View source for Malnutrition

{{Short description|Medical condition caused by receiving too little or too many nutrients}}
{{redirect|Underfeeding|the concept in metalworking|Underfeeder}}
{{Use mdy dates|date=April 2020}}
{{Infobox medical condition
| name = Malnutrition
| synonyms =
| image = A malnourished child in an MSF treatment tent in Dolo Ado.jpg
| caption = Underfed child in [[Dolo Ado]], [[Ethiopia]], at an [[Médecins Sans Frontières|MSF]] treatment tent
| field = [[Critical care medicine]]
| image_size = 280px
| symptoms = Problems with physical or mental development; poor energy levels; hair loss; [[edema|swollen legs]] and [[ascites|abdomen]]<ref name=FFL2010/><ref name=Young2012/>
| complications =
| onset =
| duration =
| types =
| causes = Eating a [[Diet (nutrition)|diet]] with too few or too many [[nutrient]]s; [[malabsorption]]<ref name=Dor2017/><ref name=PapadiaDiSabatino2014/>
| risks = Lack of [[breastfeeding]]; [[gastroenteritis]]; [[pneumonia]]; [[malaria]]; [[measles]]; poverty; [[homelessness]]<ref name=WHO2014/>
| diagnosis =
| differential =
| prevention = Improving agricultural practices; reducing poverty; improving [[sanitation]]; education
| treatment = Improved nutrition; [[dietary supplements|supplementation]]; [[therapeutic food#Ready-to-Use Therapeutic Food|ready-to-use therapeutic foods]]; treating the underlying cause<ref name=UK2012/><ref name=Bh2013/><ref name=KastinBuchman2002/>
| medication = Eating food with enough nutrients on a near daily basis
| prognosis =
| frequency = 673 million undernourished / 8.2% of the population (2024)<ref name=UNFAO2023>{{cite web|url=https://www.fao.org/publications/fao-flagship-publications/the-state-of-food-security-and-nutrition-in-the-world/en|title=The State of Food Security and Nutrition in the World 2025|publisher=[[Food and Agriculture Organization of the United Nations]]|website=fao.org|date=1 August 2025|access-date=7 September 2025}}</ref>
| deaths = 406,000 from nutritional deficiencies (2015)<ref name=GBD2015De>{{cite journal|last1=Wang|first1=Haidong|last2=Naghavi|first2=Mohsen|last3=Allen|first3=Christine|last4=Barber|first4=Ryan M.|collaboration=GBD 2015 Mortality and Causes of Death Collaborators|title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015|journal=Lancet|date=October 8, 2016|volume=388|issue=10053|pages=1459–1544|pmid=27733281|doi=10.1016/s0140-6736(16)31012-1|pmc=5388903}}</ref>
}}

'''Malnutrition''' occurs when an [[organism]] gets too few or too many [[nutrient]]s, resulting in health problems.<ref name="Clinical Nutrition in Practice (2011)">{{cite book| vauthors = Katsilambros N |title=Clinical Nutrition in Practice|year=2011|publisher=John Wiley & Sons|isbn=978-1-4443-4777-7|page=37|url=https://books.google.com/books?id=pJHU1m7BEP8C&pg=PT46}}</ref><ref>{{Cite web |title=Malnutrition |url=https://www.who.int/health-topics/malnutrition |access-date=2024-05-03 |website=www.who.int |language=en}}</ref> Specifically, it is a [[Deficiency (medicine)|deficiency]], excess, or imbalance of energy, [[protein]] and [[Vitamin deficiency|other nutrients]] which adversely affects the body's [[Tissue (biology)|tissues]] and form.<ref name="Hickson, M 2018. p.3">{{Cite book |title=Advanced nutrition and dietetics in nutrition support |date=2018 |author=<!--Staff writer(s); no by-line.-->|editor-last1=Hickson |editor-first1=Mary |editor-last2=Smith |editor-first2=Sara |collaboration=British Dietetic Association |isbn=978-1-118-99386-6 |location=Hoboken, NJ |oclc=1004376424|page=3}}</ref>

Malnutrition is a category of diseases that includes [[Undernutrition in children|undernutrition]] and [[overnutrition]].<ref>{{cite web|title=WHO, nutrition experts take action on malnutrition |url=https://www.who.int/nutrition/pressnote_action_on_malnutrition/en/|archive-url=https://web.archive.org/web/20110414112559/http://www.who.int/nutrition/pressnote_action_on_malnutrition/en/|archive-date=April 14, 2011|work=World Health Organization |access-date=February 10, 2012}}</ref> Undernutrition is a lack of nutrients, which can result in [[stunted growth]], [[wasting]], and  being [[underweight]].<ref>{{Citation |last1=Lenters |first1=Lindsey |title=Management of Severe and Moderate Acute Malnutrition in Children |date=2016 |work=Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2) |editor-last=Black |editor-first=Robert E. |url=https://www.ncbi.nlm.nih.gov/books/NBK361900/ |access-date=2024-05-03 |place=Washington (DC) |publisher=The International Bank for Reconstruction and Development / The World Bank |isbn=978-1-4648-0348-2 |pmid=27227221 |last2=Wazny |first2=Kerri |last3=Bhutta |first3=Zulfiqar A. |doi=10.1596/978-1-4648-0348-2_ch11 |editor2-last=Laxminarayan |editor2-first=Ramanan |editor3-last=Temmerman |editor3-first=Marleen |editor4-last=Walker |editor4-first=Neff}}</ref> A surplus of nutrients causes overnutrition, which can result in [[obesity]] or toxic levels of micronutrients. In some [[developing countries]], overnutrition in the form of obesity is beginning to appear within the same communities as undernutrition.<ref>{{cite web|title=Progress For Children: A Report Card On Nutrition|url=http://www.unicef.org/nutrition/files/Progress_for_Children_-_No._4.pdf|publisher=UNICEF|access-date=March 19, 2012|archive-date=January 12, 2021|archive-url=https://web.archive.org/web/20210112154958/https://www.unicef.org/nutrition/files/Progress_for_Children_-_No._4.pdf}}</ref>

Most clinical studies use the term 'malnutrition' to refer to undernutrition. However, the use of 'malnutrition' instead of 'undernutrition' makes it impossible to distinguish between undernutrition and overnutrition, a less acknowledged form of malnutrition.<ref name="Hickson, M 2018. p.3"/><ref>Ngaruiya, C., Hayward, A., Post, L. and Mowafi, H., 2017. "Obesity as a form of malnutrition: over-nutrition on the Uganda 'malnutrition' agenda". ''Pan African Medical Journal'', 28, p. 49.</ref> Accordingly, a 2019 report by [[The Lancet]] Commission suggested expanding the definition of malnutrition to include "all its forms, including obesity, undernutrition, and other [[Diet (nutrition)|dietary]] risks."<ref>Swinburn, B., Kraak, V., Allender, S., ''et al.'', 2019. "The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report." ''The Lancet'', 393(10173), pp. 791–846.</ref> The [[World Health Organization]]<ref>References Min, J., Zhao, Y., Slivka, L. and Wang, Y., 2017. "Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases". ''Obesity Reviews'', 19(1), pp. 49–61.</ref> and The Lancet Commission have also identified "[t]he double burden of malnutrition", which occurs from "the coexistence of overnutrition (overweight and obesity) alongside undernutrition (stunted growth and wasting)."<ref>{{cite web|title=The Double Burden of Malnutrition|date=16 December 2019|url=https://www.thelancet.com/series/double-burden-malnutrition|publisher=The Lancet Commission|access-date=17 January 2022}}</ref><ref name="Ghattas, H. 2020">Ghattas, H., Acharya, Y., Jamaluddine, Z., Assi, M., El Asmar, K. and Jones, A., 2020. The child-level double burden of malnutrition in the MENA and LAC regions: Prevalence and social determinants. Maternal &amp; Child Nutrition, 16(2).</ref>

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==Prevalence==
[[File:Number of people undernourished by region.svg|thumb|Number of people undernourished by region<ref>{{Cite book |last=FAO |url=https://openknowledge.fao.org/handle/20.500.14283/cd4313en |title=World Food and Agriculture – Statistical Yearbook 2025 |date=2025 |publisher=FAO |isbn=978-92-5-140174-3 |language=English |doi=10.4060/cd4313en}}</ref>]]
It was estimated in 2017 that nearly one in three persons globally had at least one form of malnutrition: [[wasting]], [[Stunting (Medical)|stunting]], [[vitamin]] or [[Mineral (nutrient)|mineral]] deficiency, overweight, obesity, or diet-related noncommunicable diseases.<ref>WHO. The double burden of malnutrition. Policy brief. Geneva: World Health Organization; 2017.</ref> Undernutrition is more common in [[developing countries]].<ref>{{cite book|author1=Liz Young|url=https://books.google.com/books?id=w4CGAgAAQBAJ&pg=PA20|title=World Hunger Routledge Introductions to Development|date=2002|isbn=978-1-134-77494-4|page=20| publisher=Routledge }}</ref> Stunting is more prevalent in urban slums than in rural areas.<ref name="Murarkar, S. 2020">Murarkar, S., Gothankar, J., Doke, P., Pore, P., Lalwani, S., Dhumale, G., Quraishi, S., Patil, R., Waghachavare, V., Dhobale, R., Rasote, K., Palkar, S. and Malshe, N., 2020. Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health, 20(1).</ref>

Studies on malnutrition have the population categorised into different groups including infants, under-five children, children, adolescents, pregnant women, adults and the elderly population. The use of different growth references in different studies leads to variances in the undernutrition prevalence reported in different studies. Some of the growth references used in studies include the [[National Center for Health Statistics]] (NCHS) growth charts, WHO reference 2007, [[Centers for Disease Control and Prevention]] (CDC) growth charts, National Health and Nutrition Examination Survey (NHANES), WHO reference 1995, Obesity Task Force (IOTF) criteria and [[Indian Academy of Pediatrics]] (IAP) growth charts.<ref>Estecha Querol, S., Al-Khudairy, L., Iqbal, R., Johnson, S. and Gill, P., 2021. Adolescent undernutrition in South Asia: a scoping review protocol. BMJ Open, 10(1), p.e031955.</ref>  In 2023, an estimated 28.9 percent of the [[World population|global population]] – 2.33 billion people – were moderately or severely food insecure.<ref>{{Cite book |url=https://openknowledge.fao.org/handle/20.500.14283/cd1254en |title=The State of Food Security and Nutrition in the World 2024 |date=2024 |publisher=FAO; IFAD; UNICEF; WFP; WHO |isbn=978-92-5-138882-2 |language=English |doi=10.4060/cd1254en}}</ref>

=== In children ===
[[File:Prevalence of undernourishment by region.svg|thumb|Prevalence of undernourishment by region<ref>{{Cite book |last=FAO |url=https://openknowledge.fao.org/handle/20.500.14283/cd4313en |title=World Food and Agriculture – Statistical Yearbook 2025 |date=2025 |publisher=FAO |isbn=978-92-5-140174-3 |language=English |doi=10.4060/cd4313en}}</ref>]]
The prevalence of undernutrition is highest among children under five.<ref name="Murarkar, S. 2020"/> In 2021, 148.1 million children under five years old were stunted, 45 million were wasted, and 37 million were overweight or obese.<ref name=":3" /> The same year, an estimated 45% of deaths in children were linked to undernutrition.<ref name=":3" /><ref name="WHO2014" /> {{As of|2020}}, the prevalence of wasting among children under five in South Asia was reported to be 16% moderately or severely wasted.<ref name="Murarkar, S. 2020"/> {{As of|2022}}, [[UNICEF]] reported this prevalence as having slightly improved, but still being at 14.8%.<ref>{{cite web|url=https://data.unicef.org/topic/nutrition/malnutrition/ |title=Child Malnutrition|work=[[UNICEF]]|date=May 2023}}</ref> India has one of the highest burdens of wasting in Asia with over 20% wasted children.<ref>Gautam, S., Verma, M., Barman, S. and Arya, A., 2018. Nutritional status and its corelates in under five slum children of Kanpur Nagar, India. International Journal of Contemporary Pediatrics, 5(2), p.584.</ref> However, the burden of undernutrition among under-five children in African countries is much higher. A pooled analysis of the prevalence of chronic undernutrition among under-five children in East Africa was identified to be 33.3%. This prevalence of undernutrition among under-five children ranged from 21.9% in Kenya to 53% in Burundi.<ref>Tesema, G., Yeshaw, Y., Worku, M., Tessema, Z. and Teshale, A., 2021. Pooled prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis. PLOS ONE, 16(3), p.e0248637.</ref>

In Tanzania, the prevalence of stunting, among children under five varied from 41% in lowland and 64.5% in highland areas. Undernutrition by underweight and wasting was 11.5% and 2.5% in lowland and 22.% and 1.4% in the highland areas of Tanzania respectively.<ref>Mrema, J., Elisaria, E., Mwanri, A. and Nyaruhucha, C., 2021. Prevalence and Determinants of Undernutrition among 6- to 59-Months-Old Children in Lowland and Highland Areas in Kilosa District, Tanzania: A Cross-Sectional Study. Journal of Nutrition and Metabolism, 2021, pp.1–9.</ref> In South Sudan, the prevalence of undernutrition explained by stunting, underweight and wasting in under-five children were 23.8%, 4.8% and 2.3% respectively.<ref>Kiarie, J., Karanja, S., Busiri, J., Mukami, D. and Kiilu, C., 2021. The prevalence and associated factors of undernutrition among under-five children in South Sudan using the standardized monitoring and assessment of relief and transitions (SMART) methodology. BMC Nutrition, 7(1).</ref> In 28 countries, at least 30% of children were still affected by stunting in 2022.<ref>{{Cite web |title=Malnutrition in Children |url=https://data.unicef.org/topic/nutrition/malnutrition/ |access-date=2023-11-07 |website=UNICEF DATA |language=en-US}}</ref>

[[Vitamin A deficiency]] affects one third of children under age 5 around the world,<ref name=":5">World Health Organization, Global prevalence of vitamin A deficiency in populations at risk 1995–2005, World Health Organization global database on vitamin A deficiency.</ref> leading to 670,000 deaths and 250,000–500,000 cases of [[Visual impairment|blindness]].<ref>Black RE et al., Maternal and child undernutrition: global and regional exposures and health consequences, The Lancet, 2008, 371(9608), p. 253.</ref> Vitamin A supplementation has been shown to reduce all-cause mortality by 12 to 24%.<ref>{{Cite web |title=Vitamin A Deficiency in Children |url=https://data.unicef.org/topic/nutrition/vitamin-a-deficiency/ |access-date=2023-10-31 |website=UNICEF DATA |language=en-US}}</ref>

=== In adults ===
{{Main|Undernutrition in older adults}}

As of June 2021, 1.9&nbsp;billion adults were overweight or obese, and 462 million adults were underweight.<ref name=":3" /> Globally, two billion people had [[iodine deficiency]] in 2017.<ref>{{cite journal | vauthors = Biban BG, Lichiardopol C | title = Iodine Deficiency, Still a Global Problem? | journal = Current Health Sciences Journal | volume = 43 | issue = 2 | pages = 103–111 | date = 2017 | pmid = 30595864 | pmc = 6284174 | doi = 10.12865/CHSJ.43.02.01 }}</ref> In 2020, 900 million women and children had anemia, which is often caused by iron deficiency.<ref>{{Cite web|title=WHO guidance helps detect iron deficiency and protect brain development|url=https://www.who.int/news/item/20-04-2020-who-guidance-helps-detect-iron-deficiency-and-protect-brain-development|access-date=2021-11-19|website=www.who.int|language=en}}</ref> More than 3.1&nbsp;billion people in the world – 42% – were unable to afford a healthy diet in 2021.<ref>{{Cite web |last=Moumen |first=Hana |date=2023-07-12 |title=State of Food Security and Nutrition in the World (SOFI) 2023 |url=https://data.unicef.org/resources/sofi-2023/ |access-date=2023-11-08 |website=UNICEF DATA |language=en-US}}</ref>

Certain groups have higher rates of undernutrition, including [[Undernutrition in older adults|elderly]] people and women (in particular while pregnant or [[breastfeeding]] [[Undernutrition in children|children]] under five years of age). Undernutrition is an increasing health problem in people aged over 65 years, even in developed countries, especially among nursing home residents and in acute care hospitals.<ref>van Zwienen-Pot, J., Visser, M., Kuijpers, M., Grimmerink, M. and Kruizenga, H., 2017. Undernutrition in nursing home rehabilitation patients. Clinical Nutrition, 36(3), pp. 755–759.
</ref> In the elderly, undernutrition is more commonly due to physical, psychological, and social factors, not a lack of food.<ref>{{cite book| veditors = Rosenthal RA, Zenilman ME, Katlic MR |url=https://books.google.com/books?id=VcgmpMZE6a8C&pg=PA87|title=Principles and practice of geriatric surgery |date=2011 |publisher=Springer |isbn=978-1-4419-6999-6 |edition=2nd |location=Berlin |page=78}}</ref> Age-related reduced dietary intake due to chewing and swallowing problems, sensory decline, depression, imbalanced gut microbiome, poverty and loneliness are major contributors to undernutrition in the elderly population. Malnutrition is also attributed due to wrong diet plan adopted by people who aim to reduce their weight without medical practitioners or nutritionist advice.<ref>McMinn, J., Steel, C. and Bowman, A., 2011. Investigation and management of unintentional weight loss in older adults. BMJ, 342(mar29 1), p. d1732.</ref>

=== Increase in 2020 ===
[[File:A 4-year-old Palestinian girl, lost her life due to malnutrition and lack of treatment due to the war on Gaza.jpg|thumb|Four year old Palestinian girl starved to death, during [[Gaza Famine]]]]
There has been a global increase in food insecurity and hunger between 2011 and 2020. In 2015, 795 million people (about one in ten people on earth) had undernutrition.<ref name="UNFAO2018">{{cite book|title=The State of Food Insecurity in the World 2018|year=2020|url=http://www.fao.org/state-of-food-security-nutrition/en/|publisher=Food and Agricultural Organization of the United Nations|doi=10.4060/CA9692EN|isbn=978-92-5-132901-6|s2cid=239729231|access-date=January 11, 2019}}</ref><ref name="FAO2010">{{cite web|title=Global hunger declining, but still unacceptably high International hunger targets difficult to reach|url=http://www.fao.org/docrep/012/al390e/al390e00.pdf|website=Food and Agriculture Organization of the United Nations|access-date=July 1, 2014|date=September 2010}}</ref> It is estimated that between 691 and 783 million people in the world faced hunger in 2022.<ref>{{Cite web |last=Moumen |first=Hana |date=2023-07-12 |title=State of Food Security and Nutrition in the World (SOFI) 2023 |url=https://data.unicef.org/resources/sofi-2023/ |access-date=2023-10-31 |website=UNICEF DATA |language=en-US}}</ref> According to UNICEF, 2.4&nbsp;billion people were moderately or severely food insecure in 2022, 391 million more than in 2019.<ref>{{Cite web |last=Moumen |first=Hana |date=2023-07-12 |title=State of Food Security and Nutrition in the World (SOFI) 2023 |url=https://data.unicef.org/resources/sofi-2023/ |access-date=2023-10-31 |website=UNICEF DATA |language=en-US}}</ref>

