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MALNUTRITION

rare in developed countries. Poverty in developing coun- tries contributes more to undernutrition than a lack of global food production and is considered the chief cause of malnutrition. Families that are poor do not have the economic, social, or environmental resources to purchase or produce enough food. Poor soil conditions may also contribute to a family’s inability to grow enough food to prevent malnutrition and the accompanying complica- tions to health. Additionally, for the urban poor, low wages, underemployment, and food prices beyond the reach of families also contribute to undernutrition.

Prolonged dietary intakes deficient in energy or calo- ries, protein, fat, vitamins, and minerals lead to illness and eventually death if not corrected. Undernutrition may also be the result of psychological disorders, such as anorexia nervosa, which manifests as an unwillingness to eat enough food to sustain life. Elderly adults often have a decrease both in appetite and intestinal function and are at an increased risk for undernutrition. Children, par- ticularly infants and those under five years of age are also at an increased risk for undernutrition due to a greater need for energy and nutrients during periods of rapid growth and development. Infants born to undernourished mothers are more likely to be low birth weight infants. Addiction to alcohol or drugs may also lead to undernu- trition when the addicted individuals favor alcohol and/or drug intake over adequate food intake. Severe, prolonged diarrhea, renal failure, infection, or diseases that cause the malabsorption of nutrients in the small intestine also may cause undernutrition even if dietary intake is ade- quate. It is obvious that the causes of undernutrition are varied and complex, requiring solutions that may also be complex.

Nutrients Required to Prevent Undernutrition

The nutrients required in adequate amounts by the body to prevent undernutrition are carbohydrates, fat or lipids, protein, vitamins, minerals, and water. Carbohydrates provide the body with energy (about 4 kilocalories per gram of carbohydrate consumed). Carbohydrates also protect protein stores in the body. A minimal intake of 50 to 100 grams (1.8 to 3.5 oz.) of carbohydrates is re- quired to prevent the development of ketones that the brain can use somewhat inefficiently for energy. The brain optimally uses carbohydrate for energy, but when carbohydrate intake is inadequate for several weeks, the body does not metabolize fatty acids completely in order to produce ketones for energy. In addition to ketone for- mation resulting from insufficient carbohydrate con- sumption, body protein will also be lost, and the body will generally become weakened.

Fats or lipids provide essential fatty acids upon me- tabolism following consumption. Essential fatty acids are obtained from dietary lipids and are termed essential be- cause the human body cannot synthesize them. Essential fatty acids are important for human health because they participate in immune processes, vision, are an integral

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part of cell structures, and participate in hormone-like compound production. If an inadequate intake of lipids is routinely consumed, the body becomes deficient in es- sential fatty acids. This results in skin problems, diarrhea, and an increase in infections with a corresponding de- crease in the ability of the body to heal wounds. Lipids also provide energy for the body (about 9 kilocalories per gram (28 kilocalories per ounce of fat consumed), can be stored for future use as energy, insulate the body and pro- tect body organs, and aid in the absorption and transport of fat-soluble vitamins (vitamins A, D, E, and K) through- out the body. The fat-soluble vitamins are important for vision (vitamin A), bone metabolism (vitamin D), provid- ing antioxidant protection from free radicals (vitamin E), and blood coagulation (vitamin K), among other functions.

Protein is a very important nutrient because so many substances in the body are made from it. Proteins are made when amino acids are combined in specific se- quences to form specific proteins. The sequence of the amino acids determines the shape of the protein, and the shape of the protein, in turn, determines the function of the protein. Amino acids can be obtained from plant or animal sources. There are nine essential amino acids: his- tidine, isoleucine, leucine, lysine, methionine, phenylala- nine, threonine, tryptophan, and valine. The human body is not able to synthesize these amino acids, so they must be derived from the foods we eat. There are eleven nonessential amino acids that the human body is able to make: alanine, arginine, asparagine, aspartic acid, cys- teine, glutamic acid, glutamine, glycine, proline, serine, and tyrosine. As stated previously, amino acids are nec- essary for protein synthesis, but they are also important because they provide the body with a special form of ni- trogen that the body cannot get from carbohydrates or lipids. Protein, like carbohydrate, provides approximately 4 kilocalories per gram of protein consumed, but requires much more metabolizing and processing by the liver and kidneys to put the energy from protein to use. Protein is a part of every cell in the human body. Blood proteins enable the body to maintain the right balance of fluid in- side and outside of cells. When adequate protein is not consumed, there is a lower concentration of blood pro- teins in the bloodstream, which causes the balance of flu- ids inside and outside of cells in tissues to be thrown off, resulting in swelling of tissues or edema, which can lead to serious medical problems. Proteins also help regulate the pH, or acid-base balance, in the blood, are necessary for the synthesis of many hormones and enzymes, and participate in important cell formation for cells vital for the immune system. Amino acids from protein can also be used to produce glucose, which is a positive thing for providing glucose after an overnight fast. But in the case of starvation, excessive muscle tissue is wasted and results in diminished health. Protein-energy malnutrition results from near starvation and may be seen in the body tissues in either a wet, dry, or combined form. The dry form, marasmus, is caused by deficiency of protein and non-

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