EC-FAO Food Security Information for
Action Programme
Distance Learning to Support Capacity Building and
Training for National and Local Food Security
Information Systems and Networks
NUTRITIONAL STATUS ASSESSMENT AND
ANALYSIS
LESSON 1. NUTRITIONAL STATUS AND
FOOD SECURITY
NOTE
Please note that this PDF version does not have the interactive features
offered through the courseware such as exercises with feedback, pop-ups,
animations etc.
We recommend that you take the lesson using the interactive courseware
environment, and use the PDF version for printing the lesson and to use as a
reference after you have completed the course.
© FAO, 2007
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 1
Learning objectives
At the end of this lesson you will be
able to:
• define the concept of malnutrition;
• identify the factors influencing
nutritional status; and
• be aware of the relationships
between nutrition, food security,
health and mortality.
Introduction
The factors affecting an individual’s nutritional
status are many and diverse.
Understanding these factors is essential in
order to assess malnutrition, to design
programmes which tackle nutrition problems,
and to correctly inform programme
management and evaluation.
Understanding malnutrition is also important
as it carries heavy costs on individuals and
households, communities and nations. In fact,
due to malnutrition, millions of lives are
destroyed by death and disability, both
mental and physical.
Besides being morally unacceptable, this
implies economic costs, in terms of lost
productivity and income caused by premature
death, lower physical capacity, absenteeism
and lower educational and occupational
opportunities.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 2
What is malnutrition?
Nutritional status is the
physiological state of an
individual, which results from the
relationship between nutrient
intake and requirements and
from the body’s ability to digest,
absorb and use these nutrients.
The term malnutrition indicates
a bad nutritional status.
Malnutrition refers to all
deviations from adequate
nutrition, including
undernutrition, overnutrition and
specific deficiencies (or excesses)
of essential nutrients such as
vitamins and minerals.
What is malnutrition?
The terms malnutrition and undernutrition are often used loosely
and interchangeably, although a distinction needs to be made at all
times.
In your opinion, what is the difference between the two terms?
Malnutrition Undernutrition
It is the outcome of insufficient It arises either from
food caused primarily by an deficiencies or excesses of
inadequate intake of dietary or specific nutrients, or from
food energy. undiversified diets (wrong
kinds or proportions of foods).
Click on each option and drag it to the correct box. Then,
click on Check Answer.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 3
What is malnutrition?
“Malnutrition" and "undernutrition" are terms generally used
interchangeably, and they often both refer to nutritional
situations that are typical in populations belonging to the
low-income and poor socio-economic groups of developing
countries.
However, in many developing countries, under- and
overnutrition are occurring simultaneously among different
population groups. This phenomenon is referred to as the
“double burden” of malnutrition.
The “double burden” of malnutrition
The “double burden” of malnutrition refers to the co-existence of undernutrition, micronutrient
deficiencies, overweight/obesity and other nutrition-related chronic diseases in the same
countries, in the same communities and even in the same households.
This phenomenon is not limited to upper-income developing countries, but is occurring across the
globe in countries with very different cultures and dietary customs.
When poor economic conditions improve, amounts and variety of food consumed tends to rise and
mortality rates of infant and young children tend to fall as communicable diseases are more
successfully put under control. This may be accompanied by rises in obesity and diet related non-
communicable diseases which may co-exist with high levels of child undernutrition.
Causes of malnutrition
Poverty is the root cause of
malnutrition. Food security, health
and care are the underlying causes as
will be described in the next screens.
Most micronutrient deficiencies
primarily affect poor and
disadvantaged households whose
members cannot produce or procure
adequate food, who live in marginal or
unsanitary environments without
access to clean water and basic
services, who lack access to
appropriate education and information,
or are otherwise socially
disadvantaged.
However, overnutrition and dietary
imbalances, which may lead to chronic
diseases, cut across many socio-
economic boundaries.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 4
Causes of malnutrition
Nutritional status is influenced by multiple and interrelated factors.
The most important factors can be grouped under the broad categories of food, health
and care.
The availability of, access to and consumption of adequate quantities
of safe good quality nutritious food is an important factor influencing
nutritional status.
Nutritional well-being is influenced by the nutrient content of food
consumed and its absorption by the body, in relation to other
requirements determined by age, sex, level of physical activity and
health status, as well as the efficiency of nutrient utilization by the
body.
FOOD
Causes of malnutrition
Health and sanitation are essential for nutrition, yet they are beyond the
reach of the majority of the world's population.
Infectious disease and inadequate diet act together, each aggravating the
effects of the other to produce what is referred to as the "malnutrition and
infection cycle".
HEALTH Nutritional requirements are higher during and following episodes of
infection. Chronic or frequent acute infections make it almost impossible to
maintain adequate nutritional status.
Care and feeding practices require time, attention and support and are
essential to meet the physical, mental and social needs of individuals.
The knowledge, attitudes and practices of household members largely
determine the nutritional status of the household.
An incomplete understanding of the body's nutritional needs and lack of
knowledge of how to meet these needs with available foods can lead to
CARE
malnutrition.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 5
Causes of malnutrition
Food, health and care are interrelated, and actions affecting
one area may have significant consequences on another.
Example
Adoption of sustainable and
labour-saving agricultural
technologies may influence
nutrition not only through
improved food supplies and
income, but also through their
beneficial impact on sanitation
and health and on the time
available for providing care to
household members.