[[File:Projected numbers of undernourished indicate that the world is far off track to achieve zero hunger by 2030.svg|thumb|250px|Projected numbers of undernourished people by FAO shows global malnutrition rates]]
These increases are partially related to the [[COVID-19 pandemic]], which continues to highlight the weaknesses of current food and health systems. It has contributed to [[food insecurity]], increasing hunger worldwide; meanwhile, lower physical activity during [[lockdown]]s has contributed to increases in overweight and obesity.<ref name=":6">{{cite journal|vauthors=Mark HE, Dias da Costa G, Pagliari C, Unger SA|date=December 2020|title=Malnutrition: the silent pandemic|journal=BMJ|volume=371|article-number=m4593|doi=10.1136/bmj.m4593|pmc=7705612|pmid=33262147}}</ref> In 2020, experts estimated that by the end of the year, the pandemic could have double the number of people at risk of suffering acute hunger, around 130 million more undernourished people.<ref>{{Cite book |last1=FAO |url=https://openknowledge.fao.org/handle/20.500.14283/cd1254en |title=The State of Food Security and Nutrition in the World 2024 |last2=IFAD |last3=UNICEF |last4=WFP |last5=WHO |date=2024 |publisher=FAO; IFAD; UNICEF; WFP; WHO |isbn=978-92-5-138882-2 |language=English |doi=10.4060/cd1254en}}</ref><ref>{{ cite web|title= Goal 2020: Zero Hunger-United Nations | date=April 20, 2020| url=https://www.wfp.org/publications/2020-global-report-food-crises}}</ref> Similarly, experts estimated that the [[prevalence]] of moderate and severe wasting could increase by 14% due to COVID-19; coupled with reductions in nutrition and health services coverage, this could result in over 128,000 additional deaths among children under 5 in 2020 alone.<ref name=":6" /> Although COVID-19 is less severe in children than in adults, the risk of severe disease increases with undernutrition.<ref>Kulkarni, R., Rajput, U., Dawre, R., Sonkawade, N., Pawar, S., & Sonteke, S. et al. (2020). Severe Malnutrition and Anemia Are Associated with Severe COVID in Infants. Journal Of Tropical Pediatrics, 67(1). doi: 10.1093/tropej/fmaa084</ref>

Other major causes of hunger include manmade conflicts, [[climate change]]s, and economic downturns.<ref>{{cite web | title= 2020 Global crisis on Food crises |date=April 20, 2020 |url=https://www.wfp.org/publications/2020-global-report-food-crises }}</ref>

==Type==
{{externalvideo|video1=[https://www.youtube.com/watch?v=pPRJQpWhE0o Daniel Quinn on Facts of World Hunger]}}

===Undernutrition===
[[File:Prevalence of undernourishment (2022–2024 average).svg|thumb|330x330px|Prevalence of undernourishment (20202–2024 average)<ref>{{Cite book |last=FAO |url=https://openknowledge.fao.org/handle/20.500.14283/cd4313en |title=World Food and Agriculture – Statistical Yearbook 2025 |date=2025 |publisher=FAO |isbn=978-92-5-140174-3 |language=English |doi=10.4060/cd4313en}}</ref>]]
[[File:Number of undernourished people (2022–2024 average).svg|thumb|330x330px|Number of undernourished people (2022–2024 average)<ref>{{Cite book |last=FAO |url=https://openknowledge.fao.org/handle/20.500.14283/cd4313en |title=World Food and Agriculture – Statistical Yearbook 2025 |date=2025 |publisher=FAO |isbn=978-92-5-140174-3 |language=English |doi=10.4060/cd4313en}}</ref>]]
[[File:The prevalence of undernourishment (PoU) is still higher in 2022 than before the pandemic in 58 percent of countries, and the situation is worse in low-income countries (77.svg|thumb|The prevalence of undernourishment (PoU) was still higher in 2022 than before the pandemic in 58% of countries, and the situation is worse in low-income countries (77%).|330x330px]]
Undernutrition can occur either due to protein-energy wasting or as a result of [[micronutrient]] deficiencies.<ref name=Young2012/><ref name=Jones2011>{{cite book|title=Essentials of International Health|date=2011|publisher=Jones & Bartlett Publishers|isbn=978-1-4496-6771-9|page=194|url=https://books.google.com/books?id=lt7TqZPZSlIC&pg=PA194}}</ref><ref name=":3">{{Cite web |title=The State of Food Security and Nutrition 2023 |url=https://data.unicef.org/resources/sofi-2023/ |access-date=2023-10-25 |website=UNICEF Data |date=July 12, 2023 |language=en}}</ref><ref name=FFL2010>{{cite book|title=Facts for life|date=2010|publisher=United Nations Children's Fund|location=New York|isbn=978-92-806-4466-1|pages=61 and 75|edition=4th|url=http://www.unicef.org/nutrition/files/Facts_for_Life_EN_010810.pdf|access-date=March 19, 2012|archive-date=December 12, 2018|archive-url=https://web.archive.org/web/20181212170249/https://www.unicef.org/nutrition/files/Facts_for_Life_EN_010810.pdf}}</ref><ref name=Dor2017>{{DorlandsDict|five/000062745|malnutrition}}</ref><ref name=":4">{{Cite book|last=World Health Organization|url=http://apps.who.int/iris/bitstream/handle/10665/84409/9789241505550_eng.pdf?sequence=1|title=Essential Nutrition Actions: Improving Maternal, Newborn, Infant and Young Child Health and Nutrition|publisher=World Health Organization|year=2013|isbn=978-92-4-1505550|location=Geneva|pages=vi-94|language=English}}</ref><ref name="Morley, J. 2012">Morley, J., 2012. Undernutrition in older adults. Family Practice, 29(suppl 1), pp.i89-i93.</ref> It adversely affects physical and mental functioning, and causes changes in body composition and body cell mass.<ref>Cederholm, T., Bosaeus, I., Barazzoni, R., Bauer, J., Van Gossum, A., Klek, S., Muscaritoli, M., Nyulasi, I., Ockenga, J., Schneider, S., de van der Schueren, M. and Singer, P., 2015. Diagnostic criteria for malnutrition – An ESPEN Consensus Statement. Clinical Nutrition, 34(3), pp. 335–340.</ref><ref>Sobotka, L., 2012. Basics in clinical nutrition. 4th ed. Prague: Galen.</ref> Undernutrition is a major health problem, causing the highest [[mortality rate]] in children, particularly in those under 5 years, and is responsible for long-lasting [[Physiology|physiologic]] effects.<ref>Martins, V., Toledo Florêncio, T., Grillo, L., Do Carmo P. Franco, M., Martins, P., Clemente, A., Santos, C., Vieira, M. and Sawaya, A., 2011. Long-Lasting Effects of Undernutrition. International Journal of Environmental Research and Public Health, 8(6), pp. 1817–1846.</ref> It is a barrier to the complete physical and mental development of children.<ref name="Morley, J. 2012"/>

Undernutrition can manifest as stunting, wasting, and underweight. If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development.<ref name=FFL2010/><ref name=":4" /> Extreme undernutrition can cause [[starvation]], chronic hunger, [[Severe Acute Malnutrition]] (SAM), and/or [[Moderate Acute Malnutrition]] (MAM).

The [[signs and symptoms]] of [[micronutrient deficiencies]] depend on which micronutrient is lacking.<ref name="Young2012" /> However, undernourished people are often thin and short, with very poor energy levels; and [[pedal edema|swelling in the legs]] [[ascites|and abdomen]] is also common.<ref name="FFL2010" /><ref name="Young2012" /><ref name=":4" /> People who are undernourished often get infections and frequently feel cold.<ref name="Young2012" />

====Micronutrient undernutrition====
Micronutrient undernutrition results from insufficient intake of vitamins and minerals.<ref name=":3" /> Worldwide, deficiencies in [[iodine]], [[Vitamin A]], and iron are the most common. Children and pregnant women in [[low-income countries]] are at especially high risk for micronutrient deficiencies.<ref name=":3" /><ref name=":4" />

[[Anemia]] is most commonly [[Iron-deficiency anemia|caused by iron deficiency]], but can also result from other micronutrient deficiencies and diseases. Vitamin B<sub>12</sub> deficiency may cause anemia, but not in all cases, in which may result in changes in consciousness or thinking, or even irreversible neurological damage.<ref>{{Cite journal |last1=Shipton |first1=Michael J. |last2=Thachil |first2=Jecko |date=April 2015 |title=Vitamin B12 deficiency - A 21st century perspective |journal=Clinical Medicine |volume=15 |issue=2 |pages=145–150 |doi=10.7861/clinmedicine.15-2-145 |issn=1470-2118 |pmc=4953733 |pmid=25824066}}</ref> This condition can have major health consequences.<ref>{{cite journal | vauthors = Safiri S, Kolahi AA, Noori M, Nejadghaderi SA, Karamzad N, Bragazzi NL, Sullman MJ, Abdollahi M, Collins GS, Kaufman JS, Grieger JA | display-authors = 6 | title = Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019 | journal = Journal of Hematology & Oncology | volume = 14 | issue = 1 | article-number = 185 | date = November 2021 | pmid = 34736513 | pmc = 8567696 | doi = 10.1186/s13045-021-01202-2 | doi-access = free }}</ref>

It is possible to have overnutrition simultaneously with micronutrient deficiencies; this condition is termed the '''double burden of malnutrition'''.

====Protein-energy malnutrition====
'Undernutrition' sometimes refers specifically to [[protein–energy malnutrition]] (PEM).<ref name="Young2012" /><ref name="Nutrition in pediatrics">{{cite book | veditors = Duggan C, Watkins JB, Walker WA |title=Nutrition in pediatrics: basic science, clinical application|year=2008|publisher=BC Decker|location=Hamilton|isbn=978-1-55009-361-2|pages=127–141|url=https://books.google.com/books?id=wSTISCdSIosC&q=Nutrition+in+pediatrics+:+basic+science,+clinical+application}}</ref> This condition involves both micronutrient deficiencies and an imbalance of protein intake and energy expenditure.<ref name="Jones2011" /> It differs from [[calorie restriction]] in that calorie restriction may not result in negative health effects. Hypoalimentation (underfeeding) is one cause of undernutrition.<ref>{{DorlandsDict|four/000051473|hypoalimentation}}</ref>

Two forms of PEM are [[kwashiorkor]] and [[marasmus]]; both commonly coexist.<ref name="Clinical Nutrition in Practice (2011)" />

[[File:Kwashiorkor 6180.jpg|thumb|Child in the United States with signs of [[kwashiorkor]], a dietary protein deficiency]]
''Kwashiorkor'' is primarily caused by inadequate protein intake.<ref name="Clinical Nutrition in Practice (2011)" /> Its symptoms include [[edema]], wasting, [[Hepatomegaly|liver enlargement]], [[hypoalbuminaemia]], and [[steatosis]]; the condition may also cause [[depigmentation]] of skin and hair.<ref name="Clinical Nutrition in Practice (2011)" /> The disorder is further identified by a characteristic [[Ascites|swelling of the belly]], and [[Limb (anatomy)|extremities]] which disguises the patient's undernourished condition.<ref name="Chowdhury 2008" /> 'Kwashiorkor' means 'displaced child' and is derived from the [[Ga language]] of coastal [[Ghana]] in West Africa. It means "the sickness the baby gets when the next baby is born," as it often occurs when the older child is deprived of breastfeeding and [[Weaning|weaned]] to a diet composed largely of carbohydrates.<ref name="listeningga">{{cite book | vauthors = Stanton J | chapter = Listening to the Ga: Cicely Williams' Discovery of Kwashiorkor on the Gold Coast | title = Women and Modern Medicine | series = Clio Medica | volume = 61 | pages = 149–171 | year = 2001 | pmid = 11603151 | doi = 10.1163/9789004333390_008 | isbn = 978-90-04-33339-0 | s2cid = 34931635 }}</ref>

''Marasmus'' (meaning 'to waste away') can result from a sustained diet that is deficient in both protein and energy. This causes their [[metabolism]] to adapt to prolong survival.<ref name="Clinical Nutrition in Practice (2011)" /> The primary symptoms are severe wasting, leaving little or no [[edema]]; minimal [[Subcutaneous tissue|subcutaneous fat]]; and abnormal [[serum albumin]] levels.<ref name="Clinical Nutrition in Practice (2011)" /> It is traditionally seen in cases of [[famine]], significant food restriction, or severe [[anorexia nervosa|anorexia]].<ref name="Clinical Nutrition in Practice (2011)" /> Conditions are characterized by extreme wasting of the muscles and a gaunt expression.<ref name="Chowdhury 2008" />

===Overnutrition===
Excessive consumption of energy-dense foods and drinks and limited physical activity causes overnutrition.<ref>{{cite web |publisher=World Health Organization |date=2021 |title=Fact sheets – Malnutrition |url=https://www.who.int/news-room/fact-sheets/detail/malnutrition |access-date=27 January 2022}}</ref> It causes overweight, defined as a [[body mass index]] (BMI) of 25 or more, and can lead to obesity (a BMI of 30 or more).<ref name=":3" /><ref name=Young2012>{{cite book| vauthors = Young EM |title=Food and development |date=2012 |publisher=Routledge |location=Abingdon, Oxon|isbn=978-1-135-99941-4|pages=36–38 |url= https://books.google.com/books?id=XhwKwNzJVjQC&pg=PA36 }}</ref> Obesity has become a major health issue worldwide.<ref>The GBD. 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N. Engl J Med. 2017;377:13–27.</ref> Overnutrition is linked to [[Chronic condition|chronic non-communicable diseases]] like [[diabetes]], certain cancers, and [[cardiovascular diseases]]. Hence identifying and addressing the immediate risk factors has become a major health priority.<ref>Nicolaidis S. Environment and obesity. Metabolism. 2019;100s:153942.</ref> The recent evidence on the impact of diet-induced obesity in fathers and mothers around the time of conception is identified to negatively program the health outcomes of multiple generations.<ref>Billah, M., Khatiwada, S., Morris, M., & Maloney, C. (2022). Effects of paternal overnutrition and interventions on future generations. International Journal Of Obesity, 46(5), 901–917. doi: 10.1038/s41366-021-01042-7</ref>

According to UNICEF, at least 1 in every 10 children under five is overweight in 33 countries.<ref>{{Cite web |title=Diets |url=https://data.unicef.org/topic/nutrition/diets/ |access-date=2023-11-08 |website=UNICEF DATA |language=en-US}}</ref>

==Classifying malnutrition==
===Definition by Gomez and Galvan===
In 1956, Gómez and Galvan studied factors associated with death in a group of undernourished children in a hospital in [[Mexico City]], Mexico. They defined three categories of malnutrition: first, second, and third degree.<ref name="Stevenson 2011">{{cite journal | vauthors = Stevenson RD, Conaway MR | title = Weight and mortality rates: "Gómez classification" for children with cerebral palsy? | journal = Pediatrics | volume = 128 | issue = 2 | pages = e436–e437 | date = August 2011 | pmid = 21768321 | doi = 10.1542/peds.2011-1472 | s2cid = 1708728 }}</ref> The degree of malnutrition is calculated based on a child's body size compared to the [[median]] weight for their age.<ref name="Grover 2009" /> The risk of death increases with increasing degrees of malnutrition.<ref name="Stevenson 2011" />

An adaptation of Gomez's original classification is still used today. While it provides a way to compare malnutrition within and between populations, this classification system has been criticized for being "[[Arbitrariness|arbitrary]]" and for not considering overweight as a form of malnutrition. Also, height alone may not be the best indicator of malnutrition; children who are [[Preterm birth|born prematurely]] may be considered short for their age even if they have good nutrition.<ref name="Gueri 1980">{{cite journal | vauthors = Gueri M, Gurney JM, Jutsum P | title = The Gomez classification. Time for a change? | journal = Bulletin of the World Health Organization | volume = 58 | issue = 5 | pages = 773–777 | year = 1980 | pmid = 6975186 | pmc = 2395976 | url = http://whqlibdoc.who.int/bulletin/1980/Vol58-No5/bulletin_1980_58(5)_773-777.pdf | archive-url = https://web.archive.org/web/20050127083406/http://whqlibdoc.who.int/bulletin/1980/Vol58-No5/bulletin_1980_58(5)_773-777.pdf | archive-date = January 27, 2005 }}</ref>

{| class="wikitable"
|-
! Degree of PEM
! % of desired body weight for age and sex
|-
| Normal
| 90–100%
|-
| Mild: Grade I (1st degree)
| 75–89%
|-
| Moderate: Grade II (2nd degree)
| 60–74%
|-
| Severe: Grade III (3rd degree)
|<60%
|-
!colspan=16|<small>SOURCE:"Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition"<ref name="Chowdhury 2008">{{cite journal | vauthors = Chowdhury MS, Akhter N, Haque M, Aziz R, Nahar N | title = Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition | journal = Journal of Bangladesh Society of Physiologist | volume = 3 | pages = 58–60 | year = 2009 | doi = 10.3329/jbsp.v3i0.1799 | doi-access = free }}</ref></small>
|}

===Definition by Waterlow===
In the 1970s, [[John Waterlow|John Conrad Waterlow]] established a new classification system for malnutrition.<ref name="Waterlow 1972"/> Instead of using just weight for age measurements, Waterlow's system combines weight-for-height (indicating acute episodes of malnutrition) with height-for-age to show the stunting that results from chronic malnutrition.<ref name="J. C. Waterlow">{{cite journal| vauthors = Watts G |title=John Conrad Waterlow|journal=The Lancet|date=December 2010|volume=376|issue=9757|page=1982|doi=10.1016/S0140-6736(10)62252-0|s2cid=54424049}}</ref> One advantage of the Waterlow classification is that weight for height can be calculated even if a child's age is unknown.<ref name="Waterlow 1972"/>

{| class="wikitable"
|-
! Degree of PEM
! Stunting (%) Height for age
! Wasting (%) Weight for height
|-
| Normal: Grade 0
| >95%
| >90%
|-
| Mild: Grade I
| 87.5–95%
| 80–90%
|-
| Moderate: Grade II
| 80–87.5%
| 70–80%
|-
| Severe: Grade III
| <80%
| <70%
|-
!colspan=16|<small>SOURCE: "Classification and definition of protein-calorie malnutrition." by Waterlow, 1972<ref name="Waterlow 1972">{{cite journal | vauthors = Waterlow JC | title = Classification and definition of protein-calorie malnutrition | journal = British Medical Journal | volume = 3 | issue = 5826 | pages = 566–569 | date = September 1972 | pmid = 4627051 | pmc = 1785878 | doi = 10.1136/bmj.3.5826.566 }}</ref></small>
|}

The World Health Organization frequently uses these classifications of malnutrition, with some modifications.<ref name="Grover 2009"/>

==Effects==
{{See also|Stunted growth|Wasting}}
[[File:Sharecropper's child suffering from rickets and malnutrition, Wilson cotton plantation, Mississippi County, Arkansas, LC-USF33-002002-M2 (6288133677) (cropped).jpg|thumb|upright|Child of a [[sharecropper]] with undernutrition and [[rickets]], 1935]]

Undernutrition weakens every part of the [[immune system]].<ref name="Stillwaggon 2008" /> Protein and energy undernutrition increases susceptibility to infection; so do deficiencies of specific micronutrients (including iron, [[zinc]], and vitamins).<ref name="Stillwaggon 2008">{{cite journal| vauthors = Stillwaggon E |title=Race, Sex, and the Neglected Risks for Women and Girls in Sub-Saharan Africa|journal=Feminist Economics|year=2008|volume=14|issue=4|pages=67–86|doi=10.1080/13545700802262923|s2cid=154082747}}</ref> In communities or areas that lack access to [[Potable|safe drinking water]], these additional health risks present a critical problem.{{citation needed|date=February 2023}}

Undernutrition plays a major role in the onset of active [[tuberculosis]].<ref>{{cite journal | vauthors = Schaible UE, Kaufmann SH | title = Malnutrition and infection: complex mechanisms and global impacts | journal = PLOS Medicine | volume = 4 | issue = 5 | article-number = e115 | date = May 2007 | pmid = 17472433 | pmc = 1858706 | doi = 10.1371/journal.pmed.0040115 | doi-access = free }}</ref> It also raises the risk of HIV transmission from mother to child, and increases [[DNA replication|replication]] of [[HIV|the virus]].<ref name="Stillwaggon 2008" /> Undernutrition can cause [[Avitaminosis|vitamin-deficiency-related diseases]] like [[scurvy]] and [[rickets]]. As undernutrition worsens, those affected have less energy and experience impairment in brain functions.{{citation needed|date=February 2023}}

Undernutrition can also cause acute problems, like [[hypoglycemia]] (low [[Blood sugar level|blood sugar]]). This condition can cause lethargy, limpness, [[seizure]]s, and [[Unconsciousness|loss of consciousness]]. Children are particularly at risk and can become hypoglycemic after 4 to 6 hours without food. [[Dehydration]] can also occur in malnourished people, and can be life-threatening, especially in babies and small children.{{citation needed|date=February 2023}}

===Signs===
There are many different signs of dehydration in undernourished people. These can include sunken eyes; a very dry mouth; decreased urine output and/or dark urine; increased heart rate with decreasing blood pressure; and [[altered mental status]].

