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{{redirect|Underfeeding|the concept in metalworking|Underfeeder}}
{{Use mdy dates|date=March 2014}}
{{Infobox medical condition
| Name = Malnutrition
| Image = Orange ribbon.svg
| Caption = An orange ribbon—the [[awareness ribbon]] for malnutrition.
| Field = [[Critical care medicine]]
| Width = 120
| DiseasesDB =
| ICD10 = {{ICD10|E|40}}-{{ICD10|E|46}}
| ICD9 = 263.9
| ICDO =
| OMIM =
| MedlinePlus = 000404
| eMedicineSubj = ped
| eMedicineTopic = 1360
| MeshID = D044342
}}
<!-- Definition and Symptoms -->
'''Malnutrition''' or '''malnourishment''' is a condition that results from eating a [[Diet (nutrition)|diet]] in which [[nutrient]]s are either not enough or are too much such that the diet causes health problems.<ref>{{DorlandsDict|five/000062745|malnutrition}}</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}}</ref> It may involve [[calories]], [[protein]], [[carbohydrates]], [[vitamin]]s or [[dietary element|mineral]]s.<ref name="FFL2010" /> Not enough nutrients is called '''undernutrition''' or '''undernourishment''' while too much is called [[overnutrition]].<ref name=Young2012>{{cite book|last1=Young|first1=E.M.|title=Food and development|date=2012|publisher=Routledge|location=Abingdon, Oxon|isbn=9781135999414|pages=36–38|url=https://books.google.com/books?id=XhwKwNzJVjQC&pg=PA36}}</ref> Malnutrition is often used specifically to refer to undernutrition where there is not enough calories, protein, or [[micronutrients]].<ref name=Young2012/><ref name=Jones2011>{{cite book|title=Essentials of International Health|date=2011|publisher=Jones & Bartlett Publishers|isbn=9781449667719|page=194|url=https://books.google.com/books?id=lt7TqZPZSlIC&pg=PA194}}</ref> 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/> Extreme undernourishment, known as [[starvation]], may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and [[abdomen]].<ref name=FFL2010/><ref name=Young2012/> People also often get infections and are frequently [[hypothermia|cold]].<!-- <ref name=Young2012/> --> The symptoms of [[micronutrient deficiencies]] depend on the micronutrient that is lacking.<ref name=Young2012/>

<!-- Cause -->
Undernourishment is most often due to not enough high-quality food being available to eat.<ref name=WHO2014/> This is often related to high food prices and [[poverty]].<ref name=FFL2010/><ref name=WHO2014/> A lack of [[breastfeeding]] may contribute, as may a number of [[infectious diseases]] such as: [[gastroenteritis]], [[pneumonia]], [[malaria]], and [[measles]], which increase nutrient requirements.<ref name=WHO2014/> There are two main types of undernutrition: [[protein-energy malnutrition]] and dietary deficiencies.<ref name=Jones2011/> Protein-energy malnutrition has two severe forms: [[marasmus]] (a lack of protein and calories) and [[kwashiorkor]] (a lack of just protein).<ref name=Young2012/> Common micronutrient deficiencies include: a lack of [[iron deficiency|iron]], [[iodine deficiency|iodine]], and [[vitamin A deficiency|vitamin A]].<ref name=Young2012/> During [[pregnancy]], due to the body's increased need, deficiencies may become more common.<ref>{{cite book|last1=Konje|first1=editor, Mala Arora ; co-editor, Justin C.|title=Recurrent pregnancy loss|date=2007|publisher=Jaypee Bros. Medical Publishers|location=New Delhi|isbn=9788184480061|edition=2nd}}</ref> In some [[developing countries]], overnutrition in the form of [[obesity]] is beginning to present 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}}</ref> Other causes of malnutrition include [[anorexia nervosa]] and [[bariatric surgery]].<ref>{{cite book|last1=Prentice|first1=editor-in-chief, Benjamin Caballero ; editors, Lindsay Allen, Andrew|title=Encyclopedia of human nutrition|date=2005|publisher=Elsevier/Academic Press|location=Amsterdam|isbn=9780080454283|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=9781455738120|page=324|edition=6th|url=https://books.google.com/books?id=yxTtmJYPUV0C&pg=PA324}}</ref>

<!-- Treatment -->
Efforts to improve [[nutrition]] are some of the most effective forms of [[development aid]].<ref name=UK2012/> Breastfeeding can reduce rates of malnutrition and death in children,<ref name=FFL2010/> and efforts to promote the practice increase the rates of breastfeeding.<ref name=Bh2013/> In young children, providing food (in addition to breastmilk) between six months and two years of age improves outcomes.<ref name=Bh2013/> There is also good evidence supporting the [[dietary supplements|supplementation]] of a number of micronutrients to women during pregnancy and among young children in the developing world.<ref name=Bh2013/> To get food to people who need it most, both delivering food and providing money so people can buy food within local markets are effective.<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|accessdate=5 July 2014|date=April 2012}}</ref> Simply feeding students at school is insufficient.<ref name=UK2012/> Management of severe malnutrition within the person's home with [[therapeutic food#Ready-to-Use Therapeutic Food|ready-to-use therapeutic foods]] is possible much of the time.<ref name=Bh2013/> In those who have severe malnutrition complicated by other health problems, treatment in a hospital setting is recommended.<ref name=Bh2013/> This often involves managing [[hypoglycemia|low blood sugar]] and [[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=9241546093}}</ref> Routine [[antibiotic]]s are usually recommended due to the high risk of infection.<ref name=WHO2003/> Longer-term measures include: improving agricultural practices,<ref name=solcultivateplanet>{{cite journal |author=Jonathan A. Foley, Navin Ramankutty, Kate A. Brauman, Emily S. Cassidy, James S. Gerber, Matt Johnston, Nathaniel D. Mueller, Christine O’Connell, Deepak K. Ray, Paul C. West, Christian Balzer, Elena M. Bennett, Stephen R. Carpenter, Jason Hill1, Chad Monfreda, Stephen Polasky1, Johan Rockström, John Sheehan, Stefan Siebert, David Tilman1, David P. M. Zaks |title=Solutions for a cultivated planet |journal=Nature |volume=478 |issue=7369 |pages=337–342 |date=October 2011|pmid=21993620|url=http://www.nature.com/nature/journal/v478/n7369/full/nature10452.html |doi=10.1038/nature10452}}</ref> reducing poverty, improving [[sanitation]], and the [[empowering women|empowerment of women]].<ref name=UK2012/>

<!-- Epidemiology, society and culture, special populations -->
There were 793&nbsp;million undernourished people in the world in 2015 (13% of the total population).<ref name=UNFAO2015>{{cite web|title=The State of Food Insecurity in the World 2015|url=http://www.fao.org/hunger/key-messages/en/|publisher=Food and Agricultural Organization of the United Nations|accessdate=27 December 2015}}</ref> This is a reduction of 216&nbsp;million people since 1990 when 23% were undernourished.<ref name=UNFAO2015/><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|accessdate=1 July 2014|date=September 2010}}</ref> In 2012 it was estimated that another billion people had a lack of vitamins and minerals.<ref name=UK2012>{{cite web|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|website=www.gov.uk|publisher=Department for International Development|accessdate=5 July 2014|date=Oct 2012}}</ref> In 2013, [[protein-energy malnutrition]] was estimated to have resulted in 469,000 deaths—down from 510,000 deaths in 1990.<ref>{{cite journal|last1=GBD 2013 Mortality and Causes of Death|first1=Collaborators|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2|volume=385|issue=9963|pages=117–71|pmc=4340604}}</ref> Other nutritional deficiencies, which include [[iodine deficiency]] and [[iron deficiency anemia]], result in another 84,000 deaths.<ref name=Loz2012>{{cite journal |vauthors=Lozano R, Naghavi M, Foreman K, etal |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=2095–128 |date=December 2012 |pmid=23245604 |doi=10.1016/S0140-6736(12)61728-0 |url=}}</ref> In 2010, malnutrition was the cause of 1.4% of all [[disability adjusted life years]].<ref name=UK2012/><ref name=Murray2012>{{cite journal|last1=Murray|first1=CJ|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|date=Dec 15, 2012|volume=380|issue=9859|pages=2197–223|pmid=23245608|doi=10.1016/S0140-6736(12)61689-4}}</ref> About a third of deaths in children are believed to be due to undernutrition, although the deaths are rarely labelled as such.<ref name=WHO2014>{{cite web|title=Maternal, newborn, child and adolescent health|url=http://www.who.int/maternal_child_adolescent/topics/child/malnutrition/en/|website=WHO|accessdate=4 July 2014}}</ref> In 2010, it was estimated to have contributed to about 1.5 million deaths in women and children,<ref name=Lim2012>{{cite journal |vauthors=Lim SS, Vos T, Flaxman AD, etal |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=2224–60 |date=December 2012 |pmid=23245609 |doi=10.1016/S0140-6736(12)61766-8 |url=}}</ref> though some estimate the number may be greater than 3&nbsp;million.<ref name="Bh2013"/> An additional 165&nbsp;million children were estimated to have [[stunted growth]] from malnutrition in 2013.<ref name=Bh2013>{{cite journal|last1=Bhutta|first1=ZA|last2=Das|first2=JK|last3=Rizvi|first3=A|last4=Gaffey|first4=MF|last5=Walker|first5=N|last6=Horton|first6=S|last7=Webb|first7=P|last8=Lartey|first8=A|last9=Black|first9=RE|last10=Lancet Nutrition Interventions Review|first10=Group|last11=Maternal and Child Nutrition Study|first11=Group|title=Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?|journal=Lancet|date=Aug 3, 2013|volume=382|issue=9890|pages=452–77|pmid=23746776|doi=10.1016/s0140-6736(13)60996-4}}</ref> Undernutrition is more common in [[developing countries]].<ref>{{cite book|author1=Liz Young|title=World Hunger Routledge Introductions to Development|date=2002|isbn=9781134774944|page=20|url=https://books.google.com/books?id=w4CGAgAAQBAJ&pg=PA20}}</ref> Certain groups have higher rates of undernutrition, including women—in particular while pregnant or breastfeeding—[[malnutrition in children|children]] under five years of age, and the elderly. In the [[elderly]], undernutrition becomes more common due to physical, psychological, and social factors.<ref>{{cite book|last1=editors|first1=Ronnie A. Rosenthal, Michael E. Zenilman, Mark R. Katlic,|title=Principles and practice of geriatric surgery|date=2011|publisher=Springer|location=Berlin|isbn=9781441969996|page=78|edition=2nd|url=https://books.google.com/books?id=VcgmpMZE6a8C&pg=PA87}}</ref>
{{TOC limit|3}}

