Malnutrition and Individual Differences in Childrens Development - Essay Example

Running head: DEVELOPMENTAL PSYCHOBIOLOGY Malnutrition: critically discuss the evidence for its contribution to individual differences in children s postnatal development Angeliki Fousteri Ian St.James-Robert While most medical professionals, government agencies and non-governmental organizations located in developed countries discuss the various aspects of overweight and obesity, malnutrition still represent a serious and concerning problem, affecting millions of people in both developing and, in certain areas, developed countries. According to Food and Agriculture Organization (FAO, 2002), the current estimates of 1996-1998 are that 826 million people do not receive proper nutrition. The estimates also show that 792 million people that were malnutrition were found in developing countries and in a sharp contrast, 34 million malnutrition people were living in developed countries. The World Food Summit of 1996 undertook the task of reducing malnutrition to 400 million, and the current estimates are that by 2015 there will be 580 million people from malnutrition, while the 400 million mark will be reached in the year 2030 (World Food Summit, 2002). Malnutrition affects the population in various ways and in various segments of society, none of which is more affected that children. It is estimated that malnutrition contributes to 1 out of 2 deaths (53%) in children under age of 5 with infectious diseases in developing countries (World Health Organization, 2009). WHO also states that 1 out of 4 preschool children suffers from malnutrition, as well as that malnutrition in pregnant mothers lead to 1 out of 6 infants born with low birth weight. It is estimated that in 2000, 26.7% of preschoolers in the developing world were underweight. These estimates are lower that 1980 however, as they are 11% lower, suggesting considerable improvement. When considering the increase of population in the developing world the total number of underweight children and children with stunted growth has not changed dramatically since 1980. (Kliegman, pp. 189) Malnutrition deals with the inappropriate intake of food, or type of food resulting in a clinical manifestation characterized by inadequate intake of protein, energy, and micronutrients such as vitamins, and the frequent infections and disorders that result (WHO, 2009). Protein-energy malnutrition is a pathological state induced by a chronic insufficiency of energy or proteins in nutrition, or a complicated dysfunction involving both. Mild forms of protein-energy dysfunctions are manifested as hypotrophy in the child. Severe forms of protein-energy malnutrition are documented as a variety of clinical manifestations, ranging from atrophy (known as marasmus) caused by a severe lack of intake of energy and proteins in food, to kwashiorkor, as a result of a reduced intake of proteins with a relate intake of energy. There are some combined states such as marasmic kwashiorkor (Mardesic, p.280). Mild, tempered and severe hypotrophy or marasmus is documented with a lack of growth, stagnation in weight, a reduced ability to fight infection and a frequent inability to stand food. If not treated, it usually leads to decomposition and death. The causes can be a variety of internal and external factors that negatively influence either the intake and use or loss of energy and proteins, and last for a long amount of time (Kliegman, p. 189). Starvation in many parts of the world, malnutrition of pregnant women, reduced lactation because of malnutrition of the breast-feeding mothers, lack of access to other quality sources of food are the most common causes of malnutrition of the infant and infant marasmus. In parts of the world where there is enough food, marasmus is caused by internal factors (Kliegman, p. 189) . Clinical manifestation of hypotrophy of the infant and small children is a combination of symptoms of the basic disease which is the cause of malnutrition (if it's not a consequence of lack of access to food, the malnutrition itself and the existence or lack of infections, which are a common complication ( Rudolph, p. 109). Clinical determination of the phase of hypotrophy is based on the estimation of size of the subcutaneous fatty tissue. Short-term malnutrition reduces the fatty tissue and musculature, so the children look thin. Long-term and severe starvation that lasts for months effects the height of the child, so besides clinical evaluation, anthropometric measurements and some laboratory analysis should be taken (Hendricks, p. 52) Widely accepted quantitative measurement of how much the child is thin is the relative deficit of weight in relation to the child's height. For determining such measure one should have a standard curve for a certain height (Mardesic, p. 281). In mild and moderate phases of hypotrophy, 1.5-2 cm is lost from the size of the subcutaneous fatty tissue, while on the extremities is almost undetectable, and on the cheeks such loss in unapparent. Basic physiological functions like basal metabolism, thermoregulation and regulation of glucose are borderline normal. Insufficiency in body weight is around 10-40% of the average weight of the same sex as the infant, and the relative deficit is around 10-30% in relation to a eutrofic infant of child (Kliegman, p. 190). In severe cases of hypotrophy, which is called atrophy or marasmus, the subcutaneous fatty tissue is non-existent in the extremities and the Bichat bodies. The skin on the gluteus muscles hangs like "an empty bag" because of the loss of fatty tissue, the face is similar to an elderly person and the eyes are wide open and have the affect of fright because of the loss of fatty