{| class="wikitable"
|-
! Site !! Sign
|-
| Face || Moon face (in kwashiorkor); shrunken, monkey-like face (in marasmus)
|-
| Eye || Dry eyes; pale [[conjunctiva]]; [[periorbital edema]]; [[Bitot's spots]] (in vitamin A deficiency)
|-
| Mouth || [[Angular stomatitis]]; [[cheilitis]]; [[glossitis]]; [[parotid enlargement]]; spongy, bleeding [[gums]] (in vitamin C and B<sub>12</sub> deficiencies)
|-
| Teeth || [[Tooth enamel|Enamel]] mottling; delayed eruption
|-
| Hair || Dull, sparse, brittle hair, with thinning of the [[hair follicle]]s; hypopigmentation; flag sign (alternating bands of light and normal color); broomstick [[eyelash]]es; [[alopecia]]
|-
| Skin || Dry skin; [[follicular hyperkeratosis]]; patchy [[Hyperpigmentation|hyper]]- and hypopigmentation; [[Erosion (dermatology)|erosions]]; poor [[wound healing]]; loose and wrinkled skin (in marasmus); shiny and edematous skin (in kwashiorkor)
|-
| Nail || [[Koilonychia]]; thin and soft nail plates; fissures or ridges
|-
| [[Musculature]]|| [[Muscle wasting]], particularly in the buttocks and thighs
|-
| [[Skeletal system|Skeletal]]|| [[Deformity|Deformities]], usually resulting from deficiencies in [[hypocalcemia|calcium]], [[Vitamin D deficiency|vitamin D]], or vitamin C
|-
| [[Abdomen]]|| Distended; [[hepatomegaly]] with [[Fatty liver disease|fatty liver]]; possible [[ascites]]
|-
| [[Circulatory system|Cardiovascular]]|| [[Bradycardia]]; [[hypotension]]; reduced [[cardiac output]]; small vessel [[vasculopathy]]
|-
| [[Neurological disorder|Neurologic]]|| [[Global developmental delay]]; [[Areflexia|loss of knee and ankle reflexes]]; poor [[memory]], often resulting from deficiencies in [[Vitamin B12|vitamin B<sub>12</sub>]] and other [[B vitamins]]
|-
| [[Hematology|Hematological]]|| [[Pallor]]; [[petechia]]e; [[bleeding diathesis]]
|-
| Behavior || Lethargic; [[Apathy|apathetic]]; [[Anxiety|anxious]]
|-
!colspan=16|<small>Source: "Protein Energy Malnutrition"<ref name="Grover 2009" /></small>
|}

===Cognitive development===
[[Protein-calorie malnutrition]] can cause [[cognitive impairment]]s. This most commonly occurs in people who were malnourished during a "critical period ... from the final third of [[gestation]] to the first 2 years of life".<ref>{{cite journal | vauthors = Laus MF, Vales LD, Costa TM, Almeida SS | title = Early postnatal protein-calorie malnutrition and cognition: a review of human and animal studies | journal = International Journal of Environmental Research and Public Health | volume = 8 | issue = 2 | pages = 590–612 | date = February 2011 | pmid = 21556206 | pmc = 3084481 | doi = 10.3390/ijerph8020590 | doi-access = free }}</ref> For example, in children under two years of age, iron deficiency anemia is likely to affect brain function acutely, and probably also chronically. Similarly, [[folate]] deficiency has been linked to [[neural tube defect]]s.<ref>{{cite book |author=Kenton R. Holden |title=Neurologic Consequences of Malnutrition|chapter=Malnutrition and Brain Development: A Review |date=2007 |publisher=Demos Medical Publishing |location=New York, NY|isbn=978-1-933864-03-7|url=http://www.siecv.net/docs/neurological-consequences-malnutrition.pdf#page=33 |access-date=March 3, 2014 |archive-url=https://web.archive.org/web/20130510182851/http://www.siecv.net/docs/neurological-consequences-malnutrition.pdf#page=33 |archive-date=May 10, 2013 }}</ref>

Iodine deficiency is "the most common preventable cause of mental impairment worldwide."<ref name="salt">{{cite news |title=In raising the world's IQ the secret is in salt |newspaper=New York Times |date=December 16, 2006 |url=https://www.nytimes.com/2006/12/16/health/16iodine.html | vauthors = McNeil Jr DG }}</ref><ref>{{cite journal | vauthors = Kapil U | title = Health consequences of iodine deficiency | journal = Sultan Qaboos University Medical Journal | volume = 7 | issue = 3 | pages = 267–272 | date = December 2007 | doi = 10.18295/2075-0528.2681 | pmid = 21748117 | pmc = 3074887 }}</ref> "Even moderate [iodine] deficiency, especially in pregnant women and [[infant]]s, lowers intelligence by 10 to 15 [[Intelligence quotient|I.Q. points]], shaving incalculable potential off a nation's development."<ref name=salt /> Among those affected, very few people experience the most visible and severe effects: disabling [[Goitre|goiters]], [[cretinism]] and [[dwarfism]]. These effects occur most commonly in mountain villages. However, 16 percent of the world's people have at least mild goiter (a swollen [[Thyroid|thyroid gland]] in the neck)."<ref name="salt" /><ref>{{Cite web|date=2021-08-27|title=Bệnh suy dinh dưỡng trẻ em: Tổng hợp năm 2021|url=https://ykhoablog.com/benh-hoc/benh-suy-dinh-duong-tre-em-tong-hop-nam-2021/|access-date=2021-10-04|website=Y Khoa Blog|language=vi}}</ref>

==Causes and risk factors==
{{See also|List of types of malnutrition}}
[[File:Prisoner of war, from Belle Isle, Richmond, at the U.S. General Hospital, Div. 1, Annapolis.jpg|thumb|upright=0.75|[[Union Army]] soldier on his release from [[Confederate States of America|Confederate]] prison, around 1865]]

===Social and political===
[[File:Starved child.jpg|thumb|upright=0.75|A child with extreme malnutrition]]

Social conditions have a significant influence on the health of people.<ref>Hossain, A., Niroula, B., Duwal, S., Ahmed, S. and Kibria, M., 2020. Maternal profiles and social determinants of severe acute malnutrition among children under-five years of age: A case-control study in Nepal. Heliyon, 6(5), p.e03849.</ref> The social determinants of undernutrition mainly include poor education, poverty, disease burden and lack of women's empowerment.<ref name="Bhutta, Z. 2008. pp.417-440">Bhutta, Z., Ahmed, T., Black, R., Cousens, S., Dewey, K., Giugliani, E., Haider, B., Kirkwood, B., Morris, S., Sachdev, H. and Shekar, M., 2008. What works? Interventions for maternal and child undernutrition and survival. The Lancet, 371(9610), pp.417–440.</ref> Identifying and addressing these determinants can eliminate undernutrition in the long term.<ref name="Bhutta, Z. 2008. pp.417-440"/> Identification of the social conditions that causes malnutrition in children under five has received significant research attention as it is a major public health problem.{{citation needed|date=March 2023}}

Undernutrition most commonly results from a lack of access to high-quality, nutritious food.<ref name="WHO2014">{{cite web|title=Maternal, newborn, child and adolescent health|url=https://www.who.int/maternal_child_adolescent/topics/child/malnutrition/en/|archive-url=https://web.archive.org/web/20120310002015/http://www.who.int/maternal_child_adolescent/topics/child/malnutrition/en/|archive-date=March 10, 2012|access-date=July 4, 2014|website=WHO}}</ref> The household income is a socio-economic variable that influences the access to nutritious food and the probability of under and overnutrition in a community.<ref>Aheto JM, Keegan TJ, Taylor BM, Diggle PJ. Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana. Paediatr Perinat Epidemiol. 2015;29(6):552–61.
</ref> In the study by Ghattas et al. (2020), the probability of overnutrition is significantly higher in higher-income families than in disadvantaged families.<ref name="Ghattas, H. 2020"/> High [[food prices]] is a major factor preventing low income households from getting nutritious food<ref name=FFL2010/><ref name=WHO2014/> For example, Khan and Kraemer (2009) found that in [[Bangladesh]], low [[socioeconomic status]] was associated with chronic malnutrition since it inhibited purchase of nutritious foods (like milk, meat, poultry, and fruits).<ref name="Factors in Bangladesh">{{cite journal | vauthors = Khan MM, Kraemer A | title = Factors associated with being underweight, overweight and obese among ever-married non-pregnant urban women in Bangladesh | journal = Singapore Medical Journal | volume = 50 | issue = 8 | pages = 804–813 | date = August 2009 | pmid = 19710981 }}</ref>

[[Famine|Food shortage]]s may also contribute to malnutritions in countries which lack technology. However, in the developing world, eighty percent of malnourished children live in countries that produce food surpluses, according to estimates from the [[FAO|Food and Agriculture Organization (FAO)]].<ref name=Gardner00>{{cite journal | vauthors = Gardner G, Halweil B |title=Escaping Hunger, Escaping Excess |journal=World Watch |volume=13 |issue=4 |page=24 |year=2000 |url=http://www.worldwatch.org/node/488 |access-date=September 25, 2011 |archive-url=https://web.archive.org/web/20120112195527/http://www.worldwatch.org/node/488 |archive-date=January 12, 2012 }}</ref> The economist [[Amartya Sen]] observes that, in recent decades, famine has always been a problem of [[food distribution]], [[purchasing power]], and/or poverty, since there has always been enough food for everyone in the world.<ref name=Sen81>{{cite book | vauthors = Sen AK |title=Poverty and famines: An essay on entitlement and deprivation |url=https://books.google.com/books?id=BzU_AwAAQBAJ |year=1981 |publisher=Oxford University Press |isbn=978-0-19-828463-5}}</ref>

There are also [[Political sociology|sociopolitical]] causes of malnutrition. For example, the population of a community might be at increased risk for malnutrition if government is poor and the area lacks health-related services. On a smaller scale, certain households or individuals may be at an even higher risk due to [[Economic inequality|differences in income levels]], access to land, or levels of education.<ref>{{cite journal | vauthors = Fotso JC, Kuate-Defo B | title = Measuring socioeconomic status in health research in developing countries: Should we be focusing on households, communities or both? | journal = Social Indicators Research | volume = 72 | issue = 2 | pages = 189–237 | year = 2005 | doi = 10.1007/s11205-004-5579-8 | s2cid = 144596985 }}</ref> Community plays a crucial role in addressing the social causes of malnutrition.<ref>Alvear-Vega, S. and Vargas-Garrido, H., 2022. Social determinants of malnutrition in Chilean children aged up to five. BMC Public Health, 22(1).</ref> For example, communities with high social support and knowledge sharing about social protection programs can enable better public service demands.<ref>Tasnim, T., 2018. Determinants of Malnutrition in Children Under Five Years in Developing Countries: A Systematic Review. Indian Journal of Public Health Research &amp; Development, 9(6), p.333.</ref> Better public service demands and social protection programs minimise the risk of malnutrition in these communities.

It is argued that [[commodity]] [[Speculation|speculators]] are increasing the cost of food. As the [[real-estate bubble]] in the United States was collapsing, it is said that trillions of dollars moved to [[Investment|invest]] in food and primary commodities, causing the 2007–2008 [[food price crisis]].<ref>{{cite news |title=The role of speculators in the global food crisis |newspaper=Spiegel Online |url=http://www.spiegel.de/international/world/0,1518,549187,00.html}}</ref>

The use of [[biofuel]]s as a replacement for traditional fuels raises the price of food.<ref>{{cite news |title=Biofuel use increasing poverty |newspaper=BBC News |date= June 25, 2008|url=https://news.bbc.co.uk/2/hi/europe/7472532.stm}}</ref> The United Nations special [[rapporteur]] on the [[right to food]], [[Jean Ziegler]] proposes that [[agricultural waste]], such as [[Corncob|corn cobs]] and [[banana leaves]], should be used as fuel instead of crops.<ref>{{cite news |title=Biofuels 'crime against humanity' |newspaper=BBC News |date= October 27, 2007|url=https://news.bbc.co.uk/2/hi/americas/7065061.stm | vauthors = Ferrett G }}</ref>

In some developing countries, overnutrition (in the form of obesity) is beginning to appear in the same communities where malnutrition occurs.<ref>{{cite web |title=Progress For Children: A Report Card On Nutrition |url=http://www.unicef.org/nutrition/files/Progress_for_Children_-_No._4.pdf |publisher=UNICEF |access-date=March 19, 2012 |archive-date=January 12, 2021 |archive-url=https://web.archive.org/web/20210112154958/https://www.unicef.org/nutrition/files/Progress_for_Children_-_No._4.pdf }}</ref> Overnutrition increases with urbanisation, food commercialisation and technological developments and increases physical inactivity.<ref>Tremblay, M., Gray, C., Akinroye, K., Harrington, D., Katzmarzyk, P., Lambert, E., Liukkonen, J., Maddison, R., Ocansey, R., Onywera, V., Prista, A., Reilly, J., Martínez, M., Duenas, O., Standage, M. and Tomkinson, G., 2014. Physical Activity of Children: A Global Matrix of Grades Comparing 15 Countries. Journal of Physical Activity and Health, 11(s1), pp.S113-S125.
</ref> Variations in the health status of individuals in the same society are associated with the societal structure and an individual's socioeconomic status which leads to income inequality, racism, educational differences and lack of opportunities.<ref>Gabriele, A. and Schettino, F., 2008. Child Malnutrition and Mortality in Developing Countries: Evidence from a Cross-Country Analysis. Analyses of Social Issues and Public Policy, 8(1), pp. 53–81.</ref>

===Diseases and conditions===
[[Infectious diseases]] which increase nutrient requirements, such as [[gastroenteritis]],<ref>{{cite book | veditors = Mandell GL, Bennett JE, Dolin R, Douglas RG |title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|year=2010|publisher=Churchill Livingstone/Elsevier|location=Philadelphia|isbn=978-0-443-06839-3|pages=Chp 93|edition=7th}}</ref> [[pneumonia]], [[malaria]], and [[measles]], can cause malnutrition.<ref name=WHO2014/> So can some chronic illnesses, especially [[AIDS|HIV/AIDS]].<ref>{{EMedicine|article|985140|Malnutrition}}</ref><ref>{{cite journal | vauthors = Baro M, Deubel TF | title = Persistent Hunger: Perspectives on Vulnerability, Famine, and Food Security in Sub-Saharan Africa | journal = Annual Review of Anthropology | volume = 35 | pages = 521–538 | year = 2006 | doi = 10.1146/annurev.anthro.35.081705.123224 }}</ref>

Malnutrition can also result from abnormal nutrient loss due to [[diarrhea]] or chronic [[Small intestine|small bowel]] illnesses, like [[Crohn's disease]] or untreated [[coeliac disease]].<ref name=PapadiaDiSabatino2014 >{{cite journal | vauthors = Papadia C, Di Sabatino A, Corazza GR, Forbes A | title = Diagnosing small bowel malabsorption: a review | journal = Internal and Emergency Medicine | volume = 9 | issue = 1 | pages = 3–8 | date = February 2014 | pmid = 23179329 | doi = 10.1007/s11739-012-0877-7 | type = Review | s2cid = 33775071 }}</ref><ref name=KastinBuchman2002 >{{cite journal | vauthors = Kastin DA, Buchman AL | title = Malnutrition and gastrointestinal disease | journal = Current Opinion in Clinical Nutrition and Metabolic Care | volume = 5 | issue = 6 | pages = 699–706 | date = November 2002 | pmid = 12394647 | doi = 10.1097/00075197-200211000-00014 | type = Review }}</ref><ref name=Newnham2017>{{cite journal | vauthors = Newnham ED | title = Coeliac disease in the 21st century: paradigm shifts in the modern age | journal = Journal of Gastroenterology and Hepatology | volume = 32 | issue = Suppl 1 | pages = 82–85 | date = March 2017 | pmid = 28244672 | doi = 10.1111/jgh.13704 | quote = The epidemiology of coeliac disease (CD) is changing. Presentation of CD with malabsorptive symptoms or malnutrition is now the exception rather than the rule | doi-access = free | type = Review }}{{free access}}</ref> "Secondary malnutrition" can result from increased energy expenditure.<ref name="Grover 2009">{{cite journal | vauthors = Grover Z, Ee LC | title = Protein energy malnutrition | journal = Pediatric Clinics of North America | volume = 56 | issue = 5 | pages = 1055–1068 | date = October 2009 | pmid = 19931063 | doi = 10.1016/j.pcl.2009.07.001 }}</ref><ref name= "WHO 2001">{{Cite web|author= World Health Organization |title=Water-related diseases: Malnutrition |year= 2001 |url=https://www.who.int/water_sanitation_health/diseases/malnutrition/en/.|archive-url=https://web.archive.org/web/20031211072636/http://www.who.int/water_sanitation_health/diseases/malnutrition/en/|archive-date=December 11, 2003}}</ref>