==Definitions==
[[File:Kwashiorkor 6180.jpg|thumb|Child in the [[United States]] with signs of [[Kwashiorkor]], a dietary protein deficiency.]]
Unless specifically mentioned otherwise, the term malnutrition refers to undernutrition for the remainder of this article. Malnutrition can divided in two different types, SAM and MAM. SAM is refers to children with severe acute malnutrition. MAM refers to moderate acute malnutrition.<ref name=":2">{{Cite journal|last=Sathish Subramanian, Sayeeda Huq, Tanya Yatsunenko, Rashidul Haque, Mustafa Mahfuz, Mohammed A. Alam|date=19 June 2014|title=Persistent gut microbiota immaturity in malnourished Bangladeshi children|url=|journal=Nature, Vol. 510|publisher=Nature Publishing Group|doi=|pmid=|access-date=}}</ref>

===Undernutrition and overnutrition===
Malnutrition is caused by eating a diet in which [[nutrient]]s are ''not enough'' or are ''too much'' such that it causes health problems.<ref name="Clinical Nutrition in Practice (2011)">{{cite book|last=Nikolaos Katsilambros|title=Clinical Nutrition in Practice|year=2011|publisher=John Wiley & Sons|isbn=978-1-4443-4777-7|pages=37|url=https://books.google.com/books?id=pJHU1m7BEP8C&pg=PT46}}</ref> It is a category of diseases that includes undernutrition and [[overnutrition]].<ref>{{cite web|title=WHO, nutrition experts take action on malnutrition |url=http://www.who.int/nutrition/pressnote_action_on_malnutrition/en/|work=World Health Organization |accessdate=February 10, 2012}}</ref> Overnutrition can result in [[obesity]] and being [[overweight]]. In some [[developing countries]], overnutrition in the form of [[obesity]] is beginning to present 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}}</ref>

However, the term malnutrition is commonly used to refer to undernutrition only.<ref name="autogenerated1">{{cite book|last=Nikolaos Katsilambros|title=Clinical Nutrition in Practice|year=2011|publisher=John Wiley & Sons|isbn=978-1-4443-4777-7|pages=39|url=https://books.google.com/books?id=pJHU1m7BEP8C&pg=PT46}}</ref> This applies particularly to the context of development cooperation. Therefore, "malnutrition" in documents by the [[World Health Organization]], [[UNICEF]], [[Save the Children]] or other international [[non-governmental organization]]s (NGOs) usually is equated to undernutrition.

===Protein-energy malnutrition===

Undernutrition is sometimes used as a synonym of [[protein–energy malnutrition]] (PEM).<ref name="Young2012" /> While other include both [[micronutrient deficiencies]] and protein energy malnutrition in its definition.<ref name="Jones2011" /> It differs from [[calorie restriction]] in that calorie restriction may not result in negative health effects. The term hypoalimentation means underfeeding.<ref>{{DorlandsDict|four/000051473|hypoalimentation}}</ref>

The term "severe malnutrition" or "severe undernutrition" is often used to refer specifically to [[protein–energy malnutrition|PEM]].<ref name="Nutrition in pediatrics">{{cite book|last=Walker|first=[edited by] Christopher Duggan, John B. Watkins, W. Allan |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/?id=wSTISCdSIosC&printsec=frontcover&dq=Nutrition+in+pediatrics+:+basic+science,+clinical+application#v=onepage&q=Nutrition%20in%20pediatrics%20%3A%20basic%20science%2C%20clinical%20application&f=false}}</ref> PEM is often associated with micronutrient deficiency.<ref name="Nutrition in pediatrics" /> Two forms of PEM are [[kwashiorkor]] and [[marasmus]], and they commonly coexist.<ref name="Clinical Nutrition in Practice (2011)" />

====Kwashiorkor====
[[Kwashiorkor]] (‘displaced child’) is mainly caused by inadequate protein intake resulting in a low concentration of amino acids.<ref name="Clinical Nutrition in Practice (2011)" /> The main symptoms are [[edema]], wasting, liver enlargement, hypoalbuminaemia, steatosis, and possibly depigmentation of skin and hair.<ref name="Clinical Nutrition in Practice (2011)" /> Kwashiorkor is identified by swelling of the extremities and belly, which is deceiving of actual nutritional status.<ref name="Chowdhury 2008" />

====Marasmus====
[[Marasmus]] (‘to waste away’) is caused by an inadequate intake of protein and energy. The main symptoms are severe wasting, leaving little or no edema, minimal subcutaneous fat, severe muscle wasting, and non-normal serum albumin levels.<ref name="Clinical Nutrition in Practice (2011)" /> Marasmus can result from a sustained diet of inadequate energy and protein, and the metabolism adapts to prolong survival.<ref name="Clinical Nutrition in Practice (2011)" /> It is traditionally seen in famine, significant food restriction, or more severe cases of [[anorexia (symptom)|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" />

===Undernutrition, hunger===
Undernutrition encompasses [[stunted growth]] (stunting), wasting, and deficiencies of essential vitamins and minerals (collectively referred to as micronutrients). The term [[hunger]], which describes a feeling of discomfort from not eating, has been used to describe undernutrition, especially in reference to food insecurity.<ref name="Black2008" />

===Definition by Gomez===
In 1956, Gómez and Galvan studied factors associated with death in a group of malnourished (undernourished) children in a hospital in Mexico City, Mexico and defined categories of malnutrition: first, second, and third degree.<ref name="Stevenson 2011">{{cite journal|last1=Stevenson|first1=R. D.|author2=Conaway, M. R.|title=Weight and Mortality Rates: "Gomez Classification" for Children With Cerebral Palsy?|journal=Pediatrics|date=August 2011|volume=128|issue=2|pages=e436–e437|doi=10.1542/peds.2011-1472|pmid=21768321}}</ref> The degrees were based on weight below a specified percentage of median weight for age.<ref name="Grover 2009" /> The risk of death increases with increasing degree 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, the classification has been criticized for being "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 born prematurely may be considered short for their age even if they have good nutrition.<ref name="Gueri 1980">{{cite journal |last1=Gueri |first1=M.|author2=J. M. Gurney, P. Jutsum|title=The gomez classification. Time for a change?|journal=Bulletin of the World Health Organization|year=1980|volume=58|issue=5|pages=773–777|url=http://whqlibdoc.who.int/bulletin/1980/Vol58-No5/bulletin_1980_58(5)_773-777.pdf|pmid=6975186|pmc=2395976}}</ref>

{| class="wikitable" border="1"
|-
! 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 | last1 = Chowdhury | first1 = M. S. I. | last2 = Akhter | first2 = N. | last3 = Haque | first3 = M. | last4 = Aziz | first4 = R. | last5 = Nahar | first5 = N. | title = Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition | journal = Journal of Bangladesh Society of Physiologist | volume = 3 | year = 2009 | pmid = | pmc = | doi = 10.3329/jbsp.v3i0.1799 }}</ref></small>
|}

