Malnutrition in Nepal

MALNUTRITION
• Malnutrition means failure to achieve nutrients requirements, which in turn results in
impaired physical and/ or mental health. Though, generally malnutrition means
undernutrition resulting from hunger, it can be referred to any kind of unhealthy nutritional
status including a result of imbalance or excess of the nutrition.
• Malnutrition is caused by eating a diet in which nutrients are not enough or too much such
that it causes health problems.
• Over nutrition can result in obesity and being overweight. In some developing countries,
over nutrition in the form of obesity is beginning to present within the same communities
as under nutrition.
• However, the term malnutrition is commonly used to undernutrition only. This applies
particularly to the context of development cooperation. Therefore, “Malnutrition” in
documents by the WHO, UNICEF, Save the Children or other international non-
governmental organizations(NGOs) usually equated to under nutrition

• One in three people suffer from some form of malnutrition,” said Lawrence
Haddad, Co- Chair of the Global Nutrition Report’s Independent Expert
Group and Senior Research Fellow at International Food Policy research
Institute.

TYPES OF MALNUTRITION
Malnutrition
Over
Nutrition
Under
Nutrition

• There were 793 million undernourished people in the world in 2015 (13 % of the total
population).
• This is reduction of 2016 million people since 1990 when 23 % were undernourished.
• In 2012 it was estimated that another billion people had a lack of vitamins and in young
children, providing food(in addition to breast milk) between 6 months and 2 yrs of age
improve outcomes.
• Malnutrition is on the rise in every country in the world and is a leading global driver of
disease. The 2016 Global Nutrition Report shows that 44% of countries with data
available (57 out of 129 countries) now experience very serious levels of both under
nutrition and adult overweight and obesity and that, despite good progress in some
countries, the world is off track to reduce and reverse this trend.

• At least 57 countries experience serious levels of both under nutrition-
including stunting and anemia- and adult overweight and obesity, putting a
massive strain on many already fragile health systems.
• Malnutrition is responsible for nearly half of all deaths of children under age
5, and together with poor diets, is the number one driver of the global
burden of disease.

2. OVER NUTRITION
• Consuming too much energy over time will cause you to gain weight unless you
increase your physical activity. It doesn't matter if those extra calories come from
fat, carbohydrates or protein because your body can take whatever it doesn't need
and store it as fat. Being overweight or obese is a risk factor for cardiovascular
disease, some types of cancer and type 2 diabetes.
• Treating this kind of over nutrition requires dietary adjustments to reduce overall
calories and improve the balance of the diet to include more fruits and vegetables,
whole grains calcium sources and healthful protein sources with a few fats.

Over nutrition of Micronutrients
• It's possible to get too much of most vitamins or minerals, but usually, this happens
when you take mega doses of dietary supplements. Getting too much of any
micronutrient from food is rare.
• Micronutrient over nutrition can cause acute poisoning, like taking too many iron
pills at once, or it can be chronic, for example taking large doses of vitamin B-6
over several weeks or months.
• The Institute of Medicine has established tolerable upper limits for most
micronutrients, but the best way to avoid this type of over nutrition is to stay away
from mega doses of dietary supplements unless directed by your healthcare
provider.

Major Risk Factor of Malnutrition
• Low birth weight
• Lack of or incomplete iron supplementation in pregnancy
• Inadequate dietary intake by mother during pregnancy
• Illiteracy

• Poverty
• Multiple births
• Closely spaced birth
• Early stoppage of breast feeding

• Globally, there has been a significant progress made in reducing the hunger and
poverty in the last decades. Yet, the focus was not made in concerned way in
improving the nutritional status, especially of women and children. (DoHS,2014)
• Malnutrition is often invisible, so there is little demand of nutrition service from
communities.
• Common clinical features of malnutrition includes dehydration, muscles wasting,
growth failure etc.
• More than 3 million children die each year because of malnutrition, accounting for
more than 50% of deaths among those under the age of 5

• In 2011 more than 165 million children were affected by stunting and a
further 50 million were affected by wasting. Even though some progress has
been achieved over recent years, the researchers believe that up to 900,000
deaths could be prevented if 10 proven interventions are scaled-up
(Lancet,2013).

Recommended food
(dietary)patterns
for
malnourished

• For good health and sound body nutrious diet is essential if a person doesn’t
take good diet, he suffers from nutrition.
• Generally, the children, pregnant women and lactating mothers suffer from
malnutrition.
• “Malnutrition is not exclusively a problem of extreme poverty, nor only of the
young, but affects all communities around the world and people of all ages”.
“Prevention is better than cure.”