In infants, a lack of breastfeeding may contribute to undernourishment.<ref name="Grover 2009"/><ref name= "WHO 2001"/> Anorexia nervosa and [[bariatric surgery]] can also cause malnutrition.<ref>{{cite book | veditors = Caballero B, Lindsay A, Prentice A |title=Encyclopedia of human nutrition |date=2005 |publisher=Elsevier/Academic Press |location=Amsterdam |isbn=978-0-08-045428-3 |page=68 |edition=2nd |url=https://books.google.com/books?id=DHtERWm0mrcC&pg=RA1-PA68}}</ref><ref>{{cite book|title=Stoelting's anesthesia and co-existing disease|date=2012|publisher=Saunders/Elsevier|location=Philadelphia|isbn=978-1-4557-3812-0|page=324|edition=6th|url=https://books.google.com/books?id=yxTtmJYPUV0C&pg=PA324}}</ref>

===Dietary practices===
==== Undernutrition ====
Undernutrition due to lack of adequate breastfeeding is associated with the deaths of an estimated one million children annually. Illegal advertising of [[breast-milk substitute]]s contributed to malnutrition and continued three decades after its 1981 prohibition under the ''WHO International Code of Marketing Breast Milk Substitutes''.<ref>{{cite journal | vauthors = Brady JP | title = Marketing breast milk substitutes: problems and perils throughout the world | journal = Archives of Disease in Childhood | volume = 97 | issue = 6 | pages = 529–532 | date = June 2012 | pmid = 22419779 | pmc = 3371222 | doi = 10.1136/archdischild-2011-301299 }}</ref>

Maternal malnutrition can also factor into the poor health or death of a baby. Over 800,000 [[neonatal deaths]] have occurred because of deficient growth of the [[fetus]] in the [[Uterus|mother's womb]].<ref>{{Cite news|url=https://www.medicalnewstoday.com/articles/261533.php|title=Malnutrition Kills Over 3 Million Children Annually Worldwide|work=Medical News Today|access-date=February 20, 2018|language=en}}</ref>

Deriving too much of one's diet from a single source, such as eating almost exclusively potato, maize or rice, can cause malnutrition. This may either be from a lack of education about proper nutrition, only having access to a single food source, or from poor healthcare access and unhealthy environments.<ref name=Burchi>{{cite journal | vauthors = Burchi F, Fanzo J, Frison E | title = The role of food and nutrition system approaches in tackling hidden hunger | journal = International Journal of Environmental Research and Public Health | volume = 8 | issue = 2 | pages = 358–373 | date = February 2011 | pmid = 21556191 | pmc = 3084466 | doi = 10.3390/ijerph8020358 | doi-access = free }}</ref><ref>{{Cite web|url=https://www.un.org/en/development/desa/population/events/pdf/expert/30/presentations/Tuesday/Session4/Causes%20-%20Consequences%20of%20Undernutrition%20ICPD%20-%20UNICEF.pdf|title = Causes and Impacts of Undernutrition over the Life Course}}</ref>

It is not just the total amount of calories that matters but specific nutritional deficiencies such as vitamin A deficiency, [[iron deficiency]] or [[zinc deficiency]] can also increase risk of death.<ref name=":1">UNICEF (2013). [http://www.susana.org/en/resources/library/details/2148 Improving Child Nutrition – The achievable imperative for global progress]. UNICEF</ref>

==== Overnutrition ====
[[File:Obesity and Diabetes Trend Chart.jpg|thumb|262x262px|Chart showing a trend between obesity and diabetes over the years]]

Overnutrition caused by [[overeating]] is also a form of malnutrition. In the United States, more than half of all adults are now overweight—a condition that, like hunger, increases susceptibility to disease and disability, reduces worker [[productivity]], and lowers [[life expectancy]].<ref name="Gardner00" /> Overeating is much more common in the United States, since most people have adequate access to food. Many parts of the world have access to a [[Surplus product|surplus]] of non-nutritious food. Increased [[sedentary lifestyle]]s also contribute to overnutrition. [[Yale University]] psychologist Kelly Brownell calls this a "[[toxic food environment]]", where fat- and sugar-laden foods have taken precedence over healthy nutritious foods.<ref name="Gardner00" />

In these developed countries, overnutrition can be prevented by choosing the right kind of food. More fast food is consumed per capita in the United States than in any other country. This mass consumption of fast food results from its affordability and accessibility. Fast food, which is low in cost and nutrition, is high in calories. Due to increasing urbanization and [[automation]], people are living more sedentary lifestyles. These factors combine to make weight gain difficult to avoid.<ref name="Gardner00_5">{{cite journal| vauthors = Gardner G, Halweil B |year=2000|title=Escaping Hunger, Escaping Excess |url= http://www.worldwatch.org/node/488 |journal=World Watch |volume=13 |issue=4 |page=5 |access-date=September 25, 2011 |archive-url=https://web.archive.org/web/20120112195527/http://www.worldwatch.org/node/488 |archive-date=January 12, 2012 }}</ref>

Overnutrition also occurs in developing countries. It has appeared in parts of developing countries where income is on the rise.<ref name="Gardner00" /> It is also a problem in countries where hunger and poverty persist. Economic development, rapid urbanisation and shifting dietary patterns have increased the burden of overnutrition in the cities of low and middle-income countries.<ref>Ofori-Asenso, R., Agyeman, A., Laar, A. and Boateng, D., 2016. Overweight and obesity epidemic in Ghana{{snd}}a systematic review and meta-analysis. BMC Public Health, 16(1).</ref> In China, consumption of high-fat foods has increased, while consumption of rice and other goods has decreased.<ref name="Gardner00" />
Overeating leads to many diseases, such as [[heart disease]] and diabetes, that may be fatal.

===Agricultural productivity===
[[File:Most of the people unable to afford a healthy diet in 2021 lived in southern Asia, and in eastern and western Africa.svg|thumb|Most of the people unable to afford a healthy diet in 2021 lived in southern Asia, and in eastern and western Africa.]]
Local food shortages can be caused by a lack of [[arable land]], adverse weather, and/or poorer farming skills (like inadequate [[crop rotation]]). They can also occur in areas which lack the technology or resources needed for the higher yields found in modern agriculture. These resources include [[fertilizer]]s, [[pesticide]]s, [[irrigation]], [[Agricultural machinery|machinery]], and storage facilities. As a result of widespread poverty, farmers and governments cannot provide enough of these resources to improve local yields.{{citation needed|date=March 2023}}

Additionally, the [[World Bank]] and some wealthy donor countries have pressured developing countries to use [[free market]] policies. Even as the United States and Europe extensively [[subsidy|subsidized]] their own farmers, they urged developing countries to cut or eliminate subsidized agricultural inputs, like fertilizer.<ref name=newyorktimes>{{cite news |title=Ending Famine, Simply by Ignoring the Experts |newspaper=New York Times |date=December 2, 2007 |url=https://www.nytimes.com/2007/12/02/world/africa/02malawi.html | vauthors = Dugger CW }}</ref><ref>{{cite news |title=Zambia: fertile but hungry |newspaper=BBC News |date= February 6, 2006|url=https://news.bbc.co.uk/2/hi/africa/4678592.stm | vauthors = Biles P }}</ref> Without subsidies, few (if any) farmers in developing countries can afford fertilizer at [[market prices]]. This leads to low agricultural production, low wages, and high, unaffordable food prices.<ref name=newyorktimes/> Fertilizer is also increasingly unavailable because Western [[Environmental movement|environmental groups]] have fought to end its use due to environmental concerns. The [[Green Revolution]] pioneers [[Norman Borlaug]] and Keith Rosenberg cited as the obstacle to feeding Africa by .<ref name=atlantic>{{cite news |title=Forgotten benefactor of humanity |newspaper=The Atlantic |url=https://www.theatlantic.com/issues/97jan/borlaug/borlaug.htm}}</ref>

===Future threats===
In the future, variety of factors could potentially disrupt global food supply and cause widespread malnutrition. According to UNICEF's projections, it is projected that almost 600 million people will be chronically undernourished in 2030.<ref>{{Cite book |url=https://openknowledge.fao.org/handle/20.500.14283/cd1254en |title=The State of Food Security and Nutrition in the World 2024 |date=2024 |publisher=FAO; IFAD; UNICEF; WFP; WHO |isbn=978-92-5-138882-2 |language=English |doi=10.4060/cd1254en}}</ref><ref>{{Cite web |last=Moumen |first=Hana |date=2023-07-12 |title=State of Food Security and Nutrition in the World (SOFI) 2023 |url=https://data.unicef.org/resources/sofi-2023/ |access-date=2023-11-08 |website=UNICEF DATA |language=en-US}}</ref>

[[Global warming]] is of importance to food security. Almost all malnourished people (95%) live in the tropics and [[subtropics]], where the climate is relatively stable. According to the [[Intergovernmental Panel on Climate Change]] report in 2007, temperature increases in these regions are "very likely."<ref name=ipcc>{{cite web |title= Climate Change 2007: Synthesis Report |date=November 12–17, 2007 |publisher=Intergovernmental Panel on Climate Change |url=http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr.pdf |access-date=January 27, 2010}}</ref> Even small changes in temperatures can make [[extreme weather]] conditions occur more frequently.<ref name=ipcc /> Extreme weather events, like drought, have a major impact on agricultural production, and hence nutrition. For example, the 1998–2001 Central Asian drought killed about 80 percent of livestock in Iran and caused a 50% reduction in wheat and [[barley]] crops there.<ref>Battisti, David S. "Climate Change in Developing Countries." University of Washington. Seattle. October 27, 2008.{{verify source|date=November 2012}}</ref> Other central Asian nations experienced similar losses. An increase in extreme weather such as drought in regions such as [[Sub-Saharan Africa]] would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productivity of many crop [[species]], and decreases food security in these regions.<ref name=ipcc /><ref>{{cite news |author=Black, Richard |title=Rice yields falling under global warming |work=BBC News; Science & Environment |date=August 9, 2010 |url=https://www.bbc.co.uk/news/science-environment-10918591}}</ref>

Another threat is [[colony collapse disorder]], a phenomenon where [[bee]]s die in large numbers.<ref>[http://aginfo.psu.edu/news/2007/1/HoneyBees.htm Honey Bee Die-Off Alarms Beekeepers, Crop growers and researchers]</ref> Since [[list of crop plants pollinated by bees|many agricultural crops worldwide are pollinated by bees]], colony collapse disorder represents a threat to the global food supply.<ref>{{cite news |title=Vanishing bees threaten US crops |work=BBC News |date= March 11, 2007|url=https://news.bbc.co.uk/2/hi/americas/6438373.stm | vauthors = Wells M }}</ref>

==Prevention==
{{See also|Famine relief}}
[[File:Vallee fertile du Nil a Louxor.jpg|thumb|right|[[Irrigation]] canals have opened dry desert areas of [[Egypt]] to agriculture.]]
Reducing malnutrition is key part of the United Nations' [[Sustainable Development Goal 2]] ([[SDG2]]), "Zero Hunger", which aims to reduce malnutrition, undernutrition, and stunted child growth.<ref>{{cite web|title= Goal2: Zero Hunger – United Nations | url= https://www.un.org/sustainabledevelopment/hunger/}}</ref> Managing severe acute undernutrition in a community setting has received significant research attention.<ref name="Bhutta, Z. 2008. pp.417-440"/><ref name="Morley, J. 2012"/>

===Food security===
{{Main|Food security}}

In the 1950s and 1960s, the [[Green Revolution]] aimed to bring modern Western agricultural techniques (like [[nitrogen fertilizers]] and [[pesticide]]s) to Asia. Investments in agriculture, such as fund fertilizers and seeds, increased food [[harvest]]s and thus [[food production]]. Consequently, food prices and malnutrition decreased (as they had earlier in Western nations).<ref name=newyorktimes/><ref>{{cite news |author=Barclay, Eliza |title=How a Kenyan village tripled its corn harvest |newspaper=Christian Science Monitor |date=June 18, 2008 |url=https://www.csmonitor.com/2008/0618/p07s01-woaf.html}}</ref>

The Green Revolution was possible in Asia because of existing infrastructure and institutions, such as a system of roads and public [[seed]] companies that made seeds available.<ref>{{cite news |title=In Africa, prosperity from seeds falls short |newspaper=New York Times |date= October 10, 2007|url=https://www.nytimes.com/2007/10/10/world/africa/10rice.html | vauthors = Dugger CW }}</ref> These resources were in short supply in Africa, decreasing the Green Revolution's impact on the continent.

For example, almost five million of the 13 million people in [[Malawi]] used to need emergency [[food aid]]. However, in the early 2000s, the Malawian government changed its agricultural policies, and implemented subsidies for fertilizer and seed introduced against World Bank strictures. By 2007, farmers were producing record-breaking corn harvests. Corn production leaped to 3.4&nbsp;million in 2007 compared to 1.2&nbsp;million in 2005, making Malawi a major food exporter.<ref name="newyorktimes" /> Consequently, food prices lowered and wages for [[farmworker]]s rose.<ref name="newyorktimes" /> Such investments in agriculture are still needed in other African countries like the [[Democratic Republic of the Congo]] (DRC). Despite the country's great agricultural potential, the prevalence of malnutrition in the DRC is among the highest in the world.<ref>
{{cite web |author=John Ulimwengu|title=Need in a land of planty |publisher= dandc.eu |date=March 2013 |url=http://www.dandc.eu/en/article/spite-drcs-huge-agricultural-potential-many-people-lack-vital-nutrients|display-authors=etal}}</ref> Proponents for investing in agriculture include [[Jeffrey Sachs]], who argues that [[First World|wealthy countries]] should [[Investment|invest]] in fertilizer and seed for Africa's farmers.<ref name="newyorktimes" /><ref name="obama">{{cite news |title=Obama enlists major powers to aid poor farmers with $15 billion |work= The New York Times |date=July 9, 2009 |url= https://www.nytimes.com/2009/07/09/world/europe/09food.html | vauthors = Baker P, Dugger CW }}</ref>

Imported [[Ready-to-use therapeutic food|Ready to Use Therapeutic Food]] (RUTF) has been used to treat malnutrition in northern [[Nigeria]]. Some Nigerians also use [[Soybean|''soy'']] ''[[kunu]],'' a [[Local purchasing|locally sourced]] and prepared blend consisting of peanut, [[millet]] and [[soybean]]s.<ref name="Soykunu">{{cite news |title=Severe Malnutrition, A Disturbance in Nigerian Health Sector |work=Public Health Nigeria |date=October 12, 2018 |url=https://publichealthng.com/severe-malnutrition-a-disturbance-in-nigerian-health-sector/ |vauthors=Chinedu O |access-date=October 17, 2018 |archive-date=October 18, 2018 |archive-url=https://web.archive.org/web/20181018011613/https://publichealthng.com/severe-malnutrition-a-disturbance-in-nigerian-health-sector/ }}</ref>

New technology in agricultural production has great potential to combat undernutrition. It makes farming easier, thus improving agricultural yields.<ref>Li, Jiming, Yeyun Xin and Longping Yuan. (2010). Pushing the Yield Frontier: Hybrid rice in China. In MillionsFed: Proved Success in Agriculture Development. Washington, DC: International Policy Research Institute</ref> By increasing farmers' incomes, this could reduce poverty. It would also open up area which farmers could use to [[Agricultural diversification|diversify crops]] for household use.

The [[World Bank]] claims to be part of the solution to malnutrition, asserting that countries can best break the [[cycle of poverty]] and malnutrition by building export-led economies, which give them the financial means to buy [[foodstuff]]s on the world market.