===Definition by Waterlow===
[[John Waterlow|John Conrad Waterlow]] established a new classification for malnutrition.<ref name="Waterlow 1972"/> Instead of using just weight for age measurements, the classification established by Waterlow 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|last=Watts|first=Geoff|title=John Conrad Waterlow|journal=The Lancet|date=December 2010|volume=376|issue=9757|pages=1982|doi=10.1016/S0140-6736(10)62252-0}}</ref> One advantage of the Waterlow classification over the Gomez classification is that weight for height can be examined even if ages are not known.<ref name="Waterlow 1972"/>

{| class="wikitable" border="1"
|-
! 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 | title= Classification and Definition of Protein-Calorie Malnutrition | author= J. C. Waterlow | journal= British Medical Journal | volume=3| pages= 566–569| year=1972 | doi= 10.1136/bmj.3.5826.566 | issue= 5826 | pmid= 4627051 | pmc= 1785878}}</ref></small>
|}

These classifications of malnutrition are commonly used with some modifications by WHO.<ref name="Grover 2009"/>

==Effects==
{{See also|Stunted growth|Wasting}}
Malnutrition increases the risk of infection and infectious disease, and moderate malnutrition weakens every part of the immune system.<ref name="Stillwaggon 2008" /> For example, it is a major risk factor in the onset of active [[tuberculosis]].<ref>{{cite journal | last1 = Schaible | first1 = U. E. | last2 = Kaufmann | first2 = S. H. E. | title = Malnutrition and Infection: Complex Mechanisms and Global Impacts | journal = PLoS Medicine | volume = 4 | issue = 5 | pages = e115 | year = 2007 | pmid = 17472433 | pmc = 1858706 | doi = 10.1371/journal.pmed.0040115 }}</ref> Protein and energy malnutrition and deficiencies of specific micronutrients (including iron, zinc, and vitamins) increase susceptibility to infection.<ref name="Stillwaggon 2008">{{cite journal|last=Stillwaggon|first=Eileen|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}}</ref> Malnutrition affects HIV transmission by increasing the risk of transmission from mother to child and also increasing replication of the virus.<ref name="Stillwaggon 2008" /> In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem. Lower energy and impaired function of the brain also represent the downward spiral of malnutrition as victims are less able to perform the tasks they need to in order to acquire food, earn an income, or gain an education.

[[Avitaminosis|Vitamin-deficiency-related diseases]] (such as [[scurvy]] and [[rickets]]).

Hypoglycemia (low blood sugar) can result from a child not eating for 4 to 6 hours. Hypoglycemia should be considered if there is lethargy, limpness, convulsion, or loss of consciousness. If blood sugar can be measured immediately and quickly, perform a finger or heel stick.

===Signs===
In those with malnutrition some of the signs of dehydration differ.<ref name=WHO2005Chp8/> Children; however, may still be interested in drinking, have decreased interactions with the world around them, have decreased urine output, and may be cool to touch.<ref name=WHO2005Chp8/>

{| class="wikitable"
|-
! Site !! Sign
|-
| Face || Moon face (kwashiorkor), simian facies (marasmus)
|-
| Eye || Dry eyes, pale conjunctiva, Bitot's spots (vitamin A), periorbital edema
|-
| Mouth || Angular stomatitis, cheilitis, glossitis, spongy bleeding gums (vitamin C), parotid enlargement
|-
| Teeth || Enamel mottling, delayed eruption
|-
| Hair || Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia
|-
| Skin || Loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry, follicular hyperkeratosis, patchy hyper- and hypopigmentation, erosions, poor wound healing
|-
| Nail || Koilonychia, thin and soft nail plates, fissures or ridges
|-
| Musculature || Muscles wasting, particularly in the buttocks and thighs
|-
| Skeletal || Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies
|-
| Abdomen || Distended - hepatomegaly with fatty liver, ascites may be present
|-
| Cardiovascular || Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy
|-
| Neurologic || Global development delay, loss of knee and ankle reflexes, poor memory
|-
| Hematological || Pallor, petechiae, bleeding diathesis
|-
| Behavior || Lethargic, apathetic
|-
!colspan=16|<small>Source: "Protein Energy Malnutrition"<ref name="Grover 2009" /></small>
|}

===Cognitive development===
[[Protein-calorie malnutrition]] can cause cognitive impairments. For humans, "critical period varies from the final third of gestation to the first 2 years of life".<ref>{{cite journal | last1 = Laus | first1 = M. F. | last2 = Duarte Manhas Ferreira Vales | first2 = L. | last3 = Braga Costa | first3 = T. M. | last4 = Sousa Almeida | first4 = S. O. | 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 | year = 2011 | pmid = 21556206 | pmc = 3084481 | doi = 10.3390/ijerph8020590 }}</ref> [[Iron deficiency anemia]] in children under two years of age likely affects brain function acutely and probably also chronically. [[Folate]] deficiency has been linked to [[neural tube defect]]s.<ref>{{cite journal |author=Kenton R. Holden |title=Chapter 2 Malnutrition and Brain Development: A Review. In Neurologic Consequences of Malnutrition, World Federation of Neurology Seminars in Clinical Neurology, 2008, World Federation of Neurology, |publisher=Demos Medical Publishing |url=http://www.siecv.net/docs/neurological-consequences-malnutrition.pdf#page=33 |deadurl=no |accessdate=March 3, 2014}}</ref>

Malnutrition in the form of [[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 |agency= |work= |newspaper=New York Times |date=2006-12-16 |url=http://www.nytimes.com/2006/12/16/health/16iodine.html?fta=y |first=Donald G. |last=McNeil Jr}}</ref>{{citation needed|date=March 2015}} "Even moderate deficiency, especially in pregnant women and infants, lowers intelligence by 10 to 15 I.Q. points, shaving incalculable potential off a nation's development. The most visible and severe effects — disabling goiters, cretinism and dwarfism — affect a tiny minority, usually in mountain villages. But 16 percent of the world's people have at least mild goiter, a swollen thyroid gland in the neck."<ref name="salt" />

==Causes==
{{See also|List of types of malnutrition}}
[[Image:Andersonvillesurvivor.jpg|thumb|160px|[[Union Army]] soldier on his release from [[Andersonville prison]], 1865]]
Major causes of malnutrition include poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors. [[Clinical malnutrition]], such as in [[cachexia]], is a major burden also in [[Developed country|developed countries]]. Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community may be at risk if the area lacks health-related services, but on a smaller scale certain households or individuals may be at even higher risk due to differences in income levels, access to land, or levels of education.<ref>{{cite journal | last1 = Fotso | first1 = J. C. | last2 = Kuate-Defo | first2 = 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 | pmid = | pmc = | doi = 10.1007/s11205-004-5579-8 }}</ref>

===Diseases===
Malnutrition can be a consequence of health issues such as [[gastroenteritis]]<ref>{{cite book|last=Dolin|first=[edited by] Gerald L. Mandell, John E. Bennett, Raphael|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|year=2010|publisher=Churchill Livingstone/Elsevier|location=Philadelphia, PA|isbn=0-443-06839-9|pages=Chp 93|edition=7th}}</ref> or [[chronic illness]],<ref>{{EMedicine|article|985140|Malnutrition}}</ref> especially the [[HIV/AIDS pandemic]].<ref>{{cite journal | last1 = Baro | first1 = M. | last2 = Deubel | first2 = T. F. | 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 | pmid = | pmc = | doi = 10.1146/annurev.anthro.35.081705.123224 }}</ref> [[Diarrhea]] and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss.<ref name=Paradox>{{cite journal|last1=Musaiger|first1=Abdulrahman O.|author2=Hassan, Abdelmonem S., Obeid, Omar|title=The Paradox of Nutrition-Related Diseases in the Arab Countries: The Need for Action|journal=International Journal of Environmental Research and Public Health|date=August 2011|volume=8|issue=9|pages=3637–3671|doi=10.3390/ijerph8093637|pmid=22016708|pmc=3194109}}</ref> Parasite infections, in particular [[helminthiasis|intestinal worm infections]] (helminthiasis), can also lead to malnutrition.<ref name=Paradox /> A leading cause of [[diarrhea]] and intestinal worm infections in children in developing countries is lack of [[sanitation]] and [[hygiene]].

