Undernourishment Overview.

What is Undernourishment? Undernourishment is a deficiency of essential nutrients, most commonly a deficiency of proteins, vitamins and minerals. The result of not getting enough nutrients from the body is impaired activity of the organs. This is especially important in children, especially around the time when children have high nutritional needs from 6-24 months of age.

Undernourishment in children often causes growth retardation and limited ability to perform physically. At a more severe level, Undernourishment also affects brain development, intelligence, communication ability and increases the likelihood of many diseases for children. Evaluate a malnourished child based on the following indicators:

  • Weight for age
  • Height for age
  • Weight for height

Unusually, child Undernourishment is divided into 3 categories: underweight, stunting and wasted Undernourishment.

  • Underweight (low weight for age): when the child’s weight is lower than the standard for children of the same age and sex. The weight-for-age values ​​for the child were below the -2SD line of lines
  • Stunting (low height for age): when the height of a child is lower than the standard for children of the same age and sex. The age-to-age value of the child is below the -2SD plot line. This is a form of chronic Undernourishment, stunting in clinical form as a result of a prolonged Undernourishment process in the first years of life, sometimes starting early from Undernourishment while still in the abdomen. mom.
  • Wasting (low weight-for height): when the child’s height weight is lower than the standard of same-sex children, that is below -2SD. At this time, muscle and fat are atrophy much. This is a short-term form of acute Undernourishment.

However, we can also pay attention to the below kinds of Undernourishment children:

  • Edema malnutrition (Kwashiokor): This is a form of severe malnutrition. From the outside, the child has a plump, plump face, but the limbs are spindly, atrophy, and the muscle tone decreases. Children have symptoms such as edema, skin pigmentation disorder with dark red or black spots and complications such as prolonged anemia, rickets, vitamin A deficiency causing corneal dryness, night blindness. A fussy child, thin hair that falls out easily, brittle nails, vomiting, and diarrhea can also be signs of the disease. Parents who lack understanding can be easy to ignore, delaying treatment for their child. Edema malnutrition is difficult to treat and the mortality rate is quite high. The cause of edema malnutrition is a lack of protid supply in the child, possibly accompanied by a lack of micronutrients such as vitamins and mineral salts.
  • Atrophic malnutrition (Maramus): This is a severe form of malnutrition, because children do not have enough energy. Children are very thin, look like skeletal skin, look old, lose all the fat layer under the skin and often experience digestive disorders. Children lose their appetite, moodiness, less flexible. Atrophic malnutrition has a better prognosis than edema because of less organ damage.
  • Mixed malnutrition: A combination of atrophic malnutrition and edema malnutrition. Because children do not get enough protid and energy.

Reason for Undernourishment

The causes of Undernourishment mostly come from external conditions such as living conditions, economic conditions, eating habits and living conditions. Undernourishment is often the result of the following problems:

  • Meals are poor in quantity and quality of nutrients (common reason in poor countries).
  • Poor absorption of nutrients due to gastrointestinal diseases or after a severe illness, the patient feels no appetite, does not want to eat despite being provided with nutritious foods and diseases caused by the digestive system.
  • Mental health problems: Many mental disorders affect a person’s eating habits, such as depression, anorexia, vomiting, and other eating disorders.
  • Infants are not exclusively breastfed for the first 6 months, do not get enough breast milk, and are breastfed too soon. Many studies have shown that not breastfeeding during the first 6 months of life can lead to Undernourishment in infants and young children. The notion that formula feeding is better than breast milk is not true. Mothers who are malnourished or do not know how to breastfeed are also indirect causes of infant Undernourishment.

Consequences of Undernourishment

  • Increase mortality for under 5-year-old children.
  • The organs, musculoskeletal system is underdeveloped affecting height.
  • The brain develops slowly, with reduced cognitive ability and poor learning outcomes..
  • The body responds slowly and is difficult to absorb.
  • Poor social communication, lower ability to work when growing up.

Measures to prevent Undernourishment.

