Childhood undernutrition: The root causes and remedies
By Dr Muhammad Imran
Undernutrition is one of the major global health challenges affecting both developed and underdeveloped countries. Global nutrition report 2018 clearly shows that the malnutrition rates are still high around the world with about two billion people suffering from it. Of which children under the age of five constitute a major portion i.e. About 165 million including cases of stunting wasting and underweight and Pakistan is no exception where childhood malnutrition rate is exceeding the global threshold. National nutrition survey 2018 (NNS-2018) has reported an increasing rate of stunting, wasting and undernutrition not only in children under-age of five but also in adolescents and women of reproductive age.
According to survey four out of every ten children which constitutes about 40.2% child population is stunted. As for the wasting the rates are highest in Pakistan’s history being 17.7%. it has also been reported that out of every three, one child (28.9%) is undernutritioned. As reported these rates are slightly higher in boys than girls whereas in respect of locality rural areas show a bit higher rate of malnutrition but still urban areas are no exception.
This crisis of health has many causes, one being the malnutrition in lactating mothers. Breast milk is considered crucial for infants as it protects them from infections however its composition varies from mother to mother mainly shaped by their diet.As most of the women of reproductive age (WRA) suffer from undernutrition in Pakistan. About 41.7% of WRA population is anemic and a major part of population suffers from vitamin A, Vitamin D and iron deficiencies both in urban and rural localities. A consequence of food insecurity in lactation mother is usually an infant that is deprived of nutrients and prebiotics which may lead to a younger or dysbiotic gut microbiota.Another major contributor to undernutrition in children is the replacement of breast feeding with formula milk.Reported states that breastfeeding rates at first hour of birth have increased whereas rate of continued breast feeding in first year has decreased from 77.3% in 2011 to 68.4% in 2018. Improper infant and children feeding practices due lack of awareness is also leading to child undernutrition.
As reported that only one out of every three children between age of 6-8 months receives age appropriate complementary food which may a contributing cause of iron, vitamin and iodine deficiency as well as dysbiotic gut microbiota in children.Also increased trend of using processed food over the years has also been a contributor to gut dysbiosis. As processed food contains a fair number of antimicrobials, they have a major impact on children gut microbiota which is still not mature causing undernutrition at young age. Poor sanitary and drinking conditions result in an increase in entero-pathogen burden and administration of antibiotics to treat the diseases caused by theses entero-pathogens in children leads to gut dysbiosis.
Many studies and surveys are advancing to illustrate the extent to which entero-pathogen burden and use of antibiotic contribute to undernutrition. Undernutrition in infants can be treated by food fortification, food supplementation and regulation of these nutritional interventions depending upon severity of undernutrition. In order to treat under nutrition, after birth the use of energy rich micronutrient fortified ready to use therapeutic foods (RUTFs) have been observed to increase short term weight gain in undernourished individuals. However recent studies have revealed that response of IgA antibodies is of prime importance in identifying and characterizingbacterial strains that can be used as potential therapeutic targets.
In addition to this, children suffering from undernutrition have been reported to have a younger and dysbiotic gut microbiota when compared to healthy children of same age.Which has led to identification of growth discriminatory taxa which can be used as targets to treat undernutrition. Microbiota directed complementary food (MCDFs) that target age discriminatory taxa thereby increasing them to a number which is similar to that in healthy individual of same age administrated to children suffering from undernutrition, are reported to be helpful in treating undernutrition.
Thus, it is important to understand the crosstalk between dietary ingredients and gut microbiota to find a way to manipulate microbiota to formulate a course of therapeutic interventions to treat undernutrition in children.
Infants and children under the age of five all around the world are the major group of population which is affected from undernutrition. Same is in Pakistan where food insecurity and lack of awareness about feeding practices and consequences of improper feeding practices has caused many children to suffer from undernutrition. This had led us to stage which is alarming and needs to be addressed at highest priority.
Undernutrition has been attempted to be treated with diet interventions by food fortification, supplementation and by energy rich micronutrient fortified ready to use therapeutic foods (RUTFs) in different programs launched by government but no remarkable progress has been seen. In recent studies on gut microbiota of children suffering from malnutrition have reported a dysbiotic and younger gut microbiota. Further progress on this front has led to identification growth discriminatory taxa which can be therapeutic targets for Microbiota directed complementary food (MCDFs). But still there is more to uncover in this aspect of gut microbiota to find appropriate gut species and therapeutic interventions to treat undernutrition.
The writer is associate professor at Quaid-i-Azam University, Islamabad