CHAPTER 2

Ecology of Nutrition
I. DEFINITION

MALNUTRITON
A state of disease caused by sustained deficiency,
excess, or imbalance of the supplies of calories,
nutrients, or both, that are available for use in the
body.
FORMS OF MALNUTRITION
UNDERNUTRITION
Pathological state resulting from the consumption of
an inadequate quantity of food over an extended
period of time
o Marasmus
o Kwashiorkor
o Chronic energy deficiency (CED)
SPECIFIC DEFICIENCY
Pathological state resulting from a relative or absolute
lack of an individual nutrient
o Vitamin A deficiency or xerophthalmia
o Iron deficiency anemia
OVERNUTRITION
Pathological state resulting from the consumption
of an excessive quantity of food, and calorie
excess, over an extended period of time
o Obesity

IMBALANCE
Pathological state resulting from a disproportion
among essential nutrient with or without absolute
deficiency of any nutrient
o Amino acid imbalance
o Certain nutrient deficiencies – calcium deficiency
symptoms appear when vitamin D is lacking,
even when calcium intake is adequate
TOXICITY
Excessive intakes of certain nutrients are toxic
o Vitamin A toxicity

o Dental fluorosis (mottled enamel)-

hypomineralization of tooth enamel caused by
excessive flouride during enamel formation
TYPES OF MALNUTRITION

ACUTE MALNUTRITION
Related to current state of nutrition, manifested by:
o weight loss
o low weight-for-height although normal height-for-
age

CHRONIC MALNUTRITION
Related to past state of nutrition, manifested by:
o stunting or nutritional dwarfism
o low weight-for-height and low height-for-age
PRIMARY MALNUTRITION
Caused by inadequate food intake
o Also referred as dietary malnutrition

SECONDARY MALNUTRITION
Caused by certain conditioning factors other than
food alone
o Disease state, parasitism
o Also referred as conditioned malnutrition
COMMON NUTRITION DEFICIENCY DISEASES

KWASHIORKOR
Results from a diet grossly deficient in protein
“sickness of the older child when the next baby is
born”
Occurs after breastfeeding stops and child is
weaned into a starchy diet
MARASMUS
Results from a diet severely lacking in calories, low
proteins, fat and carbohydrates
Greek work “wasting”
Old man’s face or “monkey” face
Due to inadequate breastfeeding or improper
(diluted) milk formula
COMMON NUTRITION DEFICIENCY DISEASES

XEROPHTHALMIA
Caused by severe vitamin A deficiency
Impairment of night vision and/or pathologic
changes in the eyes
ANEMIA
Caused primarily by iron deficiency
Aggravated by the presence of parasites
GOITER
Enlargement of thyroid gland
Caused by iodine deficiency either due to dietary
deficiency or factors other than diet
COMMON NUTRITION DEFICIENCY DISEASES

IODINE DEFICIENCY DISORDERS

Group of diseases/conditions due to iodine
deficiency
Goiter, cretinism, impaired mental and physical
development
BERI-BERI
Due to thiamine deficiency
ARIBOFLAVINOSIS
Due to gross deficiency of riboflavin (B2)
II. STAGES IN THE DEVELOPMENT OF
NUTRITIONAL DEFICIENCY DISEASE
(PATHOGENESIS)

 A nutritional deficiency disease develops in

stages, starting with nutrient inadequacy and
culminating in the appearance of anatomical
lesions. If untreated, it may result in death

 Figure 1. Pathogenesis of Nutritional Deficiency

Diseases(refer to MW)
III. MULTI-FACTORIAL CAUSALITY OF
MALNUTRITION

Malnutrition is a health problem, it has its roots in a

number on economic, demographic, socio-cultural
and ecologic factors prevailing in a community or
country.
A. HYPOTHETICAL CAUSAL MODEL

Beghin (1988) as a “set of organized and

hierarchical chains linking together the factors that
play or are supposed to play a role in a particular
nutritional situation”.

Provides an understanding of the mechanisms

that lead to malnutrition;
Useful in
o Identification of major determinants of
malnutrition
o Selection of relevant information
o Identification of links in the causal chains
o Facilitation of analysis and interpretation
Examples Of Causal Models
Figure 2
o shows the primary determinants of nutritional status
are food intake and food utilization
o food intake and food utilization are each
determined by several secondary factors, which are
in turn affected by one or more other factors, and
so on down the chain to the “root” cause(s) of the
problem

o Figure 2. Example of a Hypothetical Causal

Method
 Figure 3
Like the first example, this model shows that
malnutrition is directly caused by inadequate food
intake and poor utilization

The secondary factors are grouped into three

processes: (1) food production; (2) food distribution;
(3) food utilization

The interrelationship or links between and among

the factors are indicated by arrows.
 Figure 3. Diagrammatic model showing multi-
factorial causation of malnutrition
B. 3 CAUSES OF MALNUTRITION IN THE PHILIPPINES
– A review of the literature on PEM in the Philippines
(Corpus, 1989) as well as the national surveys of FNRI
reveal the following causes of malnutrition

1. DIRECT OR PRIMARY CAUSES

Inadequate and/or unbalanced food intake
o Dietary surveys revealed low average per capita
calorie intake
o Average per capita protein intake nearly meets
RDA
o Dietary protein is used for energy rather than for
tissue protein synthesis and maintenance, leading
to protein deficiency
B. CAUSES OF MALNUTRITION IN THE PHILIPPINES –

1. DIRECT OR PRIMARY CAUSES

Poor biological utilization of food

o DOH statistics show high prevalence of infectious
diseases and parasitism which interfere the
biological utilization of food
2. INDIRECT OR SECONDARY CAUSES