People may become malnourished due to abnormal nutrient loss (due to diarrhea or chronic illness) or increased energy expenditure (secondary malnutrition).<ref name="Grover 2009">{{cite journal|last1=Grover|first1=Zubin|author2=Ee, Looi C.|title=Protein Energy Malnutrition|journal=Pediatric Clinics of North America|year=2009|volume=56|issue=5|pages=1055–1068|doi=10.1016/j.pcl.2009.07.001|pmid=19931063}}</ref><ref name= "WHO 2001">{{Cite web|author= World Health Organization |title=Water-related diseases: Malnutrition |year= 2001 |url=http://www.who.int/water_sanitation_health/diseases/malnutrition/en/.}}</ref>

===Dietary practices===

==== Undernutrition ====
A lack of adequate breastfeeding leads to malnutrition in infants and children, associated with the deaths of an estimated one million children annually. Illegal advertising of breast milk substitutes continues three decades after its 1981 prohibition under the ''WHO International Code of Marketing Breast Milk Substitutes''.<ref>{{cite journal |journal=Arch Dis Child |date=June 2012 |volume=97 |issue=6 |pages=529–32 |title=Marketing breast milk substitutes: problems and perils throughout the world |author=Brady JP |pmid=22419779 |pmc=3371222 |doi=10.1136/archdischild-2011-301299 }}</ref>

Deriving too much of one's diet from a single source, such as eating almost exclusively corn or rice, can cause malnutrition. This may either be from a lack of education about proper nutrition, or from only having access to a single food source.<ref name=Burchi>{{cite journal |journal=Int J Environ Res Public Health |date=February 2011 |volume=8 |issue=2 |pages=358–73 |title=The role of food and nutrition system approaches in tackling hidden hunger |vauthors=Burchi F, Fanzo J, Frison E |pmid=21556191 |pmc=3084466 |doi=10.3390/ijerph8020358}}</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 ====
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, where for the majority of people, access to food is not an issue. Many parts of the world have access to a surplus of non-nutritious food, in addition to increased sedentary lifestyles. Yale 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" />

The issue in these developed countries is choosing the right kind of food. More fast food is consumed per capita in the United States than in any other country. The reason for this mass consumption of fast food is its affordability and accessibility. Often fast food, low in cost and nutrition, is high in calories and heavily promoted. When these eating habits are combined with increasingly urbanized, automated, and more sedentary lifestyles, it becomes clear why weight gain is difficult to avoid.<ref name="Gardner00_5" />

Not only does obesity occur in developed countries, problems are also occurring in developing countries in areas where income is on the rise.<ref name="Gardner00" /> Overeating is also a problem in countries where hunger and poverty persist. 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 result in death.

===Poverty and food prices===
[[File:Starved child.jpg|thumb|170px|A child with extreme malnutrition]]

In Bangladesh, poor socioeconomic position was associated with chronic malnutrition since it inhibits purchase of nutritious foods such as milk, meat, poultry, and fruits.<ref name="Factors in Bangladesh">{{cite journal |last1=Khan |first1=MM|author2=Kraemer, A|title=Factors associated with being underweight, overweight and obese among ever-married non-pregnant urban women in Bangladesh|journal=Singapore medical journal|date=August 2009|volume=50|issue=8|pages=804–13|pmid=19710981}}</ref> As much as food shortages may be a contributing factor to malnutrition in countries with lack of technology, the [[FAO]] (Food and Agriculture Organization) has estimated that eighty percent of malnourished children living in the developing world live in countries that produce food surpluses.<ref name=Gardner00>{{cite journal |last1=Gardner |first1=Gary |last2=Halweil |first2=Brian |title=Escaping Hunger, Escaping Excess |journal=World Watch |volume=13 |issue=4 |pages=24 |year=2000 |url=http://www.worldwatch.org/node/488}}</ref> The economist [[Amartya Sen]] observed that, in recent decades, famine has always been a problem of food distribution and/or poverty, as there has been sufficient food to feed the whole population of the world. He states that malnutrition and [[famine]] were more related to problems of food distribution and purchasing power.<ref name=Sen81>{{cite book |first=Amartya Kumar |last=Sen |title=Poverty and famines: An essay on entitlement and deprivation |url=https://books.google.com/books/about/Poverty_and_Famines.html?id=BzU_AwAAQBAJ&redir_esc=y |year=1981 |publisher=Oxford University Press |isbn=978-0-19-828463-5}}</ref>

It is argued that commodity 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 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 |agency= |work= |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 and raises the price of food.<ref>{{cite news |title=Biofuel use increasing poverty |agency= |work= |newspaper=BBC News |date= 2008-06-25|url=http://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 corn cobs and banana leaves, rather than crops themselves be used as fuel.<ref>{{cite news |title=Biofuels 'crime against humanity' |agency= |work= |newspaper=BBC News |date= 2007-10-27|url=http://news.bbc.co.uk/2/hi/americas/7065061.stm |first=Grant |last=Ferrett}}</ref>

===Agricultural productivity===
Local food shortages can be caused by a lack of arable land, adverse weather, lower farming skills such as [[crop rotation]], or by a lack of technology or resources needed for the higher yields found in modern [[agriculture]], such as fertilizers, pesticides, irrigation, machinery and storage facilities. As a result of widespread poverty, farmers cannot afford or governments cannot provide the resources necessary to improve local yields. The World Bank and some wealthy donor countries also press nations that depend on aid to cut or eliminate subsidized agricultural inputs such as fertilizer, in the name of [[free market]] policies even as the United States and Europe extensively subsidized their own farmers.<ref name=newyorktimes>{{cite news |title=Ending Famine, Simply by Ignoring the Experts |agency= |work= |newspaper=New York Times |date=2007-12-02 |url=http://www.nytimes.com/2007/12/02/world/africa/02malawi.html?pagewanted=1&_r=1 |first=Celia W. |last=Dugger}}</ref><ref>{{cite news |title=Zambia: fertile but hungry |agency= |work= |newspaper=BBC News |date= 2006-02-06|url=http://news.bbc.co.uk/2/hi/africa/4678592.stm |first=Peter |last=Biles}}</ref> Many, if not most, farmers cannot afford fertilizer at market prices, leading to low agricultural production and wages and high, unaffordable food prices.<ref name=newyorktimes/>
Reasons for the unavailability of fertilizer include moves to stop supplying fertilizer on [[environmental movement|environmental]] grounds, cited as the obstacle to feeding Africa by the [[Green Revolution]] pioneers [[Norman Borlaug]] and Keith Rosenberg.<ref name=atlantic>{{cite news |title=Forgotten benefactor of humanity |agency= |work= |newspaper=The Atlantic |url=http://www.theatlantic.com/issues/97jan/borlaug/borlaug.htm}}</ref>

===Future threats===
There are a number of potential disruptions to global food supply that could cause widespread malnutrition.

[[Climate change]] is of importance to food security, with 95 percent of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics. According to the latest IPCC reports, temperature increases in these regions are "very likely."<ref name=ipcc>{{cite web |title= Climate Change 2007: Synthesis Report |date=12–17 November 2007 |publisher=Intergovernmental Panel on Climate Change |url=http://www.ipcc.ch/pdf/assessment-report/ar4/syr/ar4_syr.pdf |accessdate=January 27, 2010}}</ref> Even small changes in temperatures can lead to increased frequency of extreme weather conditions.<ref name=ipcc /> Many of these have great impact on agricultural production and hence nutrition. For example, the 1998–2001 central Asian drought brought about an 80 percent livestock loss and 50 percent reduction in wheat and barley crops in Iran.<ref>Battisti, David S. "Climate Change in Developing Countries." University of Washington. Seattle. 27 October 2008.{{vn|date=November 2012}}</ref> Similar figures were present in other nations. 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, also decreasing food security in these regions.<ref name=ipcc /><ref>{{cite news |author=Black, Richard |title=Rice yields falling under global warming |agency= |newspaper=BBC News; Science & Environment |date=August 9, 2010 |url=http://www.bbc.co.uk/news/science-environment-10918591}}</ref>

[[Colony collapse disorder]] is a phenomenon where bees 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]], this represents a threat to the supply of food.<ref>{{cite news |title=Vanishing bees threaten US crops |newspaper=BBC News |date= 2007-03-11|url=http://news.bbc.co.uk/2/hi/americas/6438373.stm |first=Matt |last=Wells}}</ref>

An [[epidemic]] of [[wheat stem rust]] caused by race [[Ug99]] is currently spreading across Africa and into Asia and, it is feared, could wipe out more than 80 percent of the world’s wheat crops.<ref>{{cite news |title=Millions face famine as crop disease rages |agency= |work= |newspaper=Guardian |date=2007-04-22 |url=http://www.guardian.co.uk/science/2007/apr/22/food.foodanddrink |location=London |first1=Robin |last1=McKie |first2=Xan |last2=Rice}}</ref><ref>{{cite news |title=A time bomb for world wheat crop |newspaper=LA Times |date=2009-06-14 |url=http://articles.latimes.com/2009/jun/14/science/sci-wheat-rust14 |first=Karen |last=Kaplan}}</ref>

==Prevention==

[[File:Vallee fertile du Nil a Louxor.jpg|thumb|right|[[Irrigation]] canals have opened dry desert areas of [[Egypt]] to agriculture.]]