tissue in the orbits of the eyes. The muscles are also hypotrophic (Mardesic, p. 285). Because of the weakness of the musculature the stomach is thin and the architecture of the gut is visible. When the stomach is tense and promenaded if the child is meteoristic, and sometimes retracted, the arch of the thorax create a look of a boat. With the loss of muscle mass, motor functions are lost as well: the child can sit up straight, can keep its head straight and can't sit. The deficit of body weight is below 50% of a child the same age and sex (Kliegman, p. 191). The atrophic child is at first scared and melancholic, later apathic and uninterested. It has no appetite, has a problem eating foot, it is usually obstipated and has paradoxal diarrhea because of lack of food. These clinical symptoms are followed by laboratory sighs of exhaustion of vital function. The basal metabolism is reduced, the circulation is slowed, the arterial pressure is low and there is a strong affinity towards hypothermia and hypoglycemia that increases the chance of infection (Mardesic, 286). Untreated marasmic child dies of decomposition. It represent a crash of all vital functions of the atrophic child, and it occurs because of supplemental, frequently bowel infections that causes dehydration, metabolic acidosis and hypoglycemia. These metabolic complication because of the severe conditions of the child are usually irreversible and incurable (Rudolph, p. 1336). Treatment of severe hypotrophy demands a lot of art and patients, but if it's started on time and continuously followed, it can be completely cured. The infant is capable of come up to the same level as his peers in growth and to further develop according to its genetic potential. Lately, it has been discussed about the possibility of brain damage during atrophy of the infant, which would clearly impair intellectual functions. It is believed that either hunger alone, or the other social factors that usually accompany hunger may affect intellectual development. (Brown, p. 40) Also, latest research shows that every long term and severe malnutrition in prenatal and earliest postnatal age leaves a long term scars on the child's organism that has severe effects on health at a later age. Such phenomena is named "programming": further growth development, health and facing with various causes of diseases in adult age are preordained not only by genetic factors and outside causes (infections, nutrition) but also by certain periods of critical development during fetal and infant periods. It has been proven that children that had the lowest weight during birth and in the year after birth, they had a bigger chance of developing severe hypertension, limited tolerance to glucose, hyperlipidemia and moicardial infarction in their fifties and sixties. (Baker, p. 99) Kwashiorkor is a severe form of protein malnutrition when there is a sufficient amount of carbohydrates that are taken in the body. It is one of the most spread and most severe forms of malnutrition to date, especially in developing countries. The term is derived, appropriately, from the language of Ghana, where it means "a disease that is developed when a child is refused his mother's breasts of her new pregnancy" (Mardesic, p. 286). It is a period between 4 months and 5 years of life when the infant is not properly breast-fed and does not have other sources of important biologically important proteins, but is fed with grains. Protein deficit is usually followed by infestations of helmintes, infections and other negative psychological and social factors that are a mark of a poor environment. Protein malnutrition can be caused by pathologic absorption of proteins, as is the case in nefrosis, burns and bleeding as well as an insufficient protein synthesis like in diseases of the liver (Rudolph, p. 1337). Observational symptoms of kwashiorkor are hypoalbuminic edema on the face, arms, legs and body, as well as edema of the internal organs. Also, deficit of weight and height in relation with healthy peers except when the amount of retained fluid masks the deficit of weight, as well as a relatively well preserved subcutaneous fatty tissue, atrophy of musculature and a change in behavior (Rudloph, p. 1337). Frequent and relative signs of kwashiorkor are changes in hair such as depigmentation, dermatoses with a darker skin where there is a constant exposure to irritation (such places after desquamation become depigmented) and an increase in size of the live because of fatty infiltration (Rudolph, p.1337). The dominant laboratory findings is the hypoproteinemia, especially hypoalbuminemia. Various essential amino acids in the plasma are relatively reduced in relation with the non-essential, and there is aminoaciduria. The concentration of cholesterol in the plasma is reduced. There is also a reduced activity of many serum enzymes such as lipase, transferase, cholinesterase, and alkaline phosphatase, as well as the enzymes of the pancreas. There can be a normocyte, microcyte or macrocyte anemia, signs of lack of insufficiency of vitamins, potassium and magnesium (Mardisic, p. 286). Several studies have shown that the effect of the magnitude of both the acute and the longer-term malnutrition is considerable. They state that "severely underweight children have more than an 8-fold greater risk of mortality than normally nourished children, that moderately underweight children (60-69% of reference weight for age) have a 4- to 5-fold greater risk, and that even mildly underweight children (70-79% of reference weight for age) have a 2- to 3-fold greater risk. The high prevalence of mortality, even in children with mild and moderate undernutrition, suggests that >50% of child deaths may be caused