Give an account of the general causes of Nutritional Deficiency.

What are the various ways of

measuring Nutritional Status? Discuss Protein-Calorie Malnutrition in children with reference to
stunting and wasting.( WBCS Mains 2023)

Ans:

Nutritional deficiency remains a major public health challenge worldwide, affecting millions due
to dietary inadequacies, socioeconomic disparities, and cultural practices.

General Causes of Nutritional Deficiency

Nutritional deficiencies stem from a combination of biological, social, and environmental factors.
The key causes include:

1. Inadequate Dietary Intake – Insufficient consumption of essential nutrients leads to

malnutrition.
Among the Gond tribes of Central India, anthropologist Verrier Elwin documented seasonal food
shortages, which resulted in protein-energy malnutrition (PEM).
Additionally, food taboos during pregnancy and lactation deprived women of essential nutrients,
increasing risks for both mother and child.
Research on the Bantu-speaking populations in Central Africa found a high prevalence of
lactose intolerance, leading to calcium and vitamin D deficiencies due to the avoidance of dairy
products.

2. Malabsorption Disorders – Conditions such as Crohn’s disease, celiac disease, and chronic
diarrhea impair the body's ability to absorb nutrients effectively.

3. Increased Physiological Demand – Certain life stages require higher nutrient intake:
Pregnancy and lactation demand more iron, folic acid, and protein.
Infancy and adolescence require more calories and micronutrients for growth.
Old age often sees reduced nutrient absorption, leading to deficiencies.

Research on the Maasai of East Africa highlights how their pastoralist diet, rich in dairy and
meat, fulfills high protein and energy needs, reducing childhood stunting. However, among
sedentary populations in the region, childhood malnutrition rates remain high due to limited
dietary diversity.

4. Chronic Illnesses and Infections – Diseases such as HIV/AIDS, tuberculosis, and malaria
increase nutrient depletion. In West Africa, a study on HIV-positive mothers found that infants
born to malnourished mothers had higher rates of stunting due to poor maternal nutrition during
pregnancy.
5. Parasitic Infections – In rural India, high rates of intestinal worm infections have been linked
to stunting and wasting in children, a finding supported by the National Family Health Survey
(NFHS-5, 2022-23), which reported high malnutrition rates in tribal communities where
sanitation is inadequate.
Studies in Sub-Saharan Africa have shown that intestinal parasite infections, particularly
hookworm, significantly contribute to iron-deficiency anemia among children.

6. Socioeconomic Factors – Lack of access to nutritious food, healthcare, and sanitation

increases malnutrition risks, particularly in low-income populations.
The 2024 Global Hunger Index ranked South Asia and Sub-Saharan Africa as having the
highest levels of childhood undernutrition, with over 35% of children stunted in these regions.

7. Environmental and Political Factors –Natural disasters, conflicts, and climate change affect
food availability, causing widespread malnutrition.
In Somalia (2022-23), severe droughts led to widespread acute malnutrition, with over 50% of
children under five affected.

8. Food Processing and Storage – Over-processing and prolonged storage degrade nutrient
content, particularly vitamins like C and B-complex.

Methods of Measuring Nutritional Status

Accurate assessment of nutritional status is crucial for intervention.

1. Anthropometric Measurements:These help in detecting malnutrition and growth

abnormalities:

Height-for-age (Stunting): Indicates chronic malnutrition.

The 1992 study on the !Kung San of the Kalahari (Richard B. Lee) found that the transition from
a hunter-gatherer diet to settled agriculture led to an increase in stunting due to lower protein
intake.

Weight-for-height (Wasting): Assesses acute malnutrition.

The Horn of Africa drought crisis (2011) saw acute food shortages leading to a sharp increase in
severe wasting among Somali children, demonstrating the immediate impact of famine on
nutritional status.

Weight-for-age: Measures general undernutrition.