===Food security===
{{Main article|Food security}}
The effort to bring modern agricultural techniques found in the West, such as nitrogen fertilizers and pesticides, to Asia, called the [[Green Revolution]], resulted in decreases in malnutrition similar to those seen earlier in Western nations. This was possible because of existing infrastructure and institutions that are in short supply in Africa, such as a system of roads or public seed companies that made seeds available.<ref>{{cite news |title=In Africa, prosperity from seeds falls short |agency= |work= |newspaper=New York Times |date= 2007-10-10|url=http://www.nytimes.com/2007/10/10/world/africa/10rice.html?_r=1&hp&oref=slogin |first=Celia W. |last=Dugger}}</ref> Investments in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces food prices.<ref name=newyorktimes/><ref>{{cite news |author=Barclay, Eliza |title=How a Kenyan village tripled its corn harvest |agency= |work= |newspaper=Christian Science Monitor |date=2008-06-18 |url=http://www.csmonitor.com/2008/0618/p07s01-woaf.html}}</ref> For example, in the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced against World Bank strictures, farmers produced record-breaking corn harvests as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter.<ref name=newyorktimes/> This lowered food prices and increased wages for farm workers.<ref name=newyorktimes/> Such investments in agriculture are still needed in other African countries like the Democratic Republic of the Congo. The country has one of the highest prevalence of malnutrition even though it is blessed with great agricultural potential John Ulimwengu explains in his article for D+C.<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 has championed the idea that wealthy countries should 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 |agency= |work= The New York Times|newspaper= |date=2009-07-09 |url=http://www.nytimes.com/2009/07/09/world/europe/09food.html |first1=Peter |last1=Baker |first2=Celia W. |last2=Dugger}}</ref>

New technology in agricultural production also has great potential to combat undernutrition.<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 improving agricultural yields, farmers could reduce poverty by increasing income as well as open up area for diversification of crops for household use. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.

===Breastfeeding===
As of 2016 is estimated that about 821,000 deaths of children less than five years old could be prevented globally per year through more widespread breastfeeding.<ref name=Lancet2016>{{cite journal|last1=Victora|first1=CG|last2=Bahl|first2=R|last3=Barros|first3=AJ|last4=França|first4=GV|last5=Horton|first5=S|last6=Krasevec|first6=J|last7=Murch|first7=S|last8=Sankar|first8=MJ|last9=Walker|first9=N|last10=Rollins|first10=NC|last11=Lancet Breastfeeding Series|first11=Group|title=Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.|journal=Lancet (London, England)|date=30 January 2016|volume=387|issue=10017|pages=475–90|pmid=26869575|doi=10.1016/S0140-6736(15)01024-7}}</ref>

===Fortified foods===
Manufacturers are trying to fortify everyday foods with micronutrients that can be sold to consumers such as wheat flour for Beladi bread in Egypt or fish sauce in Vietnam and the iodization of salt.<ref name="BBC">{{cite news |title=Firms target nutrition for the poor |agency= |work= |newspaper=BBC News |date= 2009-06-24|url=http://news.bbc.co.uk/2/hi/business/8114750.stm |first=Tatum |last=Anderson}}</ref>

For example, flour has been fortified with iron, zinc, folic acid and other B vitamins such as thiamine, riboflavin,niacin and vitamin B12.<ref name=":1" />

===World population===
Restricting population size is a proposed solution. [[Thomas Malthus]] argued that population growth could be controlled by natural disasters and voluntary limits through "moral restraint."<ref>{{cite book |first1=Thomas Robert |last1=Malthus |authorlink=Thomas Malthus |first2=Philip |last2= Appleman |title=An essay on the principle of population: text, sources and background, criticism |url=https://books.google.com/books?id=raGGQgAACAAJ |year=1976 |publisher=Norton |isbn=978-0-393-09202-8}}</ref> Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth.<ref>{{cite journal | last1 = Chapman | first1 = 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 | pmid = | pmc = | doi = 10.1007/BF02436122 }}</ref> However, there are many who believe that the world has more than enough resources to sustain its population. Instead, these theorists point to unequal distribution of resources and under- or unutilized arable land as the cause for malnutrition problems.<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, Amartya Sen advocates that, "no matter how a famine is caused, methods of breaking it call for a large supply of food in the [[Public Distribution System|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 shifts in exchange entitlements in a general inflationary situation."<ref name="Sen81" />

===Food sovereignty===
{{Main article|Food sovereignty}}
One suggested policy framework to resolve access issues is termed [[food sovereignty]]—the right of peoples to define their own food, agriculture, livestock, and fisheries systems, in contrast to having food largely subjected to international market forces. Food First is one of the primary think tanks working to build support for food sovereignty. Neoliberals advocate for an increasing role of the free market.

===Health facilities===
Another possible long term solution would be to increase access to health facilities to rural parts of the world. These facilities could monitor undernourished children, act as supplemental food distribution centers, and provide education on dietary needs. These types of facilities have already proven very successful in countries such as Peru and Ghana.<ref>{{cite journal | last1 = Waters | first1 = H. R. | last2 = Penny | first2 = M. E. | last3 = Creed-Kanashiro | first3 = H. M. | last4 = Robert | first4 = R. C. | last5 = Narro | first5 = R. | last6 = Willis | first6 = J. | last7 = Caulfield | first7 = L. E. | last8 = Black | first8 = R. E. | title = The cost-effectiveness of a child nutrition education programme in Peru | journal = Health Policy and Planning | volume = 21 | issue = 4 | pages = 257–264 | year = 2006 | pmid = 16672293 | pmc = | doi = 10.1093/heapol/czl010 }}</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. http://www.popcouncil.org/pdfs/wp/180.pdf</ref>

==Global initiatives==
In April 2012, the [[Food Assistance Convention]] was signed, the world's first legally binding international agreement on food aid. The May 2012 [[Copenhagen Consensus]] recommended that efforts to combat hunger and malnutrition should be the first priority for politicians and private sector philanthropists looking to maximize the effectiveness of aid spending. They put this ahead of other priorities, like the fight against [[malaria]] and [[AIDS]].<ref>[http://www.copenhagenconsensus.com/Projects/CC12/Outcome.aspx Outcome of the 2012 Copenhagen Consensus]</ref>

The main global policy to reduce hunger and poverty are the [[Sustainable Development Goals]]. In particular Goal 2: Zero hunger sets globally agreed targets to end hunger, achieve food security and improved nutrition and promote sustainable agriculture.<ref>[http://www.un.org/sustainabledevelopment/hunger/ Description and targets for Goal 2 of the Sustainable Development Goals]</ref> The partnership Compact2025, led by [[IFPRI]] with the involvement of UN organisations, NGOs and private foundations develops and disseminates evidence-based advice to politicians and other decision-makers aimed at ending hunger and undernutrition in the coming 10 years, 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>[http://www.compact2025.org/about-compact2025/governance/leadership-council/ Leadership Council members from the website of the Compact 2025 partnership]</ref>

The [[Food and Agriculture Organization of the United Nations#Online campaign against hunger|EndingHunger]] campaign is an online communication campaign aimed at raising awareness of the hunger problem. It has many worked through viral videos depicting celebrities voicing their anger about the large number of hungry people in the world. Another initiative focused on improving the hunger situation by improving nutrition is the Scaling up Nutrition movement (SUN). Started in 2010 this movement of people from governments, civil society, the United Nations, donors, businesses and researchers, publishes a yearly progress report on the changes in their 55 partner countries.<ref>[http://scalingupnutrition.org/about Scaling Up Nutrition Website, About page]</ref>

==Management==
{{See also|Famine relief}}
[[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.]]

In response to child malnutrition, the [[Bangladesh|Bangladeshi government]] recommends ten steps for treating severe malnutrition. They are to prevent or treat [[dehydration]], [[hypoglycemia|low blood sugar]], [[hypothermia|low body temperature]], infection, correct electrolyte imbalances and micronutrient deficiencies, start feeding cautiously, achieve catch-up growth, provide psychological support, and prepare for discharge and follow-up after recovery.<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], 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>

Among those patients who are hospitalized, nutritional support improves protein, colorie intake and weight.<ref>{{cite journal|last1=Bally|first1=MR|last2=Blaser Yildirim|first2=PZ|last3=Bounoure|first3=L|last4=Gloy|first4=VL|last5=Mueller|first5=B|last6=Briel|first6=M|last7=Schuetz|first7=P|title=Nutritional Support and Outcomes in Malnourished Medical Inpatients: A Systematic Review and Meta-analysis.|journal=JAMA internal medicine|date=1 January 2016|volume=176|issue=1|pages=43–53|pmid=26720894|doi=10.1001/jamainternmed.2015.6587}}</ref>

===Food===
The evidence for benefit of supplementary feeding is poor.<ref>{{cite journal|last1=Sguassero|first1=Y|last2=de Onis|first2=M|last3=Bonotti|first3=AM|last4=Carroli|first4=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|date=Jun 13, 2012|volume=6|pages=CD005039|pmid=22696347|doi=10.1002/14651858.CD005039.pub3}}</ref> This is due to the small amount of research done on this treatment.