directly or indirectly by undernutrition. Moreover, 83% of these deaths result from mild to moderate forms of undernutrition. A major factor is the potentiation of infectious diseases by undernutrition." (Kliegman, p. 190) More extensive studies have shown the relation between psychological development and malnutrition. One such research made by Champakam and Srikantina have explained the relation between kwashiorkor and mental development. The scientists at first that several research have shown that protein malnutrition has affected memory, learning and behavior in animals. They also understand the complexity of intelligence and its measurement, as different cultural backgrounds may affect the standard test in practice. The intelligence test were divided into test for children 6-7 years and 8-11 years, and there were 2 groups of children, a group of children that were suffering from kwashiorkor but have recovered and children that were healthy. Since many of the children were illiterate, the scientists clearly opted for performance test instead of the standard verbal tests. This included block design tests, assembly tests and memory test with digits and objects. Memory tests were related with the visual and auditory memory, while the comprehension tests were related with abstract concept formation, organization of knowledge etc. It should also be mentioned that a standard test was given to all member, no matter his or her age. The test were given to 50 children, ranging from 8-11 years of age and as the scientists have stated: "The mean scores obtained by the different age groups increased with increasing age and were 52, 68, and 82% for the 8 to 9-, 9 to 10 and 10 to 1 1-year age group, respectively. The battery was, therefore, accepted as suitable." (Champakam and Srikantina p. 845). It should also be mentioned that when the subjects were chosen, they took into account the various social and economic factors, as well as sex and family care. The scientists concluded that there is a significant difference between the two test groups. Concerning the intelligence test, they were performed with a percentage of 7.69 to 78.94 in relation with the subjects. The difference was especially noticeable in the first age group of 8-9 years and the difference was a lot smaller than the group with the age of 10-11 years. The different abilities were investigated and for that purpose, they were divided into four categories: memory, perceptual, abstract and verbal ability. The complete score was 75, while each separate category scored 32 for perceptual ability, abstract 18, memory 17 and verbal ability 8. The scientists concluded that "there was a significant difference between the performance of the control and the experimental subjects with regard to the intelligence tests. This difference was particularly marked in the younger age group (8-9 years) and tended to diminish in the older age group (10-1 1 years)" (Champakam and Srikantina p. 846). They also concluded that perceptual and abstract abilities were affected and that the intersensory tests were better in older children, than in younger. (Champakam and Srikantina p. 849). Vincent C. B. also published a paper on the subject of kwashiorkor and impairment of intellectual functions in children. His research was performed on Nigerian children. It was designed with one index group consisted of children in urban areas with kwashiorkor and four other control groups consisting of a sibling group, lower class group, upper class group and a group consistent of kwashiorkor children found in rural areas (Vincent C. B., p. 1423). The experiment proved that there was a significant difference between the index group, which scored lower scores on certain intelligence tests than their peers, but far more than their rural peers. It should also be mentioned that the male students received lower scores than their female peers, and the upper class group showed to be superior that the other groups in both anthropometric measurements an intelligence test (Vincent C. B., p. 1423). References: 1. Barker, D. J. P. (1997). Fetal nutrition and cardiovascular disease in later life. British Medical Bulletin, 53: pp. 96-108. 2. Brown J. L. et al. (1996). Malnutrition, poverty and intellectual development. Scientific American pp. 38-43. 3. Champakam, S., Srikantia, G. S. (1968). Kwashiorkor and Mental Development. American Journal of Clinical Nutrition, 21: pp. 844-852. 4. Food and Agriculture Organization. (2000). Undernourishment around the world. Available at: [http://www.fao.org/DOCREP/X8200E/x8200e03.htm#TopOfPage], Accessed, 12 January 2009. 5. Hendricks, K. M., Duggan, C. (2005). Manual of Pediatric Nutrition. New York, B.C. Decker. 6. Kliegman, R, M. et al. Nelson Textbook of Pediatrics: 18th edition. Philadelphia, Saunders. 7. Mardesic D. at al. (2003). Pediatrics. Zagreb, Skolska Knjiga. 8. Rudolph, C. D. et al. (2002). Rudolph's Pediatrics. Philadelphia, McGraw-Hill professional. 9. Vincent, C. B. N. (1977). Effects of kwashiorkor on intellectual development among Nigerian children. American Journal of Clinical Nutrition, 30: pp. 1423-1430. 10. World Health Organization. (2009). Challenges. Available at [http://www.who.int/nutrition/challenges/en/index.html], Accesed, 12 January, 2009. 11. World Health Organization (1999). Management of severe malnutrition: a manual for physicians and other senior health workers. Available at [http://www.who.int/nutrition/publications/severemalnutrition/en/manage_severe_malnutrition_eng.pdf], Accessed, 12 January 2009. 12. World Health Organization. (2009). Water-related diseases. Available at: [http://www.who.int/water_sanitation_health/diseases/malnutrition/en/], Accessed 12 January, 2009. Read More