===Economics===
Many aid groups have found that giving cash assistance (or cash vouchers) is more effective than donating food. Particularly in areas where food is available but unaffordable, giving cash assistance is a cheaper, faster, and more efficient way to deliver help to the hungry.<ref name="csmonitor">{{cite news|url=https://www.csmonitor.com/World/Africa/2008/0604/p01s02-woaf.html|title=UN aid debate: give cash not food?|date=June 4, 2008|newspaper=Christian Science Monitor}}</ref> In 2008, the UN's [[World Food Program]], the biggest non-governmental distributor of food, announced that it would begin distributing cash and vouchers instead of food in some areas, which [[Josette Sheeran]], the WFP's executive director, described as a "revolution" in food aid.<ref name="csmonitor" /><ref name="wfp">{{cite web|url=http://www.wfp.org/english/?ModuleID=137&Key=2899|title=Cash roll-out to help hunger hot spots|date=December 8, 2008|publisher=World Food Programme
|archive-url=https://web.archive.org/web/20090212124012/http://www.wfp.org/english/?ModuleID=137&Key=2899|archive-date=February 12, 2009}}</ref> The aid agency [[Concern Worldwide]] piloted a method of giving cash assistance using a [[mobile phone operator]], [[Safaricom]], which runs a money transfer program that allows cash to be sent from one part of a country to another.<ref name="csmonitor" />

However, during a drought, delivering food might be the most appropriate way to help people, especially those who live far from markets and thus have limited access to them.<ref name="csmonitor" /> [[Fred Cuny]] stated that "the chances of saving lives at the outset of a relief operation are greatly reduced when food is imported. By the time it arrives in the country and gets to people, many will have died."<ref>Andrew S. Natsios (Administrator U.S. Agency for International Development)</ref> U.S. law requires food aid to be purchased at home rather than in the countries where the hungry live; this is inefficient because approximately half of the money spent goes for transport.<ref name="Let them eat micronutrients" /> Cuny further pointed out that "studies of every recent famine have shown that food was available in-country—though not always in the immediate food deficit area" and "even though by local standards the prices are too high for the poor to purchase it, it would usually be cheaper for a donor to buy the [[Hoarding|hoarded]] food at the [[Price level|inflated price]] than to import it from abroad."<ref>Memorandum to former Representative Steve Solarz (United States, Democratic Party, New York), July 1994</ref>

[[File:MontrealSoupKitchen1931.jpg|thumb|A soup kitchen in [[Montreal]], Quebec, Canada in 1931]]
[[Food bank]]s and [[soup kitchen]]s address malnutrition in places where people lack money to buy food. A [[basic income]] has been proposed as a way to ensure that everyone has enough money to buy food and other basic needs. This is a form of [[social security]] in which all citizens or residents of a country regularly receive an unconditional sum of money, either from a government or some other public institution, in addition to any income received from elsewhere.<ref>{{cite web |url = http://www.canadiansocialresearch.net/ssrgai.htm |title = Improving Social Security in Canada Guaranteed Annual Income: A Supplementary Paper |publisher = Government of Canada |year = 1994 |access-date = November 30, 2013 |archive-date = May 21, 2012 |archive-url = https://web.archive.org/web/20120521154138/http://www.canadiansocialresearch.net/ssrgai.htm }}</ref>

==== Successful initiatives ====
[[Ethiopia]] pioneered a program that later became part of the World Bank's prescribed method for coping with a food crisis. Through the country's main food assistance program, the Productive Safety Net Program, Ethiopia provided rural residents who were chronically short of food a chance to work for food or cash. Foreign aid organizations like the World Food Program were then able to buy food locally from surplus areas to distribute in areas with a shortage of food.<ref>{{cite news|url=https://www.csmonitor.com/2008/0506/p01s06-woaf.html?page=2|title=A model of African food aid is now in trouble|date=May 6, 2008|newspaper=Christian Science Monitor}}</ref> Aid organizations now view the Ethiopian program as a model of how to best help hungry nations.{{citation needed|date=March 2023}}

Successful initiatives also include [[Brazil]]'s recycling program for [[Biodegradable waste|organic waste]], which benefits farmers, the urban poor, and the city in general. City residents separate organic waste from their garbage, bag it, and then exchange it for fresh fruit and vegetables from local farmers. This reduces the country's waste while giving the urban poor a steady supply of nutritious food.<ref name="Gardner00_5" />

===World population===
Restricting population size is a proposed solution to malnutrition. [[Thomas Malthus]] argues that [[population growth]] can be controlled by [[natural disaster]]s and by voluntary limits through "moral restraint."<ref>{{cite book | vauthors = Malthus TR, Appleman P |author-link=Thomas Malthus |title=An essay on the principle of population: text, sources and background, criticism |url=https://archive.org/details/essayonprinciple0000malt |url-access=registration |year=1976 |publisher=Norton |isbn=978-0-393-09202-8}}</ref> Robert Chapman suggests that government policies are a necessary ingredient for curtailing global population growth.<ref>{{cite journal | vauthors = Chapman R | title = No room at the inn, or why population problems are not all economic | journal = Population and Environment | volume = 21 | pages = 81–97 | year = 1999 | doi = 10.1007/BF02436122 | s2cid = 154975902 }}</ref> The United Nations recognizes that poverty and malnutrition (as well as the environment) are interdependent and complementary with population growth.<ref>{{Cite web|url=http://www.un.org/en/development/desa/population/theme/environment/index.shtml|title=Environment – United Nations Population Division {{!}} Department of Economic and Social Affairs|website=www.un.org|language=EN|access-date=September 21, 2018}}</ref> According to the World Health Organization, "[[Family planning]] is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts".<ref>{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception|title=Family planning/Contraception|website=World Health Organization|language=en-US|access-date=September 21, 2018}}</ref> However, more than 200 million women worldwide lack adequate access to family planning services.

There are [[Theories of famines|different theories]] about what causes famine. Some theorists, like the Indian economist Amartya Sen, believe that the world has more than enough resources to sustain its population. In this view, malnutrition is caused by unequal distribution of resources and under- or unused arable land.<ref>Ohlin, G. (1967). Population control and economic development. Paris: Dev Centers, OECD.</ref><ref>Nielson, K. (1992). Global Justice, Capitalism and the Third World. (R.A. Wilkons, Ed.)</ref> For example, Sen argues that "no matter how a famine is caused, methods of breaking it call for a large supply of food in the [[Public Distribution System]]. This applies not only to organizing [[rationing]] and control, but also to undertaking work programmes and other methods of increasing [[purchasing power]] for those hit by [[Theories of famines#Failure of exchange entitlements|shifts in exchange entitlements]] in a general inflationary situation."<ref name="Sen81" />

===Food sovereignty===
{{Main|Food sovereignty}}

Food sovereignty is one suggested policy framework to resolve access issues. In this framework, people (rather than international market forces) have the right to define their own food, agricultural, livestock, and [[fishery]] systems. Food First is one of the primary [[think tank]]s working to build support for food sovereignty. [[Neoliberalism|Neoliberals]] advocate for an increasing role of the [[free market]].{{citation needed|date=February 2023}}

===Health facilities===
Another possible long-term solution to malnutrition is to increase access to health facilities in rural parts of the world. These facilities could monitor undernourished children, act as supplemental food distribution centers, and provide education on dietary needs. Similar facilities have already proven very successful in countries such as [[Peru]] and [[Ghana]].<ref>{{cite journal | vauthors = Waters HR, Penny ME, Creed-Kanashiro HM, Robert RC, Narro R, Willis J, Caulfield LE, Black RE | display-authors = 6 | title = The cost-effectiveness of a child nutrition education programme in Peru | journal = Health Policy and Planning | volume = 21 | issue = 4 | pages = 257–264 | date = July 2006 | pmid = 16672293 | doi = 10.1093/heapol/czl010 | doi-access = free }}</ref><ref>Nyonator, Frank, J Koku Awooner-Williams, James Phillips, Tanya Jones, Robert Miller. (2003). The Ghana Community-based Health Planning and Services Initiative: Fostering Evidence-based Organizational Change and Development in a Resource-constrained Setting. In Policy Research Division Working Papers 180. New York: Population Council. {{cite web | vauthors = Nyonator FK, Phillips JF, Awoonor-Williams JK, Jones TC, Miller JR |url=http://www.popcouncil.org/pdfs/wp/180.pdf |title=PE Initiative: Fostering Evidence-based Organizational Change and Development in a Resource- constrained Setting |access-date=March 15, 2012 |archive-url=https://web.archive.org/web/20120311103223/http://www.popcouncil.org/pdfs/wp/180.pdf |archive-date=March 11, 2012 }}</ref>

===Breastfeeding===
In 2016, estimates suggested that more widespread breastfeeding could prevent about 823,000 deaths annually of children under age 5.<ref name="Lancet2016">{{cite journal | vauthors = Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC | display-authors = 6 | title = Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect | journal = Lancet | volume = 387 | issue = 10017 | pages = 475–490 | date = January 2016 | pmid = 26869575 | doi = 10.1016/S0140-6736(15)01024-7 | doi-access = free | hdl = 10072/413175 | hdl-access = free }}</ref> In addition to reducing [[Infant mortality|infant deaths]], [[breast milk]] provides an important source of micronutrients - which are clinically proven to bolster children's immune systems – and provides long-term defenses against [[Non-communicable disease|non-communicable]] and [[Allergy|allergic]] diseases.<ref name=":7">{{cite journal | vauthors = Lessen R, Kavanagh K | title = Position of the academy of nutrition and dietetics: promoting and supporting breastfeeding | journal = Journal of the Academy of Nutrition and Dietetics | volume = 115 | issue = 3 | pages = 444–449 | date = March 2015 | pmid = 25721389 | doi = 10.1016/j.jand.2014.12.014 }}</ref> Breastfeeding may improve cognitive abilities in children, and correlates strongly with individual educational achievements.<ref name=":7" /><ref name=":03">{{cite journal | vauthors = Balogun OO, Dagvadorj A, Anigo KM, Ota E, Sasaki S | title = Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review | journal = Maternal & Child Nutrition | volume = 11 | issue = 4 | pages = 433–451 | date = October 2015 | pmid = 25857205 | pmc = 6860250 | doi = 10.1111/mcn.12180 }}</ref> As previously noted, lack of proper breastfeeding is a major factor in [[child mortality]] rates, and is a primary determinant of disease development for children. The medical community recommends exclusively breastfeeding infants for 6 months, with nutritional whole [[food supplement]]ation and continued breastfeeding up to 2 years or older for overall optimal health outcomes.<ref name=":03"/><ref name=":13">{{cite journal | vauthors = Pugh LC, Milligan RA, Frick KD, Spatz D, Bronner Y | title = Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women | journal = Birth | volume = 29 | issue = 2 | pages = 95–100 | date = June 2002 | pmid = 12000411 | doi = 10.1046/j.1523-536X.2002.00169.x | s2cid = 13510698 }}</ref><ref name=":62">{{cite journal | vauthors = Cai X, Wardlaw T, Brown DW | title = Global trends in exclusive breastfeeding | journal = International Breastfeeding Journal | volume = 7 | issue = 1 | article-number = 12 | date = September 2012 | pmid = 23020813 | pmc = 3512504 | doi = 10.1186/1746-4358-7-12 | doi-access = free }}</ref> Exclusive breastfeeding is defined as giving an infant only breast milk for six months as a source of food and nutrition.<ref name=":03"/><ref name=":62"/> This means no other liquids, including water or semi-solid foods.<ref name=":62"/>

==== Barriers to breastfeeding ====
Breastfeeding is noted as one of the most [[Cost-effectiveness analysis|cost-effective]] medical interventions benefiting child health.<ref name=":13"/> While there are considerable differences among developed and [[Developing country|developing countries]], there are universal determinants of whether a mother breastfeeds or uses [[Infant formula|formula]]; these include income, employment, [[social norm]]s, and access to healthcare.<ref name=":03"/><ref name=":13" /> Many newly made mothers face financial barriers; community-based healthcare workers have helped to alleviate these barriers, while also providing a viable alternative to traditional and expensive hospital-based medical care.<ref name=":03" /> Recent studies, based upon surveys conducted from 1995 to 2010, show that exclusive breastfeeding rates have risen globally, from 33% to 39%.<ref name=":62"/> Despite the growth rates, medical professionals acknowledge the need for improvement given the importance of exclusive breastfeeding.<ref name=":62" />

===21st century global initiatives===
Starting around 2009, there was renewed international media and political attention focused on malnutrition. This resulted in part from spikes in food prices and the [[2008 financial crisis]]. Additionally, there was an emerging consensus that combating malnutrition is one of the most cost-effective ways to contribute to development. This led to the 2010 launch of the UN's ''Scaling up Nutrition'' movement (SUN).<ref>{{Cite web|url=https://scalingupnutrition.org/about-sun/the-history-of-the-sun-movement/|title=The history of the SUN Movement|publisher=United Nations|date=2015|access-date=January 12, 2019|archive-date=October 2, 2018|archive-url=https://web.archive.org/web/20181002051232/https://scalingupnutrition.org/about-sun/the-history-of-the-sun-movement/}}</ref>

In April 2012, a number of countries signed the [[Food Assistance Convention]], the world's first [[legally binding]] international agreement on food aid. The following month, the [[Copenhagen Consensus]] recommended that politicians and [[private sector]] [[Philanthropy|philanthropists]] should prioritize interventions against hunger and malnutrition to maximize the effectiveness of aid spending. The Consensus recommended prioritizing these interventions ahead of any others, including the fights against [[malaria]] and AIDS.<ref>{{Cite web|url=https://www.copenhagenconsensus.com/copenhagen-consensus-iii/outcome|title=Outcome &#124; Copenhagen Consensus Center|website=www.copenhagenconsensus.com}}</ref>

In June 2015, the European Union and the [[Bill & Melinda Gates Foundation]] launched a partnership to combat undernutrition, especially in children. The program was first implemented in [[Bangladesh]], [[Burundi]], Ethiopia, [[Kenya]], [[Laos]] and [[Niger]]. It aimed to help these countries improve information and analysis about nutrition, enabling them to develop effective national nutrition policies.<ref>European Commission Press release. June 2015. [http://europa.eu/rapid/press-release_IP-15-5104_en.htm EU launches new partnership to combat Undernutrition with Bill & Melinda Gates Foundation]. Accessed on November 1, 2015</ref>

Also in 2015, the UN's [[Food and Agriculture Organization]] created a partnership aimed at ending hunger in Africa by 2025. The [[African Union]]'s Comprehensive Africa Agriculture Development Programme (CAADP) provided the framework for the partnership. It includes a variety of interventions, including support for improved food production, a strengthening of social protection, and integration of the [[right to food]] into national legislation.<ref>FAO. 2015. [http://www.fao.org/africa/perspectives/end-hunger/en/ Africa's Renewed Partnership to End Hunger by 2025] {{Webarchive|url=https://web.archive.org/web/20200128135659/http://www.fao.org/africa/perspectives/end-hunger/en |date=January 28, 2020 }}. Accessed on November 1, 2015.</ref>

The [[Food and Agriculture Organization of the United Nations#Online campaign against hunger|EndingHunger]] campaign is an online communication campaign whose goal is to raise awareness about hunger. The campaign has created [[viral video]]s depicting [[Celebrity|celebrities]] voicing their anger about the large number of hungry people in the world.{{citation needed|date=March 2023}}

After the [[Millennium Development Goals]] expired in 2015, the [[Sustainable Development Goals]] became the main global policy focus to reduce hunger and poverty. In particular, Goal 2: Zero Hunger sets globally agreed-upon targets to wipe out hunger, end all forms of malnutrition, and make [[Sustainable agriculture|agriculture sustainable]].<ref>{{Cite web|url=https://www.un.org/sustainabledevelopment/hunger/|title=Goal 2: Zero Hunger}}</ref> The partnership Compact2025 develops and disseminates evidence-based advice to politicians and other decision-makers, with the goal of ending hunger and undernutrition by 2025.<ref>[https://www.ifpri.org/publication/compact-2025-ending-hunger-and-undernutrition Compact2025: Ending hunger and undernutrition. 2015. Project Paper. IFPRI: Washington, DC.]</ref><ref>{{Cite web|url=https://www.compact2025.org/about-compact2025/governance/leadership-council/|archive-url=https://web.archive.org/web/20150908225722/http://www.compact2025.org/about-compact2025/governance/leadership-council/|url-status=usurped|archive-date=September 8, 2015|title=Leadership Council|website=www.compact2025.org}}</ref><ref>{{cite web|title=Goal 2: Zero hunger|url=http://www.undp.org/content/undp/en/home/sustainable-development-goals/goal-2-zero-hunger.html|access-date=April 13, 2017|website=UNDP}}</ref> The [[International Food Policy Research Institute]] (IFPRI) led the partnership, with the involvement of UN organisations, non-governmental organizations (NGOs), and [[private foundation]]s.

==Treatment==
[[File:Malnurished Afghan Child.jpg|thumb|A malnourished Afghan child being treated by a medical team]]
[[File:VOA Heinlein - Somali refugees September 2011 - 09.jpg|thumb|right|A Somali boy receiving treatment for malnourishment at a health facility]]

=== Improving nutrition ===
Efforts such as infant and young child feeding practices to improve nutrition are some of the common forms of [[development aid]].<ref name="UK2012">{{cite web|date=Oct 2012|title=An update of 'The Neglected Crisis of Undernutrition: Evidence for Action'|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/67319/undernutrition-finalevidence-oct12.pdf|access-date=July 5, 2014|website=www.gov.uk|publisher=Department for International Development}}</ref><ref name="WHO2021">{{Cite web|url = https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding|title = Infant and Young Child Feeding | access-date = February 14, 2023}}</ref> Interventions often promote breastfeeding to reduce [[Rate (mathematics)|rates]] of malnutrition and death in children.<ref name="FFL2010" /> Some of these interventions have been successful.<ref name="Bh2013">{{cite journal | vauthors = Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE | display-authors = 6 | title = Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? | journal = Lancet | volume = 382 | issue = 9890 | pages = 452–477 | date = August 2013 | pmid = 23746776 | doi = 10.1016/s0140-6736(13)60996-4 | s2cid = 11748341 }}</ref> For example, interventions with commodities such as ready to use therapeutic foods, ready to use supplementary foods, micronutrient intervention and vitamin supplementation were identified to significantly improve nutrition, reduce stunting and prevent diseases in communities with severe acute malnutrition.<ref name="Bhutta, Z. 2008. pp.417-440"/> In young children, outcomes improve when children between six months and two years of age receive complementary food (in addition to breast milk).<ref name="Bh2013" /> There is also good evidence that supports giving [[dietary supplements|supplemental]] micronutrients to pregnant women and young children in the developing world.<ref name="Bh2013" />

The United Nations has reported on the importance of nutritional [[counselling]] and support, for example in the care of HIV-infected persons, especially in "resource-constrained settings where malnutrition and food insecurity are endemic".<ref>United Nations, [https://news.un.org/en/story/2003/02/60112 Nutrition plays key role in HIV/AIDS care, UN reports], published 25 February 2003, accessed 20 September 2023</ref> [[UNICEF]] provides nutritional counselling services for malnourished children in [[Afghanistan]].<ref>UNICEF UK, ''Child Matters'', Summer 2023, p. 9</ref>

Sending food and money is a common form of development aid, aimed at feeding hungry people. Some strategies help people buy food within local markets.<ref name="UK2012" /><ref>{{cite web|title=World Food Programme, Cash and Vouchers for Food|url=http://documents.wfp.org/stellent/groups/public/documents/communications/wfp246176.pdf|website=WFP.org|access-date=July 5, 2014|date=April 2012}}</ref> Simply [[School meal|feeding students]] at school is insufficient.<ref name="UK2012" />

Longer-term measures include improving agricultural practices,<ref name="solcultivateplanet">{{cite journal|author-link3=Kate Brauman|display-authors=6|vauthors=Foley JA, Ramankutty N, Brauman KA, Cassidy ES, Gerber JS, Johnston M, Mueller ND, O'Connell C, Ray DK, West PC, Balzer C, Bennett EM, Carpenter SR, Hill J, Monfreda C, Polasky S, Rockström J, Sheehan J, Siebert S, Tilman D, Zaks DP|date=October 2011|title=Solutions for a cultivated planet|url=http://www.escholarship.org/uc/item/6xw5g085|journal=Nature|volume=478|issue=7369|pages=337–342|bibcode=2011Natur.478..337F|doi=10.1038/nature10452|pmid=21993620|s2cid=4346486}}</ref> reducing poverty, and improving [[sanitation]].