Specially formulated foods do however appear useful in those from the developing world with moderate acute malnutrition.<ref name=Lazzer2013>{{cite journal|last1=Lazzerini|first1=M|last2=Rubert|first2=L|last3=Pani|first3=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|date=Jun 21, 2013|volume=6|pages=CD009584|pmid=23794237|doi=10.1002/14651858.CD009584.pub2}}</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|last1=Schoonees|first1=A|last2=Lombard|first2=M|last3=Musekiwa|first3=A|last4=Nel|first4=E|last5=Volmink|first5=J|title=Ready-to-use therapeutic food for home-based treatment of severe acute malnutrition in children from six months to five years of age.|journal=The Cochrane database of systematic reviews|date=Jun 6, 2013|volume=6|pages=CD009000|pmid=23744450|doi=10.1002/14651858.CD009000.pub2}}</ref> They may have some benefits in humanitarian emergencies as they can be eaten directly from the packet, do not require refrigeration or mixing with clean water, and can be stored for years.<ref name=BBC/>

In those who are severely malnourished, feeding too much too quickly can result in [[refeeding syndrome]].<ref name=Via2012>{{cite journal|last1=Viana Lde|first1=A|last2=Burgos|first2=MG|last3=Silva Rde|first3=A|title=Refeeding syndrome: clinical and nutritional relevance.|journal=Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery|date=Jan–Mar 2012|volume=25|issue=1|pages=56–9|pmid=22569981}}</ref> This can result regardless of route of feeding and can present itself a couple of days after eating with [[heart failure]], [[Cardiac dysrhythmia|dysrhythmia]]s and confusion that can result in death.<ref name=Via2012/><ref>{{cite journal|last1=Boateng|first1=AA|last2=Sriram|first2=K|last3=Meguid|first3=MM|last4=Crook|first4=M|title=Refeeding syndrome: treatment considerations based on collective analysis of literature case reports.|journal=Nutrition (Burbank, Los Angeles County, Calif.)|date=Feb 2010|volume=26|issue=2|pages=156–67|pmid=20122539|doi=10.1016/j.nut.2009.11.017}}</ref>

===Micronutrients===
Treating malnutrition, mostly through [[food fortification|fortifying]] foods with micronutrients (vitamins and minerals), improves lives at a lower cost and shorter time than other forms of [[aid]], according to the World Bank.<ref name=IQ>{{cite news |title=Raising the world's IQ |agency= |work= The New York Times|newspaper= |date=2008-12-04 |url=http://www.nytimes.com/2008/12/04/opinion/04kristof.html |first=Nicholas D. |last=Kristof}}</ref> The [[Copenhagen Consensus]], which look at a variety of development proposals, ranked micronutrient supplements as number one.<ref name=hiddenhunger>{{cite news |title=The Hidden Hunger |agency= |work= |newspaper=New York Times |date=2009-05-24 |url=http://www.nytimes.com/2009/05/24/opinion/24kristof.html |first=Nicholas D. |last=Kristof}}</ref><ref name="Let them eat micronutrients">{{cite news |title=Let them eat micronutrients |agency= |work= |newspaper=Newsweek |url=http://www.newsweek.com/id/160075}}</ref>

In those with diarrhea, once an initial four-hour rehydration period is completed, zinc supplementation is recommended. Daily zinc increases the chances of reducing the severity and duration of the diarrhea, and continuing with daily zinc for ten to fourteen days makes diarrhea less likely 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>

In addition, malnourished children need both potassium and magnesium.<ref name=Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008/> This can be obtained by following the above recommendations for the dehydrated child to continue eating within two to three hours of starting rehydration,<ref name=Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008/><ref name="WHO (2005)"/> and including foods rich in potassium as above. [[Hypokalemia|Low blood potassium]] is worsened when base (as in Ringer's/Hartmann's) is given to treat acidosis without simultaneously providing potassium.<ref name="WHO (2005)"/> As above, available home products such as salted and unsalted cereal water, salted and unsalted vegetable broth can be given early during the course of a child's diarrhea along with continued eating.<ref name="WHO (2005)"/> Vitamin A, potassium, magnesium, and zinc should be added with other vitamins and minerals if available.<ref name=Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008/>

For a malnourished child with diarrhea from any cause, this should include foods rich in potassium such as bananas, green coconut water, and unsweetened fresh fruit juice.<ref name="WHO (2005)"/>

===Diarrhea===
[[File:ORT saches.JPG|thumb|Examples of commercially available oral rehydration salts (Nepal on left, Peru on right).]]
The World Health Organization (WHO) recommends rehydrating a severely undernourished child who has diarrhea relatively slowly.<!-- <ref name=WHO2005Chp8/> --> The preferred method is with fluids by mouth using a drink called [[oral rehydration solution]] (ORS).<!-- <ref name=WHO2005Chp8/> --> The oral rehydration solution is both slightly [[sweet]] and slightly [[salt]]y and the one recommended in those with severe undernutrition should have half the usual sodium and greater potassium.<!-- <ref name=WHO2005Chp8/> --> Fluids by [[nasogastric tube]] may be use in those who do not drink.<!-- <ref name=WHO2005Chp8/> --> [[Intravenous]] fluids are recommended only in those who have [[Shock (circulatory)|significant dehydration]] due to their potential complications.<!-- <ref name=WHO2005Chp8/> --> These complications include [[congestive heart failure]].<ref name=WHO2005Chp8/> Over time, ORS developed into [[Oral rehydration therapy|ORT]], or [[oral rehydration therapy]], which focused on increasing fluids by supplying salts, carbohydrates, and water. This switch from type of fluid to amount of fluid was crucial in order to prevent dehydration from diarrhea.<ref>{{Cite journal|url = http://www.scielosp.org/scielo.php?pid=S0042-96862000001000010&script=sci_arttext&tlng=e|title = Reducing deaths from diarrhoea through oral rehydration therapy|last = Victora|first = Cesar|date = Jan 2000|journal = Bulletin of the World Health Organization|doi = |pmid = |access-date = |last2 = Bryce|first2 = Jennifer|issue = 10}}</ref>

Breast feeding and eating should resume as soon as possible.<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|location=Geneva|isbn=924159318 0|pages=22–24|edition=4|url=http://whqlibdoc.who.int/publications/2005/9241593180.pdf|chapter=8. Management of diarrhoea with severe malnutrition}}</ref> Drinks such as soft drinks, fruit juices, or sweetened teas are not recommended as they contain too much sugar and 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|location=Geneva|isbn=924159318 0|pages=8–16|edition=4|url=http://whqlibdoc.who.int/publications/2005/9241593180.pdf|chapter=4. Management of acute diarrhoea without blood}}</ref> [[Broad spectrum antibiotic]]s are recommended in all severely undernourished children with diarrhea requiring admission to hospital.<ref name=WHO2005Chp8/>

To prevent dehydration readily available fluids, preferably with a modest amount of sugars and salt such as vegetable broth or salted rice water, may be used.<!-- <ref name=WHO2005Chp4/> --> The drinking of additional clean water is also recommended.<!-- <ref name=WHO2005Chp4/> --> Once dehydration develops oral rehydration solutions are preferred.<!-- <ref name=WHO2005Chp4/> --> As much of these drinks as the person wants can be given, unless there are signs of swelling.<!-- <ref name=WHO2005Chp4/> --> If vomiting occurs, fluids can be paused for 5–10 minutes and then restarting more slowly.<!-- <ref name=WHO2005Chp4/> --> Vomiting rarely prevents rehydration as fluid are still absorbed and the vomiting rarely last long.<ref name=WHO2005Chp4/> A severely malnourished child with what appears to be dehydration but who has not had diarrhea should be treated as if they have an infection.<ref name=WHO2005Chp8/>

For babies a dropper or syringe without the needle can be used to put small amounts of fluid into the mouth; for children under 2, a teaspoon every one to two minutes; and for older children and adults, frequent sips directly from a cup.<ref name="WHO (2005)"/> After the first two hours, rehydration should be continued at the same or slower rate, determined by how much fluid the child wants and any ongoing diarrheal loses. After the first two hours of rehydration it is recommended that to alternate between rehydration and food.<ref name=Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008/>