Body Mass Index (BMI): Determines nutritional status in adults.Commonly used for adults to
classify underweight, normal weight, and obesity.
2. Biochemical Assessments:Laboratory tests detect specific nutrient deficiencies:

Serum hemoglobin → Indicates iron-deficiency anemia.

studies among the Adivasi groups of Jharkhand, India, found that low hemoglobin levels due to
iron-deficiency anemia significantly affected school performance and work productivity.

Serum albumin → Measures protein status.

Serum albumin levels indicate protein deficiency, particularly in famine-stricken regions like
Sudan and Ethiopia, where kwashiorkor remains prevalent.

Vitamin D, A, and B12 tests → Detect micronutrient deficiencies & Blood vitamin levels
In West African rural communities, blood tests revealed severe vitamin A deficiencies, which
were linked to high rates of childhood blindness.

3. Clinical Assessments:Physical signs indicate nutrient deficiencies:

Pale skin and conjunctiva → Iron-deficiency anemia.

Goiter (enlarged thyroid) → Iodine deficiency.

Bleeding gums → Vitamin C deficiency (scurvy).

Bleeding gums and scurvy were historically documented among sailors and Arctic explorers,
who lacked vitamin C in their diets. Even today, cases of scurvy persist in low-income
populations with limited access to fresh fruits and vegetables.

4. Dietary Assessments:Evaluates food intake through:

24-hour recall → Assesses short-term nutrient intake.

Food frequency questionnaires → Evaluates long-term eating patterns.

Studies among the tribal populations of Orissa, India (2020) found that traditional millet-based
diets were nutritionally superior but had been replaced by low-nutrient rice-based diets due to
government food distribution programs, leading to rising micronutrient deficiencies

5. Functional Assessments:

Grip strength tests → Detects muscle wasting.

Cognitive function tests → Identifies neurological effects of malnutrition.
Immunological tests (e.g., white blood cell count)--> for immune deficiencies.
2. Protein-Calorie Malnutrition (PCM) in Children: Stunting and Wasting:

1. Stunting (Chronic Malnutrition)

Low height-for-age due to prolonged undernutrition.

Causes:

Inadequate maternal nutrition – In Bangladesh, studies have shown that low birth weight due to
maternal undernutrition significantly increases stunting risk.

Repeated infections – Research in rural Indonesia found that children experiencing frequent
diarrheal diseases had higher rates of stunting due to nutrient loss.

Consequences:

Cognitive impairment: The INCAP longitudinal study showed that stunted children had lower IQ
scores and reduced academic performance compared to well-nourished peers.
Increased adult disease risk: The Dutch Hunger Winter Study proved that children exposed to
early-life malnutrition had a higher incidence of diabetes, hypertension, and cardiovascular
diseases in adulthood.

2. Wasting (Acute Malnutrition)

Low weight-for-height due to sudden nutritional deprivation.

Causes:

Famine and food shortages – The Ethiopian famine (1983-85) led to widespread severe
wasting, increasing child mortality rates significantly.
Disease outbreaks – During the 2011 Horn of Africa crisis, a measles epidemic combined with
food insecurity led to a sharp increase in wasting among children.

Consequences:

Higher mortality rates: The 2023 Global Nutrition Report found that wasting accounts for 45% of
all child deaths under five worldwide.
Weakened immune function: According to UNICEF (2022), malnourished children are twice as
likely to contract respiratory infections and diarrheal diseases, leading to a cycle of further
malnutrition.

Conclusion:

Nutritional deficiency is a multifaceted issue, influenced by dietary habits, socioeconomic status,

health conditions, and environmental factors. Accurate measurement of nutritional status
through anthropometry, biochemical tests, and dietary assessments helps in early diagnosis and
intervention. Among children, Protein-Calorie Malnutrition (PCM) manifests as stunting (chronic)
and wasting (acute), both of which have severe long-term consequences. Addressing
malnutrition requires a comprehensive strategy involving improved maternal and child
healthcare, enhanced food security, and effective public health policies.