Malnutrition describes the measurable impairment to individual health and well-being resulting from insufficient or unbalanced food intake relative to physiological needs. The term is often compared and contrasted with hunger, which refers to the subjective feeling of discomfort caused by lack of food, and food insecurity, which describes lack of access to nutritionally adequate food in a socially acceptable manner. Malnutrition usually arises in situations of national or regional food shortage (its acute form is famine), where geographic regions or nations lack adequate food supply, and food poverty, where households lack resources (entitlements) to produce or acquire adequate nourishment. But individual food deprivation also occurs when national and household availabilities are adequate but distribution is inequitable; in famine situations, some always eat well. World hunger is a composite term covering insufficient availability, access, and utilization of food at global, national, household, and individual levels.
The United Nations Food and Agricultural Organization (FAO) and the World Bank, working from national food production and trade statistics along with household income figures relative to the price of a minimum food basket, estimate that some 800 million people in developing countries are food insecure. This is despite aggregate increases in agricultural production and improvements in market infrastructure that, since the 1970s, have made it technically possible to feed everyone a nutritionally adequate basic diet. The largest proportions of food-insecure households and undernourished children exist in South Asia, where endemic poverty is high; numbers are growing also in sub-Saharan Africa, where political instability and HIV-AIDS interfere with food production, marketing, income generation, and intergenerational care.
Within households, pregnant and lactating women, adolescent girls, infants and young (especially weaning-aged) children, and elders are particularly vulnerable to malnutrition where they suffer intrahousehold discrimination in access to food and care relative to their nutritional needs. This vulnerability is further elevated by excessive workloads, infections, malabsorption syndromes, environmental contamination, and insufficient health services. Public health nutritionists study nutrition over the life cycle, beginning with gestational nutrition and breast-feeding, to identify these culturally specific age-and gender-related patterns of malnourishment and to institute more effective food and nutrition policies and practices.
Undernutrition includes both protein-energy (protein-calorie) malnutrition and specific micronutrient deficiencies. Manifestations include growth failure in children, underweight and weight loss in adults, extra burdens of disease, and functional impairments to physical activity, work performance, cognitive abilities, reproductive outcomes, and social life. From the 1930s through the late 1960s, nutritionists working with the FAO, the World Health Organization (WHO), and the United Nations University (UNU) made prevention of protein deficiency (the "protein gap") the priority for interventions. In the 1970s emphasis shifted to energy (calories) on the reasoning that if nutritionally deprived children (or adults) could get sufficient quantities of their traditional balanced diet, protein would take care of itself. Increasing food energy also fit the agricultural-intensification agenda of the green revolution that was producing piles of rice, wheat, and to a lesser extent maize in Asia and Latin America but reducing protein-balanced cereal-legume crop mixes. Malnutrition, conceptualized as a factor in longer-term national economic growth and development, also became part of integrated national nutrition and rural development strategies. These strategies were promoted by the World Bank and other foreign-assistance agencies, which launched national maternal-child health and school feeding programs, targeted food subsidies, agricultural diversification and marketing programs as well as income generation and nutrition and health education efforts. Basic needs investments in education, health, clean water, and sanitation tried to address poverty alleviation and malnutrition together while contributing to longer-term economic growth.
In the late 1980s and early 1990s priorities and framing shifted yet again, this time to ending "hidden hunger." With UNICEF taking the lead, the World Summit for Children (WSC) in 1990 set goals to reduce--by half-- mild to moderate energy-protein malnutrition, which had been implicated in more than half of child deaths in the developing world, and virtual elimination of vitamin A, iodine, and iron deficiencies as public health problems. By this time dietary diversification had practically eliminated beriberi (thiamin deficiency, associated with polished rice diets), pellagra (niacin deficiency, associated with maize), kwashiorkor (protein deficiency, associated with dependence on a starchy tuber or sap), rickets (associated with too little vitamin D and exposure to sunlight), and scurvy (vitamin C deficiency). The WSC initiatives combined nutrient supplementation, food fortification, and food-based strategies as strategies to end vitamin A deficiency blindness and impaired immune response, cretinism and goiter (associated with severe gestational and later deficiencies of iodine), and severe iron deficiency anemias. At the same time the WSC's goal was to correct more moderate deficiencies, which researchers showed could depress physical and intellectual development, work performance, and child survival.
Subsequently the World Food Summit (1996) and the Millennium Development Goals set additional targets and action plans for reducing world hunger numbers and proportions by half, along with their causes, by 2015. In follow-up, nongovernmental organizations (NGOs) and community-based organizations, collaborating with governments and international agencies, increasingly frame approaches in terms of livelihood security (income generation, microcredit, female education) and rights-based development or the right to adequate food (emphasizing government accountability and public-private-community partnerships and participation). NGOs also play a growing role in humanitarian assistance, including the SPHERE project, which disseminates principles, minimum technical standards, and best practices for responding to disasters. Although international famine early warning systems--and attendant obligations for food aid response--have eliminated most severe malnutrition apart from areas of political instability, active conflict, or oppression, seasonal and chronic malnutrition persist where people lack access to markets and government or international assistance and among those experiencing the immediate economic displacements of globalization. Local and global studies analyzing these contexts of malnutrition suggest that to reduce malnutrition and poverty everywhere, it is necessary to overcome the economic, political, and social exclusion of women by improving women's education, entitlements, livelihoods, and empowerment, especially across South Asia, and providing fairer access to land, water, infrastructure, and terms of trade.
Although conventionally through the 1980s malnutrition usually referred to undernutrition, caused primarily by poverty and improper diet, there has since been increased attention to overweight, obesity, and nutritional "diseases of civilization," including diabetes, coronary heart disease, and certain cancers associated with unhealthy diets and behaviors. These syndromes are on the rise also in developing countries, which are experiencing dietary transitions away from traditional, balanced local diets based on grains, legumes, oilseeds, and small amounts of animal protein plus fruits and vegetables toward modern, unbalanced, global diets characterized by more processed and "fast" foods that are higher in fats and simple sugars. Nutritionists studying the etiology of malnutrition now find overweight and underweight individuals residing in the same households, as both low- and higher-income people fill up on cheaper, calorie-dense snacks and sugary beverages. Genetically modified foods and corporate control over the global food system are additional contentious issues for the present and future.
DeRose, Laurie, Ellen Messer, and Sara Millman, eds. 1998. Who's Hungry? And How Do We Know? Food Shortage, Poverty, and Deprivation. Tokyo: United Nations University Press.
Food and Agricultural Organization. 2011. State of Food Insecurity in the World. http://www.fao.org/publications/sofi/en/.
Runge, C. Ford, Benjamin Senauer, Philip G. Pardey, and Mark W. Rosegrant. 2003. Ending Hunger in Our Lifetime: Food Security and Globalization. Baltimore, MD: Johns Hopkins University Press.
World Health Organization. 2007. Global Database on Child Growth and Malnutrition. http://www.who.int/nutgrowthdb/en/.
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