=== Identifying malnourishment ===
Measuring children is crucial to identifying malnourishment. In 2000, the United States [[Centers for Disease Control and Prevention]] (CDC) established the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) program. It tested children for malnutrition by conducting a three-dimensional scan, using an [[iPad]] or a [[Tablet computer|tablet]]. Its objective was to help doctors provide more efficient treatments.<ref name=":2">{{Cite web|date=June 18, 2020|title=Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion|url=https://www.cdc.gov/nutrition/micronutrient-malnutrition/projects/malnutrition-and-innovative-technologies.html}}</ref> There may be some chance of error when using this method.<ref name=":2" /> The Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMPa) is another method for the identification and evaluation of malnutrition in young children.<ref name="doi.org">McCarthy, H. et al. (2012) "The development and evaluation of the screening tool for the assessment of malnutrition in  Paediatrics (Stamp©) for use by Healthcare staff," Journal of Human Nutrition and Dietetics, 25(4), pp. 311–318. Available at: https://doi.org/10.1111/j.1365-277x.2012.01234.x.</ref> The assessment tool has fair to medium reliability in the identification of children at risk of malnutrition.<ref name="doi.org"/>

A [[systematic review]] of 42 studies found that many approaches to mitigating acute malnutrition are equally effective; thus, intervention decisions can be based on cost-related factors. Overall, evidence for the effectiveness of acute malnutrition interventions is not robust. The limited evidence related to cost indicates that community and outpatient management of children with uncomplicated malnutrition may be the most cost-effective strategy.<ref>{{Cite journal|vauthors=Das JK, Salam RA, Saeed M, Kazmi FA, Bhutta ZA|date=2020|title=Effectiveness of interventions to manage acute malnutrition in children under 5 years of age in low- and middle-income countries: A systematic review|journal=Campbell Systematic Reviews|language=en|volume=16|issue=2|article-number=e1082 |doi=10.1002/cl2.1082|pmid=37131422 |pmc=8356333 |issn=|s2cid=242985650|doi-access=free}}</ref>

Regularly measuring and charting children's growth and including activities to promote health (an intervention called growth monitoring and promotion, also known as GPM) is often considered by policy makers and is recommended by the [[World Health Organization]].<ref>{{Cite web |title=Child growth |url=https://www.who.int/health-topics/child-growth |access-date=2023-10-17 |website=www.who.int |language=en}}</ref> This program is often performed at the same time as a child has their regular [[immunization]]s.<ref name=":8">{{Cite journal |last1=Taylor |first1=Melissa |last2=Tapkigen |first2=Janet |last3=Ali |first3=Israa |last4=Liu |first4=Qin |last5=Long |first5=Qian |last6=Nabwera |first6=Helen |date=2023-10-12 |editor-last=Cochrane Developmental, Psychosocial and Learning Problems Group |title=The impact of growth monitoring and promotion on health indicators in children under five years of age in low- and middle-income countries |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=10 |article-number=CD014785 |doi=10.1002/14651858.CD014785.pub2 |pmc=10568659 |pmid=37823471}}</ref> Despite widespread use of this type of program, further studies are needed to understand the impact of these programs on overall child health and how to better address faltering growth in a child and improve practices related to feeding children in lower to middle income countries.<ref name=":8" />

=== Medical management ===
It is often possible to manage severe malnutrition within a person's home, using [[therapeutic food#Ready-to-Use Therapeutic Food|ready-to-use therapeutic foods]].<ref name="Bh2013" /> In people with severe malnutrition complicated by other health problems, treatment in a hospital setting is recommended.<ref name="Bh2013" /> In-hospital treatment often involves managing [[hypoglycemia|low blood sugar]], maintaining adequate [[hypothermia|body temperature]], addressing [[dehydration]], and gradual feeding.<ref name="Bh2013" /><ref name="WHO2003">{{cite book|author= Ann Ashworth|title=Guidelines for the inpatient treatment of severely malnourished children|date=2003|publisher=World Health Organization|location=Geneva|isbn=978-92-4-154609-6}}</ref>

Routine [[antibiotic]]s are usually recommended because malnutrition weakens the immune system, causing a high risk of infection.<ref name="WHO2003" /> Additionally, [[broad spectrum antibiotic]]s are recommended in all severely undernourished children with diarrhea requiring admission to hospital.<ref name="WHO2005Chp8">{{cite book|title=The Treatment of diarrhoea: a manual for physicians and other senior health workers.|date=2005|publisher=World Health Organization|isbn=978-92-4-159318-2|edition=4|location=Geneva|pages=22–24|chapter=8. Management of diarrhoea with severe malnutrition|chapter-url=http://whqlibdoc.who.int/publications/2005/9241593180.pdf}}</ref>

A severely malnourished child who appears to have dehydration, but has not had diarrhea, should be treated as if they have an infection.<ref name="WHO2005Chp8" />

Among malnourished people who are hospitalized, nutritional support improves protein intake, calorie intake, and weight.<ref>{{cite journal | vauthors = Bally MR, Blaser Yildirim PZ, Bounoure L, Gloy VL, Mueller B, Briel M, Schuetz P | title = Nutritional Support and Outcomes in Malnourished Medical Inpatients: A Systematic Review and Meta-analysis | journal = JAMA Internal Medicine | volume = 176 | issue = 1 | pages = 43–53 | date = January 2016 | pmid = 26720894 | doi = 10.1001/jamainternmed.2015.6587 | doi-access = free }}</ref>

==== Bangladeshi model ====
[[File:Protein malnutrition.jpg|thumb|Baby with protein malnutrition due to insufficient amount of nutrients]]

In response to child malnutrition, the [[Bangladesh|Bangladeshi government]] recommends ten steps for treating severe malnutrition:<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008" />

# Prevent or treat [[dehydration]]
# Prevent or treat low blood sugar
# Prevent or treat [[hypothermia|low body temperature]]
# Prevent or treat infection;
# Correct [[electrolyte imbalance]]s
# Correct micronutrient deficiencies
# Start feeding cautiously
# Achieve catch-up growth
# Provide psychological support
# Prepare for discharge and follow-up after recovery

===Therapeutic foods===
Due in part to limited research on supplementary feeding, there is little evidence that this strategy is beneficial.<ref>{{cite journal | vauthors = Sguassero Y, de Onis M, Bonotti AM, Carroli G | title = Community-based supplementary feeding for promoting the growth of children under five years of age in low and middle income countries | journal = The Cochrane Database of Systematic Reviews | issue = 6 | article-number = CD005039 | date = June 2012 | volume = 2012 | pmid = 22696347 | pmc = 8078353 | doi = 10.1002/14651858.CD005039.pub3 }}</ref> A 2015 systematic review of 32 studies found that there are limited benefits when children under 5 receive supplementary feeding, especially among younger, poorer, and more undernourished children.<ref>{{cite journal | vauthors = Kristjansson E, Francis DK, Liberato S, Benkhalti Jandu M, Welch V, Batal M, Greenhalgh T, Rader T, Noonan E, Shea B, Janzen L, Wells GA, Petticrew M | display-authors = 6 | title = Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 3 | pages = CD009924 | date = March 2015 | pmid = 25739460 | doi = 10.4073/csr.2015.11 | pmc = 6885042 | doi-access = free }}</ref>

However, specially formulated foods do appear to be useful in treating moderate acute malnutrition in the developing world.<ref name="Lazzer2013">{{cite journal | vauthors = Lazzerini M, Rubert L, Pani P | title = Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries | journal = The Cochrane Database of Systematic Reviews | issue = 6 | article-number = CD009584 | date = June 2013 | pmid = 23794237 | doi = 10.1002/14651858.CD009584.pub2 }}</ref> These foods may have additional benefits in humanitarian emergencies, since they can be stored for years, can be eaten directly from the packet, and do not have to be mixed with clean water or refrigerated.<ref name="BBC">{{cite news|url=https://news.bbc.co.uk/2/hi/business/8114750.stm|title=Firms target nutrition for the poor| vauthors = Anderson T |date=June 24, 2009|newspaper=BBC News}}</ref> In young children with severe acute malnutrition, it is unclear if ready-to-use therapeutic food differs from a normal diet.<ref>{{cite journal | vauthors = Schoonees A, Lombard MJ, Musekiwa A, Nel E, Volmink J | title = Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | article-number = CD009000 | date = May 2019 | issue = 5 | pmid = 31090070 | pmc = 6537457 | doi = 10.1002/14651858.CD009000.pub3 }}</ref>

Severely malnourished individuals can experience [[refeeding syndrome]] if fed too quickly.<ref name="Via2012">{{cite journal | vauthors = Viana L, Burgos MG, Silva R | title = Refeeding syndrome: clinical and nutritional relevance | journal = Arquivos Brasileiros de Cirurgia Digestiva | volume = 25 | issue = 1 | pages = 56–59 | date = Jan–Mar 2012 | pmid = 22569981 | doi = 10.1590/s0102-67202012000100013 | doi-access = free }}</ref> Refeeding syndrome can result regardless of whether food is taken orally, [[enteral nutrition|enterally]] or [[Parenteral nutrition|parenterally]].<ref name="Via2012" /> It can present several days after eating with potentially fatal heart failure, [[Cardiac dysrhythmia|dysrhythmias]], and confusion.<ref name="Via2012" /><ref>{{cite journal | vauthors = Boateng AA, Sriram K, Meguid MM, Crook M | title = Refeeding syndrome: treatment considerations based on collective analysis of literature case reports | journal = Nutrition | volume = 26 | issue = 2 | pages = 156–167 | date = February 2010 | pmid = 20122539 | doi = 10.1016/j.nut.2009.11.017 }}</ref>

Some manufacturers have [[Food fortification|fortified]] everyday foods with micronutrients before selling them to consumers. For example, flour has been fortified with iron, zinc, folic acid, and other B vitamins like thiamine, riboflavin, niacin and vitamin [[B12]].<ref name=":1" /> Baladi bread (Egyptian [[flatbread]]) is made with fortified wheat flour. Other fortified products include [[fish sauce]] in Vietnam and [[Iodised salt|iodized salt]].<ref name="BBC" />

===Micronutrient supplementation===
According to the World Bank, treating malnutrition – mostly by fortifying foods with micronutrients – improves lives more quickly than other forms of aid, and at a lower cost.<ref name="IQ">{{cite news|url=https://www.nytimes.com/2008/12/04/opinion/04kristof.html|title=Raising the world's IQ| vauthors = Kristof ND |date=December 4, 2008|work=The New York Times}}</ref> After reviewing a variety of development proposals, The [[Copenhagen Consensus]], a group of economists who reviewed a variety of development proposals, ranked micronutrient supplementation as its number-one treatment strategy.<ref name="hiddenhunger">{{cite news|url=https://www.nytimes.com/2009/05/24/opinion/24kristof.html|title=The Hidden Hunger| vauthors = Kristof ND |date=May 24, 2009|newspaper=New York Times}}</ref><ref name="Let them eat micronutrients">{{cite news|url=http://www.newsweek.com/id/160075|title=Let them eat micronutrients|newspaper=Newsweek}}</ref>

In malnourished people with [[diarrhea]], [[Zinc deficiency|zinc supplementation]] is recommended following an initial four-hour rehydration period. Daily zinc supplementation can help reduce the severity and duration of the diarrhea. Additionally, continuing daily zinc supplementation for ten to fourteen days makes diarrhea less likely to recur in the next two to three months.<ref name="WHO (2005)">[http://whqlibdoc.who.int/publications/2005/9241593180.pdf The Treatment of Diarrhoea: A manual for physicians and other senior health workers], World Health Organization, 2005. See especially Ch. 4 "Management of Acute Diarrhoea (Without Blood)" and Ch. 8 "Management of Diarrhoea With Severe Malnutrition."</ref>

Malnourished children also need both [[potassium]] and [[magnesium]].<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008">[http://www.unicef.org/bangladesh/SAM_Guideline.pdf National Guidelines for the Management of Severely Malnourished Children in Bangladesh] {{Webarchive|url=https://web.archive.org/web/20111019171912/http://www.unicef.org/bangladesh/SAM_Guideline.pdf |date=October 19, 2011 }}, Institute of Public Health Nutrition, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, May 2008, page 18 (19 in PDF) and following pages.</ref> Within two to three hours of starting rehydration, children should be encouraged to take food, particularly foods rich in potassium<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008" /><ref name="WHO (2005)" /> like bananas, green [[coconut water]], and unsweetened fresh fruit juice.<ref name="WHO (2005)" /> Along with continued eating, many homemade products can also help restore normal electrolyte levels. For example, early during the course of a child's diarrhea, it can be beneficial to provide cereal water (salted or unsalted) or vegetable broth (salted or unsalted).<ref name="WHO (2005)" /> If available, vitamin A, potassium, magnesium, and zinc supplements should be added, along with other vitamins and minerals.<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008" />

Giving base (as in [[Ringer's lactate solution|Ringer's lactate]]) to treat [[acidosis]] without simultaneously supplementing potassium worsens [[Hypokalemia|low blood potassium]].<ref name="WHO (2005)" />

===Treating diarrhea===
==== Preventing dehydration ====
Food and drink can help prevent dehydration in malnourished people with diarrhea. Eating (or breastfeeding, among infants) should resume as soon as possible.<ref name="WHO2005Chp8" /> Sugary beverages like soft drinks, fruit juices, and sweetened teas are not recommended as they may worsen diarrhea.<ref name="WHO2005Chp4">{{cite book|title=The Treatment of diarrhoea: a manual for physicians and other senior health workers|date=2005|publisher=World Health Organization|isbn=978-92-4-159318-2|edition=4|location=Geneva|pages=8–16|chapter=4. Management of acute diarrhoea without blood|chapter-url=http://whqlibdoc.who.int/publications/2005/9241593180.pdf}}</ref>

Malnourished people with diarrhea (especially children) should be encouraged to drink fluids; the best choices are fluids with modest amounts of sugar and salt, like [[Broth|vegetable broth]] or salted [[rice water]].<!--<ref name=WHO2005Chp4/> --> If clean water is available, they should be encouraged to drink that too.<!--<ref name=WHO2005Chp4/> --> Malnourished people should be allowed to drink as much as they want, unless signs of swelling emerge.<!--<ref name=WHO2005Chp4/> -->

Babies can be given small amounts of fluids via an eyedropper or a syringe without the needle. Children under two should receive a teaspoon of fluid every one to two minutes; older children and adults should take frequent sips of fluids directly from a cup.<ref name="WHO (2005)" /> After the first two hours, fluids and foods should be alternated, rehydration should be continued at the same rate or more slowly, depending on how much fluid the child wants and whether they are having ongoing diarrhea.<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008" />

If vomiting occurs, fluids can be paused for 5–10 minutes and then restarted more slowly.<!--<ref name=WHO2005Chp4/> --> Vomiting rarely prevents rehydration, since fluids are still absorbed and vomiting is usually short-term.<ref name="WHO2005Chp4" />

==== Oral rehydration therapy ====
If prevention has failed and dehydration develops, the preferred treatment is rehydration through [[oral rehydration therapy]] (ORT).<!--<ref name=WHO2005Chp4/> --> In severely undernourished children with diarrhea, rehydration should be done slowly, according to the World Health Organization.<!--<ref name=WHO2005Chp8/> -->

Oral rehydration solutions consist of clean water mixed with small amounts of sugars and salts. These solutions help restore normal electrolyte levels, provide a source of [[carbohydrate]]s, and help with fluid replacement.<ref>{{cite journal|vauthors=Victora CG, Bryce J, Fontaine O, Monasch R|date=Jan 2000|title=Reducing deaths from diarrhoea through oral rehydration therapy|journal=Bulletin of the World Health Organization|volume=78|issue=10|pages=1246–1255|pmc=2560623|pmid=11100619|hdl-access=free|hdl=10665/268000}}</ref>

Reduced-[[Osmotic concentration|osmolarity]] ORS is the current standard of care for oral rehydration therapy, with reasonably wide availability.<ref>{{Cite web|url=http://apps.who.int/medicinedocs/en/d/Js4950e/2.4.html|title=WHO Drug Information Vol. 16, No. 2, 2002: Current Topics: New formula oral rehydration salts|date=September 23, 2012|archive-url=https://web.archive.org/web/20120923132010/http://apps.who.int/medicinedocs/en/d/Js4950e/2.4.html |archive-date=September 23, 2012 }}</ref><ref>[http://rehydrate.org/ors/low-osmolarity-ors.htm Low-osmolarity oral rehydration solution (ORS)], Rehydrate Project, updated: April 23, 2014.</ref> Introduced in 2003 by WHO and UNICEF, reduced-osmolarity solutions contain lower concentrations of sodium and glucose than original ORS preparations. Reduced-osmolarity ORS has the added benefit of reducing stool volume and vomiting while simultaneously preventing dehydration. Packets of reduced-osmolarity ORS include glucose, table salt, [[potassium chloride]], and [[trisodium citrate]]. For general use, each packet should be mixed with a liter of water. However, for malnourished children, experts recommend adding a packet of ORS to two liters of water, along with an extra 50 grams of [[sucrose]] and some stock potassium solution.<ref>[http://whqlibdoc.who.int/publications/2005/9241593180.pdf The Treatment of Diarrhoea: A manual for physicians and other senior health workers], WHO, 2005. Specifically, 45 milliliters of potassium chloride solution from a stock solution containing 100g KCl per liter, along with one packet of ORS, ''<u>two</u>'' liters of water, and 50 grams of sucrose. And please remember, sucrose has approximately twice the molecular weight of glucose, with one mole of glucose weighing 180 g and one mole of sucrose weighing 342 g.</ref>

People who have no access to commercially available ORS can make a homemade version using water, sugar, and table salt. Experts agree that homemade ORS preparations should include one liter (34 [[Fluid ounce|oz.]]) of clean water and 6 teaspoons of sugar; however, they disagree about whether they should contain half a teaspoon of table salt or a full teaspoon. Most sources recommend using half a teaspoon of salt per liter of water.<ref name="WHO (2005)" /><ref>[http://whqlibdoc.who.int/publications/2005/9241592330.pdf "Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1".] World Health Organization, 2005, Annex 12 – Preparation of Home Made Oral Rehydration Solution, p. 51 (57 in PDF): "Ingredients: Half a teaspoon of salt (2.5 grams), six level teaspoons of sugar (30 grams) and one litre of safe drinking water".</ref><ref>[http://www.mayoclinic.org/diseases-conditions/dehydration/basics/treatment/con-20030056 "Dehydration, treatments and drugs."] Mayo Clinic January 7, 2011. "In an emergency situation where a pre-formulated solution is unavailable, you can make your own oral rehydration solution by mixing half teaspoon salt, six level teaspoons of sugar and one litre (about 1 quart) of safe drinking water."</ref><ref name="Family-Practice-Notebook-Feb-2014">[http://www.fpnotebook.com/peds/Pharm/OrlRhydrtnSltn.htm Family Practice Notebook], Oral Rehydration Solution, Scott Moses, MD, February 1, 2014.</ref> However, people with malnutrition have an excess of body sodium.<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008" /> To avoid worsening this symptom, ORS for people with severe undernutrition should contain half the usual amount of sodium and more potassium.<!--<ref name=WHO2005Chp8/> -->

Patients who do not drink may require fluids by [[nasogastric tube]].<!--<ref name=WHO2005Chp8/> --> [[Intravenous]] fluids are recommended only in those who have [[Shock (circulatory)|significant dehydration]] due to their potential complications,<!--<ref name=WHO2005Chp8/> --> including [[congestive heart failure]].<ref name="WHO2005Chp8" /> [[File:ORT saches.JPG|thumb|Examples of commercially available oral rehydration salts (Nepal on left, Peru on right)]]

===Low blood sugar===
[[Hypoglycemia]], whether known or suspected, can be treated with a mixture of sugar and water. If the patient is conscious, the initial dose of sugar and water can be given by mouth.<ref>[http://www.unicef.org/bangladesh/SAM_Guideline.pdf National Guidelines for the Management of Severely Malnourished Children in Bangladesh] {{Webarchive|url=https://web.archive.org/web/20111019171912/http://www.unicef.org/bangladesh/SAM_Guideline.pdf |date=October 19, 2011 }} recommends, for initial hypoglycemia, a 50 milliliter bolus of 10% glucose or sucrose. This can also be achieved by added 1 rounded teaspoon of sugar to 10.5 teaspoons of water (which is 3.5 tablespoons of water).</ref> Otherwise, they should receive glucose by [[intravenous]] or [[nasogastric tube]]. If seizures occur (and continue after glucose is given), rectal [[diazepam]] may be helpful. Blood sugar levels should be re-checked on two-hour intervals.<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008" />

===Hypothermia===
[[Hypothermia]] (dangerously low [[Human body temperature|core body temperature]]) can occur in malnutrition, particularly in children. Mild hypothermia causes confusion, trembling, and clumsiness; more severe cases can be fatal. Keeping malnourished children warm can prevent or treat hypothermia. Covering the child (including their head) in blankets is one method. Another method is to warm the child through direct skin-to-skin contact with their mother or father, then covering both parent and child.