The Five Food Groups
Type Food-Stuff Nutrient Substances
1 Milk
(curd, cheese, powder of tond milk)
Pulses
(Beans, peas, dry nuts)
Meat
(Fish, egg, Chicken etc.)
Protein
Calcium
2 Fruit
(orange, mango, papaya, lime juice, Aamla, tomato, guava
& seasonal fruits.)
Green leafy Vegetables
(Spinach (palak), saag, methi, carrot, radish etc.)
Vitamin C
Mineral salts especially iron

Type Food-Stuff Nutrient Substances
3 Other vegetables
(Brinjal, lauki, green beans, pumpkin and tinde etc.) Some quantity of vitamins and
minerals salts
4 Cereals
(Rice, wheat, maize, mullet etc.)
Starchy vegetables
(kachalu, zimikand, Beat and potato)
Carbohydrates, vitamin B and
some amount of protein.
5 Ghee and Oils
(Butter, ghee, vanspati ghee and oils)
Sugar
(Jaggery, Gur, honey)
Fats essential fatty acids
Carbohydrates

Planning of Diet for the Family
• Knowledge of the daily nutritional requirement.
• Knowledge of food-stuffs that can provide essential nutrients.
• Planning of meals.
• Different methods of cooking of food.
• Serving of food.

For children of 5-10 years age
• Physical development does take place in this period but is less marked as
compared to earlier period; so the requirement of nutrition food is also
essential in this age.
• The children can be given all types of food-stuffs but spices should not be
included in their diet.
• The food should be digestible.

Diet plan for Adolescents boys and girls
S.N. Food –stuff Boys (13-15)yrs Boys (16-18)yrs Girls (13-18)yrs
(Veg) (non veg) (veg) (non veg) (veg) (non veg)
1 Cereals 430 430 450 450 350 350
2 Pulses 70 50 70 50 70 50
3 Green leafy vegetables 100 100 100 100 150 150
4 Other vegetables 75 75 75 75 75 75
5 Root vegetables 75 75 100 100 75 75
6 Fruit 30 30 30 30 50 50
7 Milk 250 150 250 150 250 150
8 Ghee and Oils 35 40 45 50 35 40
9 Meat and Fish - 30 - 30 - 30
10 Sugar and Gur 30 30 40 40 30 30
11 Eggs - 30 - 30 - 30
12 Groundnut - - 50* 50* - -

For adolescent boys and girls between the age group
10-12 years and 13-18 years
• In this stage, the physical development takes place very rapidly. So, the
requirement for nutrients also increases.
• In this age, the nutrition of selection of diet is very important because the
changes of reproductive organs are also affects the likes and dislikes of the
children.
• Protein and Vitamin should be in adequate quality in the diet of children and
adolescents.

Diet plan for Men aging 19 t0 40-45 years
S.N. Food-stuff Ordinary labour
(veg) (Non-veg)
(Grams)
Medium labour
(veg) (Non-veg)
(Grams)
Heavy labour
(veg) (Non-veg)
(Grams)
1 Cereals 400 400 475 475 650 650
2 Pulses 70 55 80 65 80 65
3 Green leafy vegetables 100 100 125 125 125 125
4 Other vegetables 75 75 75 75 100 100
5 Root vegetables 75 75 100 100 100 100
6 Fruit 30 30 30 30 30 30
7 Milk 200 100 200 100 200 100
8 Ghee and Oils 35 40 40 40 50 50
9 Meat and Fish - 30 - 30 - 50
10 Sugar and Gur 30 30 40 40 55 55
11 Groundnut - - - - 50 50

Diet plan for Women aging 19 t0 40-45 years
S.N Food-stuff Ordinary labour medium labour Heavy labour (feeding mother)
(veg) (non veg) (veg) (non veg) (veg) (non veg) (spe. veg) pregnancy
1 Cereals 300 300 350 350 475 475 80 100
2 Pulses 60 45 70 55 70 55 - 10
3 Green leafy
vegetables
125 125 125 125 125 125 25 25
4 Other vegetables 75 75 75 75 100 100 - -
5 Root vegetables 50 50 75 75 100 100 - -
6 Fruit 30 30 30 30 30 30 - -
7 Milk 200 100 200 100 200 100 125 125
8 Ghee and Oils 30 35 35 40 40 45 - 15
9 Meat and Fish - 30 - 30 - 30 - -
10 Sugar and Gur 30 30 30 30 30 40 10 20
11 Egg - 30 - 30 - 30 - -
12 Groundnut - - - 40 - 40* - -

For men and women of 19 years to 40- 45 years
• During this age, no physical development take place but good diet required
to work and to fight from diseases.
• The protein requirement should be met with sources of good quality protein,
Vitamins and Minerals are required for keeping body healthy and smart.

For pregnant women and breast feeding mothers
• During these conditions, nutrients are needed in increased quantity.
• During pregnancy, if the diet of a mother is not nutritious, it will not only affect the
health of mother but that of the child too.
• Similarly, in lactation period the nutritional food is required for the formation of
milk, and also for changes that take place in the body.
• Some essential minerals such as calcium, phosphorus and iodine should be include
for diet of pregnant women. More energy required due to physical changes. So
increased the quantity of milk, pulses, green vegetables should be included in diet.

Food is also main reason for being malnourished
 Poverty
 Education
 Life Style
 Culture
 Environment
 Facilities
 Unhealthy food

Malnutrition in Nepal

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