In 2003, WHO and UNICEF recommended a reduced-[[osmolarity]] ORS which still treats dehydration but also reduced stool volume and vomiting. Reduced-osmolarity ORS is the current standard ORS with reasonably wide availability.<ref>[http://apps.who.int/medicinedocs/en/d/Js4950e/2.4.html WHO Drug Information Vol. 16, No. 2, 2002.]</ref><ref>[http://rehydrate.org/ors/low-osmolarity-ors.htm Low-osmolarity oral rehydration solution (ORS)], Rehydrate Project, updated: April 23, 2014.</ref> For general use, one packet of ORS (glucose sugar, salt, potassium chloride, and trisodium citrate) is added to one liter of water; however, for malnourished children it's recommended that one packet of ORS be added to two liters of water along with an extra 50 grams of sucrose sugar 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>

Malnourished children have an excess of body sodium.<ref name=Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008/> Recommendations for home remedies agree with one liter of water (34 oz.) and 6 teaspoons sugar and disagree regarding whether it's then one teaspoon of salt added or only 1/2, with perhaps most sources recommending 1/2 teaspoon of added salt to one liter 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, page 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 7 January 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, Feb. 1, 2014.</ref>

===Low blood sugar===
[[Hypoglycemia]], whether known or suspected, can be treated with a mixture of sugar and water. If the child 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] 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> If the child is unconscious, give glucose by [[intravenous]] or [[nasogastric tube]]. If seizures occur after despite glucose, rectal [[diazepam]] is recommended. Blood sugar levels should be re-checked on two hour intervals.<ref name=Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008/>

===Hypothermia===
[[Hypothermia]] can occur. To prevent or treat this, the child can be kept warm with covering including of the head or by direct skin-to-skin contact with the mother or father and then covering both parent and child. Prolonged bathing or prolonged medical exams should be avoided. Warming methods are usually most important at night.<ref name=Bangladeshi-Ministry-of-Health-and-Family-Welfare-2008/>

===Economics===
There is a growing realization among aid groups that giving cash or cash vouchers instead of food is a cheaper, faster, and more efficient way to deliver help to the hungry, particularly in areas where food is available but unaffordable.<ref name=csmonitor>{{cite news |title=UN aid debate: give cash not food? |agency= |work= |newspaper=Christian Science Monitor |date=2008-06-04 |url=http://www.csmonitor.com/World/Africa/2008/0604/p01s02-woaf.html}}</ref> The UN's [[World Food Program]], the biggest non-governmental distributor of food, announced that it will 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 |title=Cash roll-out to help hunger hot spots |date=December 8, 2008 |publisher= World Food Programme|url=http://www.wfp.org/english/?ModuleID=137&Key=2899}}</ref> The aid agency [[Concern Worldwide]] is piloting a method through a mobile phone operator, Safaricom, which runs a money transfer program that allows cash to be sent from one part of the country to another.<ref name=csmonitor/>

However, for people in a drought living a long way from and with limited access to markets, delivering food may be the most appropriate way to help.<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, which requires buying food at home rather than where the hungry live, is inefficient because approximately half of what is spent goes for transport.<ref name="Let them eat micronutrients"/> Cuny further pointed out "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 hoarded food at the inflated price than to import it from abroad."<ref>Memorandum to former Representative Steve Solarz (United States, Democratic Party, New York), July 1994</ref>

[[Ethiopia]] has been pioneering a program that has now become part of the World Bank's prescribed method for coping with a food crisis and had been seen by aid organizations as a model of how to best help hungry nations. Through the country's main food assistance program, the Productive Safety Net Program, Ethiopia has been giving rural residents who are 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 |title=A model of African food aid is now in trouble |agency= |work= |newspaper=Christian Science Monitor |date=2008-05-06 |url=http://www.csmonitor.com/2008/0506/p01s06-woaf.html?page=2}}</ref> Ethiopia been pioneering a program, and Brazil has established a recycling program for organic waste that benefits farmers, 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. As a result, the country's waste is reduced and the urban poor get a steady supply of nutritious food.<ref name=Gardner00_5>{{cite journal |last1=Gardner |first1=Gary |last2=Halweil |first2=Brian |title=Escaping Hunger, Escaping Excess |journal=World Watch |volume=13 |issue=4 |page=5 |year=2000 |url=http://www.worldwatch.org/node/488}}</ref>

==Epidemiology==
{{Main article|Epidemiology of malnutrition}}
[[Image:Percentage population undernourished world map.PNG|thumb|upright=1.3|Percentage of population affected by undernutrition by country]]
[[Image: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=http://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 |accessdate=}}</ref>
{{Multicol}}
{{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>}}
{{Multicol-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>}}
{{Multicol-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.

===People affected===
There were 793 million undernourished people in the world in 2015.<!-- <ref name = UNFAO2015/> --> This was 216 million fewer people than in 1990 when it was 991 million undernourished people.<ref name = UNFAO2015/> This is 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" />

{| class="wikitable"
|+Number of undernourished globally
!Year!!1970!!1980!!1990!!1995!!2005!!2007/08!!2014/16
|-
!Number in millions<ref name = UNFAO2015/><ref>[[Food and Agriculture Organization]] Economic and Social Development Department. [http://www.fao.org/docrep/011/i0291e/i0291e00.htm "The State of Food Insecurity in the World, 2008 : High food prices and food security — threats and opportunities"]. [[Food and Agriculture Organization]] of the [[United Nations]], 2008, p. 48.</ref>
|||||843||788||848||923||793
|-
!Percentage in the developing world<ref name = UNFAO2015/><ref>[[Food and Agriculture Organization]] Agricultural and Development Economics Division. [http://www.fao.org/docrep/009/a0750e/a0750e00.htm "The State of Food Insecurity in the World, 2006 : Eradicating world hunger – taking stock ten years after the World Food Summit"]. [[Food and Agriculture Organization]] of the [[United Nations]], 2006, p. 8. "Because of population growth, the very small decrease in the number of hungry people has nevertheless resulted in a reduction in the proportion of undernourished people in the developing countries by 3 percentage points – from 20 percent in 1990–92 to 17 percent in 2001–03. (...) the prevalence of undernourishment declined by 9 percent (from 37 percent to 28 percent) between 1969–71 and 1979–81 and by a further 8 percentage points (to 20 percent) between 1979–81 and 1990–92.".</ref><ref>[[Food and Agriculture Organization]] Economic and Social Development Department. [http://www.fao.org/docrep/011/i0291e/i0291e00.htm "The State of Food Insecurity in the World, 2008 : High food prices and food security — threats and opportunities"]. [[Food and Agriculture Organization]] of the [[United Nations]], 2008, p. 6. "Good progress in reducing the share of hungry people in the developing world had been achieved – down from almost 20 percent in 1990–92 to less than 18 percent in 1995–97 and just above 16 percent in 2003–05. The estimates show that rising food prices have thrown that progress into reverse, with the proportion of undernourished people worldwide moving back towards 17 percent.".</ref>
|37%||28%||20%||||16%||17%||13.5%
|}

===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 {{refbegin|3}}{{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}}{{refend}}]]
Mortality due to malnutrition accounted for 58 percent of the total mortality in 2006: "In the world, approximately 62 million people, all causes of death combined, die each year. One in twelve people worldwide is malnourished and according to the [[Save the Children]] 2012 report, one in four of the world’s children are chronically malnourished.<ref>http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/STATE-OF-THE-WORLDS-MOTHERS-REPORT-2012-FINAL.PDF {{webarchive |url=https://web.archive.org/web/20120523015344/http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/STATE-OF-THE-WORLDS-MOTHERS-REPORT-2012-FINAL.PDF |date=May 23, 2012 }}</ref> In 2006, more than 36 million died of hunger or diseases due to deficiencies in micronutrients".<ref>{{cite book |first=Jean |last=Ziegler |authorlink=Jean Ziegler |title=L'Empire de la honte |publisher=Fayard |location= |year=2007 |isbn=978-2-253-12115-2 |page=130 }}</ref>

In 2010 [[protein-energy malnutrition]] resulted in 600,000 deaths down from 883,000 deaths in 1990.<ref name="Loz2012" /> 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 million deaths in women and children.<ref name="Lim2012" />

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 |agency= |work= |newspaper=The Economist |date= 2008-01-24|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=2009-11-17}}</ref> [[Underweight]] births and intrauterine growth restrictions cause 2.2 million child deaths a year. Poor or non-existent breastfeeding causes another 1.4 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 as measles, pneumonia and diarrhea. But malnutrition actually causes diseases and can be fatal in its own right.<ref name="economist" />

==Society and culture==
Roughly $300 million of aid goes to basic nutrition each year, less than $2 for each child below two in the 20 worst affected countries.<ref name=economist/> In contrast, [[AIDS|HIV/AIDS]], which causes fewer deaths than child malnutrition, received $2.2 billion—$67 per person with HIV in all countries.<ref name=economist/>