  • Treat thoroughly diseases of the gastrointestinal tract as well as other diseases.
  • Provide adequate food, ensure adequate nutrition in meals.
  • Ensure food safety.
  • Breastfeed immediately after birth and lasts 18 to 24 months of age.
  • Worm once every 6 months for children 2 years and older.



The WHO defines overweight and obesity as follows:

Overweight: is the state of excess weight “should have” compared to height.

Obesity: is a medical condition characterized by local or global excess and abnormal fat accumulation to the extent of adverse health effects.

The obesity assessment takes into account not only weight but also body fat percentage.

Obesity is considered a disease because it is a risk factor for chronic noncommunicable disease and a risk factor for death


60-80% of obesity is due to nutritional reasons, in addition, it may be due to metabolic disorders of the body through the role of the nervous system, endocrine glands such as pituitary, adrenal, thyroid and pancreas. but it only accounts for a very small percentage.

The causes of simple obesity:

Simple obesity, also known as exogenous obesity, is very common in the clinic and in the community. The cause of simple obesity is complex, as a result of many factors (interactions between genetics and the environment).

The main reason is due to changes in energy balance: energy intake> energy consumption resulting in fat accumulation.

Obesity caused by the endocrine reasons.


Most of the long-term consequences for obese children are persistent until adolescents (70% of childhood obesity exists in adults), which is the type of obesity that is difficult to treat, affecting much of its health. Obesity in children, if not prevented, and early treatment will become a burden on society and health.

Obese adults have an obesity history from childhood, have a high risk of many diseases (high blood pressure, stroke, increased cholesterol leading to myocardial infarction, diabetes, osteoarthritis. They can also have risks of cancers, and reduce the life expectancy in adults.

The incidence of diseases increases, affect the psychosocial.

Complications of the liver and stomach

Anatomical complications: Blount’s disease (a deformed bone due to overgrowth of the tibia); be vulnerable to impact such as the knee, ankle sprains.

Other complications: Sleep apnea, encephalopathy is a rare disease associated with increased intracranial pressure that requires immediate medical attention.


Children who are breastfed adequately and properly will prevent obesity. Breastfeeding reduces the risk of obesity by 5% for each month of breastfed babies.

Educate children for a healthy lifestyle, eat a reasonable diet.

Sports activities regularly every day.

Watching television or other static activities should not exceed 7 hours / day. Avoid eating while watching TV

Regularly monitor the child’s weight and height so that it can timely intervene to avoid obesity


Depending on the cause, age and obesity level of the child to determine treatment goals

Develop healthy eating habits and exercise

The basic principles are adjusting eating habits, making healthy food choices, and increasing physical activity. Limiting the excess energy supply from energy-rich foods such as grease, sugar, sweets, …; Encourage increased intensity of exercise at least 60 minutes per day: through games and sports: jumping rope, swimming, running or brisk walking, … prioritize sports that match the interests of the child.

Exercise enhances fitness, reduces the risk of obesity

Refrain from eating and exercising

Building a strict menu and exercise commands in the case of severe obesity need to define weight loss goals

Multidisciplinary active intervention

It is necessary to have the participation of many experts, including doctors, moderators, psychologists, and advocacy counselors to combine many measures to change perception and behavior in addition to Solutions to abstain from eating and exercising.

Drug treatment

Often obese children having unbalanced and skew diet will be considered to add protein, vitamins, minerals, omega3, fiber, … depending on the case. In addition, drug treatment is also available to treat the cause/ complications of obesity.



Anorexia is a very common condition in children, of all ages. Anorexia has many different manifestations: the child eats less than usual, keeps food in the mouth for a long time, refuses to swallow, refuses to eat certain foods such as meat, fish, eggs, or milk or refuses to eat all kinds of food. food, run away when it comes to meals, hear the clutter of a spoon or bowl, or see the food react to nausea or the feeding father or mother refuses to eat but is fed by someone else.