Warming methods are usually most important at night.<ref name="Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008" /> Prolonged bathing or prolonged medical exams can further lower body temperature and are not recommended for malnourished children at high risk of hypothermia.

==Epidemiology==
{{Main|Epidemiology of malnutrition}}

[[File:Hunger Map 2020 World Food Programme.svg|thumb|upright=1.3|Percentage of population suffering from hunger, [[World Food Programme]], 2020:<br />
{{Legend|#29b8c7|< 2.5%}}
{{Legend|#16b484|< 5.0%}}
{{Legend|#fec960|5.0–14.9%}}
{{Legend|#f47846|15.0–24.9%}}
{{Legend|#f2203a|25.0–34.9%}}
{{Legend|#7f0928|> 35.0%}}
{{Legend|#b5aba4|No data}}]]
[[File:Nutritional deficiencies world map - DALY - WHO2004.svg|thumb|upright=1.3|[[Disability-adjusted life year]] for nutritional deficiencies per 100,000 inhabitants in 2004. Nutritional deficiencies included: protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and iron deficiency anaemia.<ref>{{cite web |url=https://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls |title=Mortality and Burden of Disease Estimates for WHO Member States in 2002|format=xls |work=World Health Organization|year=2002 }}</ref>
{{Col-begin}}
{{Col-break}}
{{legend|#b3b3b3|<small>no data</small>}}
{{legend|#ffff65|<small><200</small>}}
{{legend|#fff200|<small>200–400</small>}}
{{legend|#ffdc00|<small>400–600</small>}}
{{legend|#ffc600|<small>600–800</small>}}
{{legend|#ffb000|<small>800–1000</small>}}
{{legend|#ff9a00|<small>1000–1200</small>}}
{{Col-break}}
{{legend|#ff8400|<small>1200–1400</small>}}
{{legend|#ff6e00|<small>1400–1600</small>}}
{{legend|#ff5800|<small>1600–1800</small>}}
{{legend|#ff4200|<small>1800–2000</small>}}
{{legend|#ff2c00|<small>2000–2200</small>}}
{{legend|#cb0000|<small>>2200</small>}}
{{col-end}}]]

The figures provided in this section on epidemiology all refer to ''undernutrition'' even if the term malnutrition is used which, by definition, could also apply to too much nutrition.

The [[Global Hunger Index]] (GHI) is a multidimensional statistical tool used to describe the state of countries' hunger situation. The GHI measures progress and failures in the global fight against hunger.<ref name="bbc">{{cite news| url= https://news.bbc.co.uk/2/hi/europe/8306556.stm |title= Global hunger worsening, warns UN |publisher= BBC (Europe) |date= October 14, 2009 |access-date=August 22, 2010}}</ref> The GHI is updated once a year. The data from the 2015 report shows that Hunger levels have dropped 27% since 2000. Fifty two countries remain at serious or alarming levels. In addition to the latest statistics on Hunger and Food Security, the GHI also features different special topics each year. The 2015 report include an article on conflict and food security.<ref>K. von Grebmer, J. Bernstein, A. de Waal, N. Prasai, S. Yin, Y. Yohannes: [http://www.ifpri.org/cdmref/p15738coll2/id/129681/filename/129892.pdf 2015 Global Hunger Index – Armed Conflict and the Challenge of Hunger]. Bonn, Washington DC, Dublin: Welthungerhilfe, IFPRI, and Concern Worldwide. October 2015.</ref>

===People affected===
The United Nations estimated that there were 821 million undernourished people in the world in 2017. This is using the UN's definition of 'undernourishment', where it refers to insufficient consumption of raw calories, and so does not necessarily include people who lack micro nutrients.<ref name = UNFAO2018/> The undernourishment occurred despite the world's farmers producing enough food to feed around 12 billion people—almost double the current world population.<ref>[[Jean Ziegler]]. [http://www2.ohchr.org/english/bodies/hrcouncil/docs/7session/A-HRC-7-5.doc "Promotion And Protection Of All Human Rights, Civil, Political, Economic, Social And Cultural Rights, Including The Right To Development: Report of the Special Rapporteur on the right to food, Jean Ziegler"]. [[United Nations Human Rights Council|Human Rights Council]] of the United Nations, January 10, 2008."According to the [[Food and Agriculture Organization]] of the United Nations (FAO), the world already produces enough food to feed every child, woman and man and could feed 12 billion people, or double the current world population."</ref>

Malnutrition, as of 2010, was the cause of 1.4% of all [[disability adjusted life years]].<ref name="Murray2012">{{cite journal | vauthors = Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, etal | title = Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2197–2223 | date = December 2012 | pmid = 23245608 | doi = 10.1016/S0140-6736(12)61689-4 | s2cid = 205967479 }}</ref>

{| class="wikitable"
|+Number of undernourished globally<ref name=":22">{{Cite web |title=Putting a number on hunger |url=https://www.fao.org/interactive/state-of-food-security-nutrition/2023/en/ |access-date=2024-09-04 |website=Putting a number on hunger |language=en}}</ref>
!Year!!2005!!2006!!2007!!2008!!2009!!2010!!2011!!2012!!2013
|-
!Number in millions
|793.4||746.5||691.0||663.1||661.8||597.8||578.3||580.0||572.3
|-
!Percentage (%)
|12.1%||11.2%||10.3%||9.7%||9.6%||8.6%||8.2%||8.1%||7.9%
|-
!Year
!2014
!2015
!2016
!2017
!2018
!2019
!2020
!2021
!2022
|-
!Number in millions
|563.9
|588.9
|586.4
|571.8
|586.8
|612.8
|701.4
|738.9
|735.1
|-
!Percentage (%)
|7.7%
|7.9%
|7.8%
|7.5%
|7.6%
|7.9%
|8.9%
|9.3%
|9.2%
|}

{| class="wikitable"
|+Number of undernourished in the developing world<ref name="UNFAO2006">{{cite web |title=The State of Food Insecurity in the World 2006 |url=http://www.fao.org/3/a0750e/a0750e00.htm |access-date=April 6, 2019 |publisher=Food and Agricultural Organization of the United Nations}}</ref><ref name="UNFAO2008">{{cite web |title=The State of Food Insecurity in the World 2008 |url=http://www.fao.org/3/i0291e/i0291e00.htm |access-date=April 6, 2019 |publisher=Food and Agricultural Organization of the United Nations}}</ref><ref name="UNFAO2015">{{cite web |title=The State of Food Insecurity in the World 2015 |url=http://www.fao.org/3/a-i4646e.pdf |access-date=April 6, 2019 |publisher=Food and Agricultural Organization of the United Nations}}</ref><!--Note that the UN no longer seems to track this specific statistic-->
!Year!!1970!!1980!!1991!!1996!!2002!!2004!!2006||2011
|-
!Number in millions
|875||841||820||790||825||848||927||805
|-
!Percentage (%)
|37%||28%||20%||18%||17%||16%||17%||14%
|}

===[[Mortality (book)|Mortality]]===
[[File:Nutritional deficiencies world map-Deaths per million persons-WHO2012.svg|thumb|left|upright=1.3|Deaths from nutritional deficiencies per million persons in 2012: {{Div col|small=yes|colwidth=10em}}{{legend|#ffff20|0–4}}{{legend|#ffe820|5–8}}{{legend|#ffd820|9–13}}{{legend|#ffc020|14–23}}{{legend|#ffa020|24–34}}{{legend|#ff9a20|35–56}}{{legend|#f08015|57–91}}{{legend|#e06815|92–220}}{{legend|#d85010|221–365}}{{legend|#d02010|366–1,207}}{{div col end}}]]
In 2010 [[protein-energy malnutrition]] resulted in 600,000 deaths down from 883,000 deaths in 1990.<ref name=Loz2012>{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | display-authors = 6 | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–2128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | hdl-access = free | s2cid = 1541253 | hdl = 10536/DRO/DU:30050819 | url = http://www.cobiss.si/scripts/cobiss?command=DISPLAY&base=cobib&rid=1537267652&fmt=11 }}{{Dead link|date=August 2025 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> Other nutritional deficiencies, which include [[iodine deficiency]] and [[iron deficiency anemia]], result in another 84,000 deaths.<ref name="Loz2012" /> In 2010 malnutrition caused about 1.5&nbsp;million deaths in women and children.<ref name="Lim2012">{{cite journal | vauthors = Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA | display-authors = 6 | title = A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2224–2260 | date = December 2012 | pmid = 23245609 | pmc = 4156511 | doi = 10.1016/S0140-6736(12)61766-8 }}</ref>

According to the World Health Organization, malnutrition is the biggest contributor to [[child mortality]], present in half of all cases.<ref name="economist">{{cite news |title=Malnutrition The Starvelings |newspaper=The Economist |date= January 24, 2008|url=http://www.economist.com/world/international/displaystory.cfm?story_id=10566634}}</ref> Six million children die of hunger every year.<ref>{{cite news| url=http://edition.cnn.com/2009/WORLD/europe/11/17/italy.food.summit/ | work=CNN | title=U.N. chief: Hunger kills 17,000 kids daily | date=November 17, 2009}}</ref> [[Underweight]] births and intrauterine growth restrictions cause 2.2&nbsp;million child deaths a year. Poor or non-existent breastfeeding causes another 1.4&nbsp;million. Other deficiencies, such as lack of [[vitamin A]] or [[zinc]], for example, account for 1 million. Malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower education achievement. Their own children tend to be smaller. Malnutrition was previously{{when|date=September 2016}} seen as something that exacerbates the problems of diseases such as measles, pneumonia and diarrhea, but malnutrition actually causes diseases, and can be fatal in its own right.<ref name="economist" />

==History==
{{see also|Hunger#The fight against hunger}}
Hunger has been a perennial human problem. However, until the early 20th century, there was relatively little awareness of the qualitative aspects of malnutrition.

Throughout history, various peoples have known the importance of eating certain foods to prevent symptoms now associated with malnutrition. Yet such knowledge appears to have been repeatedly lost and then re-discovered. For example, the [[ancient Egypt]]ians reportedly knew the symptoms of [[scurvy]]. Much later, in the 14th century, [[Crusades|Crusaders]] sometimes used anti-scurvy measures – for example, ensuring that [[Citrus|citrus fruits]] were planted on Mediterranean islands, for use on sea journeys. However, for several centuries, Europeans appear to have forgotten the importance of these measures. They rediscovered this knowledge in the 18th century, and by the early 19th century, the [[Royal Navy]] was issuing frequent rations of [[Lemon|lemon juice]] to every crewman on their ships. This massively reduced scurvy deaths among British sailors, which in turn gave the British a significant advantage in the [[Napoleonic Wars]]. Later on in the 19th century, the Royal Navy replaced lemons with limes (unaware at the time that lemons are far more effective at preventing scurvy).<ref name="Ruxin">{{Cite web|url=http://discovery.ucl.ac.uk/1317860/1/288630.pdf|title=Hunger, Science, and Politics: FAO, WHO, and Unicef Nutrition Policies, 1945–1978|publisher= [[University College London]]|date=1996|author=Joshua Ruxin|access-date=January 12, 2019|author-link=Josh Ruxin}}</ref><ref name="HungerModHist">{{cite book|author= James Vernon|title= Hunger: A Modern History|pages= [https://archive.org/details/hungermodernhist00vern_0/page/81 81–140, ''passim'']|year= 2007|isbn= 978-0-674-02678-0|publisher= [[Harvard University Press]]|url-access= registration|url= https://archive.org/details/hungermodernhist00vern_0/page/81}}</ref>

According to historian Michael Worboys, malnutrition was essentially discovered, and the [[Nutritional science|science of nutrition]] established, between [[World War I]] and [[World War II]]. Advances built on prior works like [[Casimir Funk]]'s 1912 formulisation of the concept of vitamins. Scientific study of malnutrition increased in the 1920s and 1930s, and grew even more common after World War II.

Non-governmental organizations and United Nations agencies began to devote considerable energy to alleviating malnutrition around the world. The exact methods and priorities for doing this tended to fluctuate over the years, with varying levels of focus on different types of malnutrition like [[Kwashiorkor]] or [[Marasmus]]; varying levels of concern on protein deficiency compared to vitamins, minerals and lack of raw calories; and varying priorities given to the problem of malnutrition in general compared to other health and development concerns. The [[green Revolution]] of the 1950s and 1960s saw considerable improvement in capability to prevent malnutrition.<ref name="HungerModHist" /><ref name="Ruxin" /><ref name="Grigg">{{cite journal | vauthors = Grigg D | title = The historiography of hunger: changing views on the world food problem, 1945–1980 | journal = Transactions | volume = 6 | issue = 3 | pages = 279–292 | year = 1981 | pmid = 12265450 | doi = 10.2307/622288 | series = NS | quote = Before 1945 very little academic or political notice was taken of the problem of world hunger, since 1945 there has been a vast literature on the subject. | jstor = 622288 | bibcode = 1981TrIBG...6..279G }}</ref>

One of the first official global documents addressing Food security and global malnutrition was the 1948 [[Universal Declaration of Human Rights]](UDHR). Within this document it stated that access to food was part of an adequate right to a standard of living.<ref>{{Cite web|url=http://www.un.org/en/universal-declaration-human-rights/index.html|title=Universal Declaration of Human Rights|website=www.un.org|language=en|access-date=February 24, 2018|date=October 6, 2015}}</ref> The [[Right to food]] was asserted in the [[International Covenant on Economic, Social and Cultural Rights]], a [[treaty]] adopted by the [[United Nations General Assembly]] on December 16, 1966. The Right to food is a [[human rights|human right]] for people to feed themselves in dignity, be free from hunger, food insecurity, and malnutrition.<ref>{{Cite web|url=http://www.righttofood.org/work-of-jean-ziegler-at-the-un/what-is-the-right-to-food/|title=What is the Right to Food? {{!}} Right to food|website=www.righttofood.org|language=en-US|access-date=February 24, 2018}}</ref> As of 2018, the treaty has been signed by 166 countries, by signing states agreed to take steps to the maximum of their available resources to achieve the right to adequate food.

However, after the 1966 International Covenant the global concern for the access to sufficient food only became more present, leading to the first ever World Food Conference that was held in 1974 in Rome, Italy. The [[Universal Declaration on the Eradication of Hunger and Malnutrition]] was a UN resolution adopted November 16, 1974 by all 135 countries that attended the 1974 World Food Conference.<ref>{{Cite web|url=https://berkleycenter.georgetown.edu/publications/universal-declaration-on-the-eradication-of-hunger-and-malnutrition.htm|title=Universal Declaration on the Eradication of Hunger and Malnutrition|language=en|access-date=February 24, 2018|archive-url=https://web.archive.org/web/20181008061238/https://berkleycenter.georgetown.edu/publications/universal-declaration-on-the-eradication-of-hunger-and-malnutrition.htm|archive-date=October 8, 2018}}</ref> This non-legally binding document set forth certain aspirations for countries to follow to sufficiently take action on the global food problem. Ultimately this document outline and provided guidance as to how the international community as one could work towards fighting and solving the growing global issue of malnutrition and hunger.

Adoption of the right to food was included in the [[American Convention on Human Rights#Additional Protocols|Additional Protocol to the American Convention on Human Rights in the area of Economic, Social, and Cultural Rights]], this 1978 document was adopted by many countries in the Americas, the purpose of the document is, "to consolidate in this hemisphere, within the framework of democratic institutions, a system of personal liberty and [[social justice]] based on respect for the essential rights of man."<ref>{{Cite web|url=http://www.hrcr.org/docs/American_Convention/oashr.html|title=American Convention on Human Rights|website=www.hrcr.org|access-date=March 17, 2018}}</ref>

A later document in the timeline of global initiatives for malnutrition was the 1996 [[Rome Declaration on World Food Security]], organized by the [[Food and Agriculture Organization]]. This document reaffirmed the right to have access to safe and nutritious food by everyone, also considering that everyone gets sufficient food, and set the goals for all nations to improve their commitment to food security by halving their number of undernourished people by 2015.<ref>{{Cite web|url=http://www.fao.org/docrep/003/w3613e/w3613e00.htm|title=Rome Declaration and Plan of Action|website=www.fao.org|access-date=March 17, 2018}}</ref> In 2004 the Food and Agriculture Organization adopted the [[Right to Food Guidelines]], which offered states a framework of how to increase the right to food on a national basis.