The [[International Crops Research Institute for the Semi-Arid Tropics]] ([[ICRISAT]]), a member of the [[CGIAR]] consortium, partners with farmers, governments, researchers and NGOs to help farmers grow nutritious crops, such as [[chickpea]], [[groundnut]], [[pigeonpea]], [[millet]] and [[sorghum]]. This helps their
communities have more balanced diets and become more resilient to pests and drought. The Harnessing Opportunities for Productivity Enhancement of Sorghum and Millets in Sub-Saharan Africa and South Asia (HOPE) project, for example, is increasing yields of [[eleusine coracana|finger millet]] in [[Tanzania]] by encouraging farmers to grow improved varieties. Finger millet is very high in calcium, rich in iron and fiber, and has a better energy content than other cereals. These characteristics make it ideal for feeding to infants and the elderly.<ref>Alina Paul Bossuet, ''Nourishing Communities Through Holistic Farming'' http://exploreit.icrisat.org/page/sorghum/882/249. [[ICRISAT]]. Downloaded 26 January 2014.</ref>

Some organizations have begun working with teachers, policymakers, and managed food service contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university-level institutions. Health and nutrition have been proven to have close links with overall educational success.<ref>{{cite journal|doi=10.1093/wbro/11.1.23|jstor=3986477|title=The Impact of Health and Nutrition on Education|author=Jere R. Behrman|journal=The World Bank Research Observer |volume= 11 |issue= 1 |date=February 1996 |pages=23–37}}</ref>

The verb form is "malnourish"; "malnourishment" is sometimes used instead of "malnutrition."

==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 | last1 = Black | first1 = R. E. | last2 = Allen | first2 = L. H. | last3 = Bhutta | first3 = Z. A. | last4 = Caulfield | first4 = L. E. | last5 = De Onis | first5 = M. | last6 = Ezzati | first6 = M. | last7 = Mathers | first7 = C. | last8 = Rivera | first8 = J. | title = Maternal and child undernutrition: Global and regional exposures and health consequences | journal = The Lancet | volume = 371 | issue = 9608 | pages = 243–260 | year = 2008 | pmid = 18207566 | pmc = | doi = 10.1016/S0140-6736(07)61690-0 | author9 = Maternal Child Undernutrition Study Group }}</ref>

===Children===
{{Main article|Malnutrition in children}}
[[File:Niger childhood malnutrition 16oct06.jpg|thumb|right|Malnourished children in [[Niger]], during the 2005 famine.]]
The World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide,<ref name="Nutrition in pediatrics" /> about 1 million children.<ref name="ENJM013113">{{cite journal|last1=Manary|first1=Mark J.|author2=Indi Trehan, Hayley S. Goldbach, Lacey N. LaGrone, Guthrie J. Meuli, Richard J. Wang, and Kenneth M. Maleta|title=Antibiotics as Part of the Management of Severe Acute Malnutrition|journal=The New England Journal of Medicine|date=January 31, 2013|volume=368|issue=5|pages=425–435|doi=10.1056/NEJMoa1202851|url=http://www.nejm.org/doi/full/10.1056/NEJMoa1202851|accessdate=January 31, 2013|quote=The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates.|pmid=23363496|pmc=3654668}}</ref> Another estimate also by WHO states that childhood underweight is 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). [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>

As underweight children are more vulnerable to almost all infectious diseases, the ''indirect'' disease burden of malnutrition is estimated to be an order of magnitude higher than the disease burden of the ''direct'' effects of malnutrition.<ref name=":0" /> The combination of direct and indirect deaths from malnutrition caused by unsafe water, sanitation and hygiene ([[WASH]]) practices is estimated to lead to 860,000 deaths per year in children under five years of age.<ref name=":0" />

===Women===

====Gender====
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 | last1 = Nubé | first1 = M. | last2 = Van Den Boom | first2 = G. J. M. | title = Gender and adult undernutrition in developing countries | journal = Annals of Human Biology | volume = 30 | issue = 5 | pages = 520–537 | year = 2003 | pmid = 12959894 | pmc = | doi = 10.1080/0301446031000119601 }}</ref> [[Gender]] inequality in nutrition in some countries such as India is present in all stages of life.<ref name="Women 2008">{{cite journal|last=Dewan|first=Manju|title=Malnutrition in Women|journal=Stud. Home Comm. Sci.|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 |deadurl=no |accessdate=March 3, 2014}}</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|last=Carter|first=Rachel Bonham|title=Survey Reveals High Malnutrition Rates Among Pregnant Women in Kenya|url=http://www.unicef.org/infobycountry/kenya_33782.html|publisher=UNICEF |deadurl=no |accessdate=March 3, 2014}}</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 |deadurl=no |accessdate=August 22, 2016}}</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 afflicted 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 | last1 = Bhutta | first1 = Z. A. | last2 = Ahmed | first2 = T. | last3 = Black | first3 = R. E. | last4 = Cousens | first4 = S. | last5 = Dewey | first5 = K. | last6 = Giugliani | first6 = E. | last7 = Haider | first7 = B. A. | last8 = Kirkwood | first8 = B. | last9 = Morris | first9 = S. S. | last10 = Sachdev | first10 = H. P. S. | last11 = Shekar | first11 = M. | title = What works? Interventions for maternal and child undernutrition and survival | journal = The Lancet | volume = 371 | issue = 9610 | pages = 417–440 | year = 2008 | pmid = 18206226 | pmc = | doi = 10.1016/S0140-6736(07)61693-6 | author12 = Maternal Child Undernutrition Study Group }}</ref>

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

====Educating children====
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|last1=Kvamme|first1=January–Magnus|author2=Olsen, Jan Abel, Florholmen, Jon, Jacobsen, Bjarne K.|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|year=2011|volume=20|issue=4|pages=575–582|doi=10.1007/s11136-010-9788-0|pmid=21076942|pmc=3075394}}</ref> If elderly people are healthy and active, the aging process alone does not usually cause malnutrition.<ref name="Elder Insecurities">{{cite journal|last1=Wellman|first1=N.S|author2=Weddle, D.O, Kranz, S, Brain, C.T|title=Elder Insecurities: Poverty, Hunger, and Malnutrition|journal=Journal of the American Dietetic Association|date=October 1997|volume=97|issue=10|pages=S120–S122|doi=10.1016/S0002-8223(97)00744-X|pmid=9336570}}</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 |last1=Saka|first1=Bulent|author2=Kaya, Omer, Ozturk, Gulistan Bahat, Erten, Nilgun, Karan, M. Akif|title=Malnutrition in the elderly and its relationship with other geriatric syndromes|journal=Clinical Nutrition|year=2010|volume=29|issue=6|pages=745–748|doi=10.1016/j.clnu.2010.04.006|pmid=20627486}}</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|last=Volkert|first=Dorothee|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 | last1 = Volkert | first1 = D. | title = Malnutrition in the elderly — prevalence, causes and corrective strategies | journal = Clinical Nutrition | volume = 21 | pages = 110–112 | year = 2002 | pmid = | pmc = | 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" /> Because of this, one of the main requirements of [[elderly care]] is to provide an adequate diet and all [[essential nutrients]].<ref>{{cite journal |last1=Mamhidir |first1=Anna-Greta |author2=Kihlgren, Mona, Soerlie, Venke|title=Malnutrition in elder care: qualitative analysis of ethical perceptions of politicians and civil servants|journal=BMC Medical Ethics|year=2010|volume=11|pages=11|doi=10.1186/1472-6939-11-11|pmid=20553607|pmc=2927875|last3=Soerlie |first3=V }}</ref>

In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission.<ref>{{cite journal | last1 = Bolin | first1 = T. | last2 = Bare | first2 = M. | last3 = Caplan | first3 = G. | last4 = Daniells | first4 = S. | last5 = Holyday | first5 = M. | title = Malabsorption may contribute to malnutrition in the elderly | journal = Nutrition | volume = 26 | issue = 7–8 | pages = 852–853 | year = 2010 | pmid = 20097534 | pmc = | 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|Hunger relief}}
* [[Agrobiodiversity]]
* [[Hunger]]
* [[Eating disorder]]
* [[Community Therapeutic Care]]
* [[NutritionDay]]
* [[Malnutrition in South Africa]]
* [[Malnutrition in India]]
* [[Malnutrition in Zimbabwe]]
* [[Malnutrition in Peru]]
* [[Metabolic disease]]

==References==
{{Reflist|30em}}

==External links==
{{Wiktionary|malnutrition|undernutrition}}
*{{dmoz|Health/Conditions_and_Diseases/Nutrition_and_Metabolism_Disorders/Malnutrition/|Malnutrition}}

{{Nutritional pathology}}
{{Diseases of Poverty}}

{{Authority control}}

[[Category:Malnutrition| ]]
[[Category:Public health]]
[[Category:Humanitarian aid]]
[[Category:Nutrition]]
[[Category:Global issues]]
[[Category:RTT]]

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