.
An observational study with prospectively obtained data reviewed acute malnutrition was defined as weight-for-age <-2 SD. The duration of stay, the days on the ventilator, the duration of antibiotic administration and the number of new infections were recorded.
Of the subjects (age 0.14 (0.0–18.0 years), 19% were acutely malnourished at admission.
In the median, 86% of the energy targets were administered enteral. With enteral energy delivery, 7% of patients were fed within the target frame, 50% below and 43% above the target frame. Acute malnutrition was observed very frequently at admission and discharge. In a subgroup (n=223) the acute malnutrition rate at discharge (26%) did not differ significantly from that at admission (22%).
However, there was no correlation between the amount of energy intake or the type of food intake and the clinical outcome.
de Betue CTI et al., Clinical Nutrition 2015
Iron supplementation in the first years of life
The first 1,000 days in a child‘s life are crucial for the developing brain. During this
time, iron deficiency has far-reaching consequences, especially affecting cognitive development.
There is therefore great interest in preventing or treating anaemia in pregnancy and during the first 2 years of life. However, there is a lack of meaningful data from high-quality randomised studies investigating the effects of various iron interventions during pregnancy, infancy and early childhood on cognitive development. Despite decades
of research, there is a lack of conclusive evidence for the optimal strategy for treating iron deficiency in infants and children. The varying results from different studies may be due to variations in dosage, duration and timing of iron treatment and basic characteristics of the study population.
While there is clear evidence of the benefits of iron supplementation in cognitive performance in children who are anaemic, at school age. Studies in pre-school children have shown mixed results for visual, cognitive and psychomotor development.
The evidence for basic iron supplementation in children under 2 years of age remains
unclear. Some studies show small benefits, while others show no differences compared to placebo.
Caution should also be exercised when exceeding the recommended doses. This is because some studies report negative effects of high iron accumulation.
Larson LM et al., Ann Nutr Metab 2017
Iron deficiency has long-term effects
Iron deficiency is the most widespread deficiency of micronutrients worldwide. There is evidence that iron deficiency causes changes in the developing brain, which eventually lead to long-term effects on various cognitive functions.
A long-term Chilean research project investigated motor learning and its consolidation after sleep in adolescents who had persistent iron deficiency anaemia (IDA) in infancy.
53 adolescents (15–16 years) who had had proven anaemia as infants and 40 control adolescents practiced sequential motor finger tapping before and after a night‘s sleep. Performance was measured at the end of learning, 30 minutes later (boost effect) and the next morning.
It was shown that adolescents with iron deficiency anaemia learned more slowly in infancy than those in the control group, followed by a proportionally similar increase in performance after 30 minutes. Overnight performance remained stable in the control group but improved in the IDA adolescents. This suggests a positive effect of a post-training sleep to consolidate the incompletely learned motor skills. The overnight improvement in performance was observed mainly in the female IDA adolescents, but not in the male ones. This indicates a gender effect.
These results indicate long-lasting motor learning deficits, which sleep after training could compensate for to a certain extent.
Reyes S et al., Sleep Medicine 2019