Economic factors (poverty) – PEM is more

likely to occur in household where:

o Low income
o Limited food expenditure and food prices are
high
o Unsteady or irregular income due to
household head occupation
o Among farmer, size of land holding, tenure
status and type of crops grown interact to
affect nutritional status
Socio-cultural factors – malnutrition is more
likely to occur in households where:

o Low Parental educational background

o Mothers lack nutrition knowledge – faulty food
habits, beliefs and practices
o Poor infant feeding practices – early weaning from
breast, late introduction of complementary foods,
giving dilute formulas especially if made with
condensed milk
o Intra-household food distribution or sharing – not
related to nutritional needs but to other factors like
position in the family
Demographic factors

o Malnutrition is more likely to occur large families

• 1-3yrs old is the most vulnerable
• If more than 1 preschooler the younger ones are
likely to be more malnourished than the older ones
o Mother’s characteristics such as age and fertility
behaviors also affect children’s nutritional status
• Incidence of PEM has been found higher among
children of teen0age mothers
• Where birth interval is less than 17 months
o Rural to urban migration over-crowded slum areas,
breeding places for infectious diseases has given rise
to which predispose to malnutrition
Health factors – risk of malnutrition is higher
when:
o Mother’s nutritional status is poor
o Child has low birth weight
o Infectious diseases like diarrhea, upper
respiratory diseases, measles, primary complex
and parasitism co-exist with poor dietary intake.
Environmental/ecological factors
o Exposure to drastic weather conditions which
affect food production
o Geographic location and topography which affect
access to basic services
o Natural seasonal variations in availability of food
o Availability of safe water and waste disposal
facilities
3. UNDERLYING CAUSES – some of the above
are government policies, the political structure and
the peace and order situation or socio-political
unrest. Latham (1984) adds the following root
causes of malnutrition:
Economic disorder, national and international
Inappropriate development strategies resulting to
poverty
Modernization, westernization
Actions of multinational corporations
Corruption in government
 IV. OVERNUTRITION, THE OTHER “FACE” OF
MALNUTRITION

While “malnutrition” is more commonly used to refer to

under nutrition due to dietary deficiencies, it also includes
over nutrition due to dietary excesses.
A. COMMON OVERNUTRITION PROBLEMS ON
THE RISE AND DIETARY FACTOR(S)
IMPLICATED
Obesity – total calories
Coronary artery disease – total calories, especially
saturated fats and cholesterol
Hypertension – total calories and salt
Diabetes mellitus – total calories
Some cancers – total calories and fat
B. OTHER FACTORS CONTRIBUTING TO
OVERNUTRITION
Lifestyle factors
Shift in activity patterns (more sedentary activities)
Adoption of “western” food patterns (high fat and
simple carbohydrates, low in fiber)
Smoking and alcohol abuse
Increasing affluence of certain sectors which
facilitates the change in lifestyles
Change in demographic structure (increasing number
of elderly who are more predisposed to nutrition-
related degenerative diseases
Genetics
 V. EFFECTS OF MALNUTRITION
A. ON MENTAL DEVELOPMENT AND PERFORMACE
When nutritional deprivation is severe and prolonged and
occurs during the first year of life, the retardation of brain
development and function may be such that it cannot be
cured by nutritional rehabilitation (Joint FAO/WHO
Expert Committee)
Brain development begins even before birth and
continues in early childhood
About 66% or 2/3 of the adult brain weight is attained
before the age of one year and 90% before the age of
four years.
Abnormal behavior due to malnutrition such as
listlessness, apathy, inattention and poor visual acuity and
judgment impair the learning process
Malnutrition leads to sub-optimal performance at
school age and subsequent school drop-outs
Selected Philippines studies using indicators of
dietary intake or nutritional status have shown:
o Significant positive relationship between size and
scores in mathematics but not other subjects
among rural and urban children aged 12-14yrs
(Popkin and Lim).
o High correlation between mental scores and
physical measurements and dietary intake of most
nutrients (CYRC. Guzman and Guthrie cited by
Corpus, 1989).
o Nutritional status (height for age) is a significant
predictor of academic performance (Florencio,
cited by Herrin 1994).
B. ON PHYSICAL DEVELOPMENT, FITNESS AND
PRODUCTIVITY
Inadequate dietary intake impairs growth and physical
development
Parameters of growth physical development and fitness
have been found to be associated with physical
performance measure by work output and length of
working time (cited by Loyola and Corpus, 1993 and
Herrin 1994).
Productivity is also affected by mental ability which in
turn, is affected by nutritional status. (Herrin 1994).
C. ON HEALTH
In addition to the well-known deficiency diseases
due to inadequate dietary intake of specific
nutrients, malnutrition increases susceptibility to
and severity of infectious diseases.
Figure 4. Synergism between malnutrition and
infection
Research findings also indicated the sub-optimal
intakes of certain nutrients are associated with
degenerative diseases like cardiovascular diseases and
diabetes
On the other hand, overconsumption of calories leads
to obesity which is a predisposing factor to many
diseases.
Figure 5. Obesity is a risk factor for degenerative disease
Increased morbidity, also leading to lowered productivity
and increased expenditure for health care
D. ON NATIONAL GOVERNMENT
Slow economic growth due to low productivity and shorter span of
productive years of the population
Slow social development due to poor mental development of a large
sector of the population
Increased expenditures for basic services – health, social welfare and
non-formal education (due to high school drop-out rates)
Social unrest, high criminality rates

VI. OTHER NUTRITION-RELATED PROBLEMS OF

PUBLIC HEALTH SIGNIFICANCE
Dental carries
An overall poor diet, excessive consumption of sugar-rich foods,
poor personal hygiene and genetics are important etiological
factors.
Osteoporosis, postmenopausal and senile
As the age structure of the population changes osteoporosis is
expected to become a problem of public health significance.
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