==Special populations==
Undernutrition is an important determinant of maternal and child health, accounting for more than a third of child deaths and more than 10 percent of the total global [[disease burden]] according to 2008 studies.<ref name="Black2008">{{cite journal | vauthors = Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J | display-authors = 6 | title = Maternal and child undernutrition: global and regional exposures and health consequences | journal = Lancet | volume = 371 | issue = 9608 | pages = 243–260 | date = January 2008 | pmid = 18207566 | doi = 10.1016/S0140-6736(07)61690-0 | s2cid = 3910132 | author9 = Maternal Child Undernutrition Study Group }}</ref>

===Children===
{{Main|Undernutrition in children}}

[[File:Niger childhood malnutrition 16oct06.jpg|thumb|right|Malnourished children in [[Niger]], during the 2005 famine]]
Undernutrition adversely affects the cognitive development of children, contributing to poor earning capacity and poverty in adulthood.<ref>Tomkins, A., 2014. Tackling undernutrition in children – new opportunities for innovation and action. Paediatrics and International Child Health, 34(4), pp.235–238.</ref> The development of childhood undernutrition coincides with the introduction of complementary weaning foods which are usually nutrient deficient.<ref>Mupunga, I., Mngqawa, P. and Katerere, D., 2017. Peanuts, Aflatoxins and Undernutrition in Children in Sub-Saharan Africa. Nutrients, 9(12), p. 1287.</ref> The World Health Organization estimated in 2008 that malnutrition accounted for 54 percent of child mortality worldwide,<ref name="Nutrition in pediatrics" /> about 1 million children.<ref name="ENJM013113">{{cite journal | vauthors = Trehan I, Goldbach HS, LaGrone LN, Meuli GJ, Wang RJ, Maleta KM, Manary MJ | title = Antibiotics as part of the management of severe acute malnutrition | journal = The New England Journal of Medicine | volume = 368 | issue = 5 | pages = 425–435 | date = January 2013 | pmid = 23363496 | pmc = 3654668 | doi = 10.1056/NEJMoa1202851 | quote = The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates. }}</ref> There is a strong association between undernutrition and child mortality.<ref>Caulfield, L., de Onis, M., Blössner, M. and Black, R., 2004. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. The American Journal of Clinical Nutrition, 80(1), pp.193–198.</ref>

Another estimate in 2008 also by WHO stated that childhood underweight was the cause for about 35% of all deaths of children under the age of five years worldwide.<ref name=":0">Prüss-Üstün, A., Bos, R., Gore, F., Bartram, J. (2008). [https://web.archive.org/web/20111031014721/http://www.who.int/quantifying_ehimpacts/publications/saferwater/en/ Safer water, better health – Costs, benefits and sustainability of interventions to protect and promote health]. World Health Organization (WHO), Geneva, Switzerland</ref> Over 90% of the stunted children below five years of age live in sub-Saharan Africa and South Central Asia.<ref name="Bhutta, Z. 2008. pp.417-440"/> Although access to adequate food and improving nutritional intake is an obvious solution to tackling undernutrition in children, the progress in reducing children undernutrition has been disappointing.<ref>Collins, S., Sadler, K., Bahwere, P. and Hallam, A., 2007. Management of severe acute malnutrition in children – Authors' reply. The Lancet, 369(9563), p.741.</ref>

===Women===
{{main|Food security#Gender and food security}}

[[File:Lange-MigrantMother02.jpg|thumb|''[[Migrant Mother]]'' by [[Dorothea Lange]] (1936)]]
[[File:Starved girl.jpg|thumb|183x183px|Starved girl]]

In 2022, more than 1&nbsp;billion adolescent girls and women suffered from undernutrition, according to UNICEF's 2023 report "Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women".<ref name=":10">{{Cite web |last=Moumen |first=Hana |date=2023-02-24 |title=Undernourished and Overlooked |url=https://data.unicef.org/resources/undernourished-and-overlooked/ |access-date=2023-11-08 |website=UNICEF DATA |language=en-US}}</ref> The gender gap in food insecurity more than doubled between 2019 (49 million) and 2021 (126 million). The report shows that globally, 30% of women aged 15–49 years are living with anaemia while 10 per cent of women aged 20–49 years suffer from underweight. South Asia, West and Central Africa and Eastern and Southern Africa are home to 60% of women with anaemia and 65% of women being underweight. In contrast, overweight is affecting more than 35% of women aged 20–49 years, of which 13% are living with obesity.<ref name=":10"/>

The Middle East and North Africa has the highest prevalence of overweight with 61% affected. North America closely follows at 60%.<ref name=":10"/> Fewer than 1 in 3 adolescent girls and women have diets meeting the minimum dietary diversity in the Sudan (10%), Burundi (12%), Burkina Faso (17%) and Afghanistan (26%).<ref name=":10" /> In Niger, the percentage of women accessing a minimally diverse diet fell from 53% to 37% between 2020 and 2022.<ref name=":10"/>

Researchers from the Centre for World Food Studies in 2003 found that the gap between levels of undernutrition in men and women is generally small, but that the gap varies from region to region and from country to country.<ref name="Nube 2003" /> These small-scale studies showed that female undernutrition prevalence rates exceeded male undernutrition prevalence rates in South/Southeast Asia and Latin America and were lower in Sub-Saharan Africa.<ref name="Nube 2003" /> Datasets for Ethiopia and Zimbabwe reported undernutrition rates between 1.5 and 2 times higher in men than in women; however, in India and Pakistan, datasets rates of undernutrition were 1.5–2 times higher in women than in men. Intra-country variation also occurs, with frequent high gaps between regional undernutrition rates.<ref name="Nube 2003">{{cite journal | vauthors = Nubé M, Van Den Boom GJ | title = Gender and adult undernutrition in developing countries | journal = Annals of Human Biology | volume = 30 | issue = 5 | pages = 520–537 | year = 2003 | pmid = 12959894 | doi = 10.1080/0301446031000119601 | s2cid = 25229403 }}</ref> [[Gender]] inequality in nutrition in some countries such as India is present in all stages of life.<ref name="Women 2008">{{cite journal| vauthors = Dewan M |title=Malnutrition in Women|journal= Studies on Home and Community Science|year=2008|volume=2|issue=1|pages=7–10|url=http://www.krepublishers.com/02-Journals/S-HCS/HCS-02-0-000-08-Web/HCS-02-1-001-08-Abst-Text/HCS-02-1-007-08-013-Dewan-M/HCS-02-1-007-08-013-Dewan-M-Tt.pdf |access-date=March 3, 2014|doi=10.1080/09737189.2008.11885247|s2cid=39557892}}</ref>

Studies on nutrition concerning gender bias within households look at patterns of food allocation, and one study from 2003 suggested that women often receive a lower share of food requirements than men.<ref name="Nube 2003" /> Gender discrimination, gender roles, and social norms affecting women can lead to early marriage and childbearing, close birth spacing, and undernutrition, all of which contribute to malnourished mothers.<ref name="Factors in Bangladesh" />

Within the household, there may be differences in levels of malnutrition between men and women, and these differences have been shown to vary significantly from one region to another, with problem areas showing relative deprivation of women.<ref name="Nube 2003" /> Samples of 1000 women in India in 2008 demonstrated that malnutrition in women is associated with poverty, lack of development and awareness, and illiteracy.<ref name="Women 2008" /> The same study showed that gender discrimination in households can prevent a woman's access to sufficient food and healthcare.<ref name="Women 2008" /> How socialization affects the health of women in Bangladesh, Najma Rivzi explains in an article about a research program on this topic.<ref>{{cite web |author=Najma Rizvi |publisher=dandc.eu |title=Enduring misery |date=March 2013 |url=http://www.dandc.eu/en/article/bangladesh-does-not-guarantee-food-security-demanded-its-constitution}}</ref> In some cases, such as in parts of Kenya in 2006, rates of malnutrition in pregnant women were even higher than rates in children.<ref>{{cite web|vauthors=Carter RB|title=Survey Reveals High Malnutrition Rates Among Pregnant Women in Kenya|work=UNICEF |url=http://www.unicef.org/infobycountry/kenya_33782.html|access-date=March 3, 2014|archive-date=March 28, 2014|archive-url=https://web.archive.org/web/20140328115626/http://www.unicef.org/infobycountry/kenya_33782.html}}</ref>

Women in some societies are traditionally given less food than men since men are perceived to have heavier workloads.<ref name="Gender and Nutrition 2001" /> Household chores and agricultural tasks can in fact be very arduous and require additional energy and nutrients; however, physical activity, which largely determines energy requirements, is difficult to estimate.<ref name="Nube 2003" />

====Physiology====
Women have unique nutritional requirements, and in some cases need more nutrients than men; for example, women need twice as much calcium as men.<ref name="Gender and Nutrition 2001">{{cite web|title=Gender and Nutrition 2001|url=https://www.uthfa.com/gender-nutrition-2001/|publisher=Food and Agriculture of the United Nations |access-date=August 22, 2016|date=July 2001}}</ref>

====Pregnancy and breastfeeding====
During pregnancy and breastfeeding, women must ingest enough nutrients for themselves and their child, so they need significantly more protein and calories during these periods, as well as more vitamins and minerals (especially iron, iodine, calcium, folic acid, and vitamins A, C, and K).<ref name="Gender and Nutrition 2001" /> In 2001 the FAO of the UN reported that iron deficiency affected 43 percent of women in [[developing countries]] and increased the risk of death during childbirth.<ref name="Gender and Nutrition 2001" /> A 2008 review of interventions estimated that universal supplementation with calcium, iron, and folic acid during pregnancy could prevent 105,000 maternal deaths (23.6 percent of all maternal deaths).<ref name="Bhutta 2008">{{cite journal | vauthors = Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M | display-authors = 6 | title = What works? Interventions for maternal and child undernutrition and survival | journal = Lancet | volume = 371 | issue = 9610 | pages = 417–440 | date = February 2008 | pmid = 18206226 | doi = 10.1016/S0140-6736(07)61693-6 | s2cid = 18345055 | author12 = Maternal Child Undernutrition Study Group }}</ref> Malnutrition has been found to affect three-quarters of UK women aged 16–49 indicated by them having less folic acid than the WHO recommended levels.<ref>{{Cite news |url= https://www.theguardian.com/society/2018/oct/14/folic-acid-to-be-added-to-flour-in-effort-to-reduce-serious-birth-defects |title= Folic acid to be added to UK flour in effort to reduce birth defects |newspaper= [[The Guardian]] |author= Denis Campbell |date = October 14, 2014 |access-date=October 15, 2018}}</ref>

Frequent pregnancies with short intervals between them and long periods of breastfeeding add an additional nutritional burden.<ref name="Nube 2003" />

====Educating children====
"[[Action for Healthy Kids]]" has created several methods to teach children about nutrition. They introduce 2 different topics, self-awareness which teaches children about taking care of their own health and social awareness, which is how culinary arts vary from culture to culture. As well as its importance when it comes to nutrition. They include eBooks, tips, cooking clubs. including facts about vegetables and fruits.<ref>{{Cite web|url=https://www.actionforhealthykids.org/activity/nutrition-education/|title=Nutrition Education|website=Action for Healthy Kids}}</ref>

Team Nutrition has created "[[MyPlate|MyPlate eBooks]]" this includes 8 different eBooks to download for free. These eBooks contain drawings to color, audio narration, and a large number of characters to make nutrition lessons entertaining for children.<ref>{{Cite web|url=https://www.fns.usda.gov/tn/team-nutrition-myplate-ebooks|archive-url=https://web.archive.org/web/20170516084952/https://www.fns.usda.gov/tn/team-nutrition-myplate-ebooks|archive-date=May 16, 2017|title=Team Nutrition MyPlate eBooks}}</ref>

According to the FAO, women are often responsible for preparing food and have the chance to educate their children about beneficial food and health habits, giving mothers another chance to improve the nutrition of their children.<ref name="Gender and Nutrition 2001" />

===Elderly===
[[File:Sea buckthorn seed oil gel.JPEG|thumb|right|[[Essential nutrient]]s are one of the main requirements of [[elderly care]].]]
Malnutrition and being underweight are more common in the elderly than in adults of other ages.<ref name="quality of life 2011">{{cite journal | vauthors = Kvamme JM, Olsen JA, Florholmen J, Jacobsen BK | title = Risk of malnutrition and health-related quality of life in community-living elderly men and women: the Tromsø study | journal = Quality of Life Research | volume = 20 | issue = 4 | pages = 575–582 | date = May 2011 | pmid = 21076942 | pmc = 3075394 | doi = 10.1007/s11136-010-9788-0 }}</ref> If elderly people are healthy and active, the aging process alone does not usually cause malnutrition.<ref name="Elder Insecurities">{{cite journal | vauthors = Wellman NS, Weddle DO, Kranz S, Brain CT | title = Elder insecurities: poverty, hunger, and malnutrition | journal = Journal of the American Dietetic Association | volume = 97 | issue = 10 Suppl 2 | pages = S120–S122 | date = October 1997 | pmid = 9336570 | doi = 10.1016/S0002-8223(97)00744-X }}</ref> However, changes in body composition, organ functions, adequate energy intake and ability to eat or access food are associated with aging, and may contribute to malnutrition.<ref name="geriatric syndromes" /> Sadness or depression can play a role, causing changes in appetite, digestion, energy level, weight, and well-being.<ref name="Elder Insecurities" /> A study on the relationship between malnutrition and other conditions in the elderly found that malnutrition in the elderly can result from gastrointestinal and endocrine system disorders, loss of taste and smell, decreased appetite and inadequate dietary intake.<ref name="geriatric syndromes">{{cite journal | vauthors = Saka B, Kaya O, Ozturk GB, Erten N, Karan MA | title = Malnutrition in the elderly and its relationship with other geriatric syndromes | journal = Clinical Nutrition | volume = 29 | issue = 6 | pages = 745–748 | date = December 2010 | pmid = 20627486 | doi = 10.1016/j.clnu.2010.04.006 }}</ref> Poor dental health, ill-fitting dentures, or chewing and swallowing problems can make eating difficult.<ref name="Elder Insecurities" /> As a result of these factors, malnutrition is seen to develop more easily in the elderly.<ref name= "Volkert 2002">{{cite journal| vauthors = Volkert D |title=Malnutrition in the elderly – prevalence, causes and corrective strategies|journal=Clinical Nutrition|year=2002|volume=21|pages=110–112|doi=10.1016/S0261-5614(02)80014-0}}</ref>

Rates of malnutrition tend to increase with age with less than 10 percent of the "young" elderly (up to age 75) malnourished, while 30 to 65 percent of the elderly in home care, long-term care facilities, or acute hospitals are malnourished.<ref>{{cite journal | vauthors = Volkert D | title = Malnutrition in the elderly – prevalence, causes and corrective strategies | journal = Clinical Nutrition | volume = 21 | pages = 110–112 | year = 2002 |doi=10.1016/S0261-5614(02)80014-0}}</ref> Many elderly people require assistance in eating, which may contribute to malnutrition.<ref name="Volkert 2002" /> However, the mortality rate due to undernourishment may be reduced.<ref name="ener.2009">{{cite journal | vauthors = Milne AC, Potter J, Vivanti A, Avenell A | title = Protein and energy supplementation in elderly people at risk from malnutrition | journal = The Cochrane Database of Systematic Reviews | issue = 2 | article-number = CD003288 | date = April 2009 | volume = 2009 | pmid = 19370584 | pmc = 7144819 | doi = 10.1002/14651858.CD003288.pub3 }}</ref> Because of this, one of the main requirements of [[elderly care]] is to provide an adequate diet and all [[essential nutrients]].<ref>{{cite journal | vauthors = Mamhidir AG, Kihlgren M, Soerlie V | title = Malnutrition in elder care: qualitative analysis of ethical perceptions of politicians and civil servants | journal = BMC Medical Ethics | volume = 11 | article-number = 11 | date = June 2010 | pmid = 20553607 | pmc = 2927875 | doi = 10.1186/1472-6939-11-11 | doi-access = free }}</ref> Providing the different nutrients such as protein and energy keeps even small but consistent weight gain.<ref name="ener.2009" /> Hospital admissions for malnutrition in the United Kingdom have been related to insufficient social care, where vulnerable people at home or in care homes are not helped to eat.<ref>{{cite news |title=Care crisis triggers rise in malnutrition, charities claim |url=https://www.homecareinsight.co.uk/care-crisis-triggers-rise-in-malnutrition-charities-claim/ |access-date=October 1, 2019 |publisher=Home care Insight |date=August 19, 2019}}</ref>

In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission.<ref>{{cite journal | vauthors = Bolin T, Bare M, Caplan G, Daniells S, Holyday M | title = Malabsorption may contribute to malnutrition in the elderly | journal = Nutrition | volume = 26 | issue = 7–8 | pages = 852–853 | year = 2010 | pmid = 20097534 | doi = 10.1016/j.nut.2009.11.016 }}</ref> Malnutrition and weight loss can contribute to [[sarcopenia]] with loss of lean body mass and muscle function.<ref name="quality of life 2011" /> Abdominal obesity or weight loss coupled with sarcopenia lead to immobility, skeletal disorders, insulin resistance, hypertension, atherosclerosis, and [[metabolic disorders]].<ref name="geriatric syndromes" /> A paper from the ''Journal of the American Dietetic Association'' noted that routine nutrition screenings represent one way to detect and therefore decrease the prevalence of malnutrition in the elderly.<ref name="Elder Insecurities" />

== See also ==
{{Portal|Food}}
{{col div|colwidth=20em}}
* [[Action Against Hunger]]
* ''[[A Place at the Table]]''
* [[Agrobiodiversity]]
* [[Child health and nutrition in Africa]]
* [[Childhood obesity]]
* [[Community Therapeutic Care]]
* [[Deficiency (medicine)]]
* [[Eating disorder]]
* [[Economic issues]]
* [[Famine scales]]
* [[Fome Zero]] (Zero Hunger)
* [[Food Donation Connection]]
* [[Homelessness]]
* [[Hunger in the United Kingdom]]
* [[Hunger in the United States]]
* [[Hunger marches]]
* [[The Hunger Project]]
* [[Income inequality]]
* [[Integrated Food Security Phase Classification]]
* [[List of global issues]]
* [[Malnutrition in India]]
* [[Malnutrition in South Africa]]
* [[Malnutrition in Peru]]
* [[Malnutrition in Zimbabwe]]
* [[NutritionDay]]
* [[Nutrition and Education International]]
* [[Muselmann]]
* [[National Security Study Memorandum 200]] (1974)
* [[Oxfam]]
* [[Poverty trap]]
* [[Project Open Hand]]
* [[Social programs]]
* [[Starvation response]]
* [[Sustainable fishery]]
* [[United Nations Millennium Declaration]]
* [[Vitamin deficiency]]
{{div col end}}

== References ==
{{Reflist}}

== Sources ==
* {{Free-content attribution
| title = The State of Food Security and Nutrition in the World 2024
| author = Food and Agriculture Organization
| documentURL = https://openknowledge.fao.org/server/api/core/bitstreams/d5be2ffc-f191-411c-9fee-bb737411576d/content
| license statement URL = https://openknowledge.fao.org/items/ebe19244-9611-443c-a2a6-25cec697b361
| license = CC BY-SA 4.0
}}

== External links ==
{{Medical resources
| DiseasesDB =
| ICD10 = {{ICD10|E|40}}-{{ICD10|E|46}}
| ICD9 = 263.9
| ICDO =
| OMIM =
| MedlinePlus = 000404
| eMedicineSubj = ped
| eMedicineTopic = 1360
| MeshID = D044342
| SNOMED CT = 2492009
| ICD10CM = {{ICD10CM|E40-E46}}
}}
{{Wiktionary|malnutrition|undernutrition}}
{{wikiquote}}
{{commons category}}
* [http://documents-dds-ny.un.org/doc/UNDOC/GEN/N07/487/05/PDF/N0748705.pdf?OpenElement United Nation 2007 report]
* [http://wfp.org World Food Programme | WFP]
* [https://www.un.org/sustainabledevelopment/hunger/ UN]
* [https://www.wfp.org/publications/2020-global-report-food-crises WFP]

{{Nutritional pathology}}
{{Diseases of Poverty}}
{{Disease groups}}
{{Authority control}}

[[Category:Malnutrition| ]]
[[Category:Global issues]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia infectious disease articles ready to translate]]
[[Category:Health effects of food and nutrition]]
[[Category:Limbic system]]
[[Category:Motivation]]
[[Category:Neuropsychology]]
[[Category:Eating behaviors]]
[[Category:Hazards of outdoor recreation]]