Social Causes of Weight Loss

In developing countries, malnutrition takes on different forms of multiple or partial deficiencies, ranging from simple undernourishment to denutrition and cachexia. High rates of malnutrition persist, in spite of progress in the production, preservation, and distribution of food, and in sanitary measures and education.

UNO, FAO, WHO and UNICEF data collected in the 1990s (Table 2) show that 20% of the popu-

Table 2. Prevalence of undernourishment in developing countries (source: FAO)

Countries Total Number of Proportion Proportion Proportion population undernourished people of total of total of total

1997 1996-1998

(millions) (millions)

Developing world 4 501.2 791.9

Asia and Pacific 3 091.2 515.2

East Asia 1 321.9 155.0

China 1 244.1 140.1

China, Hong Kong 6.5 0.1

North Korea 23.0 13.2

South Korea 45.7 0.5

Mongolia 2.5 1.1

1979-1981 1990-1992 1996-1998

29 21 18

32 21 17

29 16 12

30 17 11

19 19 57

16 34

lations of developing countries, particularly in the group of least-developed countries (LDCs), comprising more than 800 million people, eats an amount of food that is only enough to guarantee energy for a sedentary life (1.2-1.4 times the basal metabolism). More than 192 million children suffer from PEM and 2000 million people lack various micronutrients (vitamins, minerals, essential amino acids)!

In Western countries, where an enormous surplus of food exists, many people belonging to various groups (the poor, the elderly, drug-addicts, pregnant women, as well as hepatopathic, nephro-pathic, gastroenteropathic, neoplastic, and AIDS patients) have nutritional deficits that are either unknown or evident.

An insufficient intake of food is the first cause of malnutrition, but a lack of nourishment is often associated with other aggravating factors. These can be the main cause of undernourishment, such as is the case in patients with infectious or parasitic diseases [12, 13], poor alimentary habits, traumas, burns, neoplasms, or who have undergone surgery [14,7].

Infectious diseases produce a series of metabolic alterations [15] that either separately or jointly give rise to malnutrition (Table 3 ).

'Hospital malnutrition,' due to incongruous alimentary habits before hospitalisation or to the irrational diets of some health-care organisations, deserves special attention [16, 17]. It is calculated that 20-40% of patients admitted to medical wards and 20-25% of surgical patients show signs of protein-caloric malnutrition, which usually increases after 7-10 days of hospitalisation or after surgery. Malnutrition is a common feature in

Table 3. Metabolic disturbances induced by infectious diseases

Hypercatabolism High consumption of O2

Loss of potassium, phosphorous and magnesium

Hydric-saline retention

Hypertriglyceridaemia

Hypoglycaemia

Negative nitrogen balance hospitalised AIDS patients, who take in only 70% of resting energy expenditure (REE) needs and 65% of protein needs, excluding the extra needs resulting from the hypermetabolism associated with fever, acute infections, and physical activity. Dietetic deficits in protein and calorie consumption interfere with the natural course of the main disease, emphasising subjective symptoms such as sickness, asthenia, anorexia, emesis, and constipation, which in turn interfere with feeding. A close relationship exists between susceptibility to infectious diseases and nutritional status: regular nutrition and general good health make individuals more resistant to infections. Similarly, anergy to cutaneous tests (PPD, candidin, DNCB, etc.) is closely related to body-weight insufficiency and hypoalbuminaemia. The pre-surgical correction of denutrition reduces the incidence of post-surgical infectious complications, favouring the healing of the wounds and a quicker return to health [18-20].

Diseases that are usually benign in Western countries (measles, pertussis, TBC) are particularly serious in developing countries [21]. The individual effects of undernourishment/denutrition consist of a progressive loss of weight, lack of body development, anaemia, loss of muscular strength and working capacity, blindness, and a greater susceptibility to diseases. The general effects are economic and social, as well as health-related, as, in a vicious circle, entire populations in some regions are not able to work and produce food because of undernourishment.

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