– The first reason to mention is due to lack of food. Lack of food during pregnancy (iron deficiency, calcium deficiency, zinc deficiency, vitamin deficiency …) … leads to a lack of food right from the womb and malnutrition right from the womb. Babies born normally, with enough height may be lazy to breastfeed, stop breastfeeding or suddenly reduce their food intake or give up formula altogether. The same goes for older children. This is also due to lack of food (unbalanced diet, lack of quality) leading to lack of vitamin D, lack of vitamin C, vitamin B group, lack of magnesium, especially zinc deficiency makes children very anorexic. … When the child is fed too early, the unbalanced diet with lots of starch also makes the child anorexic

– The second cause is that the children are sick, acute diseases due to infections, respiratory system virus infection, digestive system (gastritis, enteritis …). When children are infected, the amount of vitamins and minerals is greatly lost, especially vitamin A, vitamin C, vitamin B group, Magnesium, B6, iron, and zinc make children anorexia. Moreover, children infected with bacterial infections often use antibiotics that easily lead to intestinal dysbacteriosis along with physical damage in the digestive system, so the child has bloating, indigestion, and anorexia.

– Early complementary feeding, an unbalanced diet with lots of starch also makes the child anorexia. Usually the first few weeks of supplementation, the child has a delicious appetite, then the child will eat less gradually due to the need for vitamin B group (especially vitamin B1) and magnesium deficiency.

– Some other causes such as teething, mouth ulcers, eating with uncertain time, eating snacks, or eating sweets, soft drinks before meals.

– Food that is not suitable for the child’s taste also causes anorexia.

– Finally, some children do not eat due to psychological reasons (called psychological anorexia).

To help children regain their appetite, parents need to be patient and coordinate with the nutritionists and pediatricians to eliminate the cause of anorexia.


– There should be a diet and medicine exclusively for premature and underweight babies.

Prevention of rickets, iron deficiency anemia from the second month of age, continuously until at least 5 years old.

– During the treatment of bacterial infections, it is necessary to fully supplement vitamins A, vitamin C, B vitamins and minerals such as magnesium, zinc. Especially not to abuse antibiotics.

– Reduce pain during teething or mouth ulcers. Usually, adults are less concerned with the pain when the baby teething, which is normal, but in fact, when the teething children are very painful, they have a fever and dare not eat because of fear of pain.

– Practice for your child to eat a variety of foods and always change dishes and recipes to make them eat well. Complementary foods should not be given too soon. When children are 6 months old, they should give complementary foods. Do not want your child to gain weight quickly, but force him to eat too much.

– To deal with pathological anorexia, it is necessary to consult a nutritionist about a specific diet, suitable for each child, and it is important that during meals to create a happy atmosphere. comforting appearance helps children to eat well. Avoid “pushing” children out to eat, do not scold, intimidate, but must find out the cause of anorexia in children to overcome.

You can refer to the tables below and find the right diet for your child.

Energy demand for Group of children by age Energy recommended (Kcal)
<06 months 555
7 – 12 months 710
1 – 3 years old 1,180
4 – 6 years old 1,470
7 – 9 years old 1,825

Table 1: Energy demand for children from 1 to 9 years old

The ratio of energy-generating substances should be balanced in the correlation between Protein: Lipid: Carbohydrates = 15:30:55 (%)

PROTEIN DEMAND FOR GROUPS OF CHILDREN Recommend (g/day) animal protein ratio (%)
NPU estimated (70%)
1 – 3 years old 23 ≥60
4 – 6 years old 29 ≥50
7 – 9 years old 34 ≥50
LIPID DEMAND Ratio (%) in total energy Maximum rate between Plant fats and animal fats.

Table 2: Amount of protein recommended for each group of children (regarding to age)

(NPU): is the percentage of accumulated protein compared to protein intake

Group of children by age Calci (mg/day) Phosphorus (mg/day) Magnesium (mg/day)
<06 months 300 90 36
7 – 12 months 400 275 54
1 – 3 years old 500 65
4 – 6 years old 600 76
7 – 9 years old 700 100
*) Ca/P > 0.8 (expected: 1 to 1.5) **) Ca/Mg = 1/0.6

Table 3: Recommended Mineral demand for group of children by age.

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