Development policies, which affect the economy and the society as a
whole, usually are not included in the domain of nutrition as such.
However, they impact considerably on the nutritional well-being of the
population, and their effects may be monitored on food, health and care.
Conceptual frameworks
The most commonly
used framework for
understanding the
causes of malnutrition
is adapted from the
UNICEF conceptual
framework.
This framework sets
out causes that
operate at three
levels: immediate,
underlying and basic,
whereby factors at
one level influence
other levels.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 6
Conceptual frameworks
Can you classify the following causes of malnutrition within the UNICEF
conceptual framework?
LEVEL OF CAUSES
Immediate Underlying Basic
Diarrhoea
Restrictive land-holding policies
Malaria
Diets with low vitamin A
content
Ethnic bias in government
resource allocation
Poor breast-feeding practices
Please select the answers of your choice
Conceptual frameworks
There are other conceptual frameworks for malnutrition, such as the Food
Insecurity and Vulnerability Mapping System (FIVIMS) framework for
food security, livelihoods and nutrition.
Care
practices Food
consumption
Performance
of the food
Socio- economy: Nutritional
economic • availability status
and political
• access
environment
• stability Food
utilization
Health and
sanitation
See the detailed diagram
of FIVIMS framework
The key difference between the UNICEF and FIVIMS framework is that the
latter gives a greater centrality to food availability, access, consumption and
utilization and their determinants. However, health and sanitation and care
practices still occupy an important place within the framework.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 7
Nutritional status, health, mortality and low birth weight
To better understand the concept of malnutrition and its implications, let’s
consider the relationships between nutritional status and health status,
mortality and low birth weight.
NUTRITIONAL STATUS NUTRITIONAL NUTRITIONAL STATUS
STATUS
MORTALITY LOW BIRTH WEIGHT
HEALTH STATUS
There is a ‘vicious cycle’ Mortality increases Inadequate maternal
in which malnutrition exponentially with nutritional status is the
and diseases influence declining nutritional most significant cause
each other. status. of low birth weight.
Let’s see these relationships more in detail...
Nutritional and health status
Nutrition and health are closely linked, as
NUTRITIONAL STATUS
disease contributes to malnutrition, while
malnutrition makes an individual more
susceptible to disease.
This ‘vicious cycle’ in which one exacerbates the
HEALTH STATUS
other is known as the “malnutrition-infection
cycle” and can eventually lead to severe
malnutrition and death.
This leads to... Weight loss, growth
INADEQUATE DIETARY
faltering and reduced
INTAKE
immunity, which lower the
body’s ability to resist
infection.
This results in...
This causes...
Loss of appetite,
malabsorption of nutrients, Longer, more severe and
altered metabolism and more frequent disease
increased nutrient needs. This leads to... episodes.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 8
Nutritional and health status
Certain diseases are
particularly frequent causes of
poor growth.
Among these are diarrhoea,
respiratory infections,
HIV/AIDS and malaria.
Moreover, certain diseases
may predispose a person to
certain types of malnutrition;
vice versa, certain types of
malnutrition may predispose a
person to certain types of
infection.
For example, lack of vitamin A
can predispose a person to
measles.
The relationship between nutrition and infection is also affected by the type
of caring that takes place for sick individuals.
Nutritional and health status
The relationship between nutrition and
disease can be observed in the seasonal
changes in nutritional status.
Seasonal changes in nutritional status
are more evident in rural populations,
especially when they depend on a single
harvest.
However, the seasonal peaks of
malnutrition coincide not just with the
hungry season, when food may be in
most scarce supply, but also when the
frequency of certain diseases is highest,
particularly diarrhoea and malaria.
Seasonal changes in nutritional status
Many communities, especially in the rural areas, experience periods in the year when
malnutrition levels are higher.
Changes in the levels of malnutrition are influenced by seasonal patterns such as: cropping
patterns, food availability, disease, child care, income sources, price of foods, labour demand.
These expected changes in malnutrition need to be taken into account when interpreting
changes in observed rates of malnutrition.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 9
Nutritional status and mortality
It is often assumed that as malnutrition increases
NUTRITIONAL so does mortality, but the reality is more complex.
STATUS In fact, the relationship between malnutrition and
mortality is not linear but increases exponentially.
In other words, mortality increases
exponentially with declining nutritional status.
MORTALITY
Many factors impact mortality, Example: Northern Iraq refugees
especially the health
environment and caring In 1991 during the
capacity, which are often northern Iraq refugee
compromised in situations of crisis, a survey of
conflict and displacement. Kurdish refugees
found a prevalence of
In emergencies, where acute malnutrition
exposure to disease varies, among under-fives of
there may therefore be only 4.3% (which is
varying levels of mortality low) but a crude
associated with the same level mortality rate (CMR)
of malnutrition. of 3/10,000/day,
Consequently, mortality rates which is very high.
cannot be predicted from Most deaths were due to diarrhoea and
prevailing rates of dehydration.
malnutrition.
Nutritional status and low birth weight
NUTRITIONAL STATUS
It is estimated that each year 24 million
babies are born with low birth weight
LOW BIRTH WEIGHT (LBW), which means less than 2.5 kg.
Ninety five percent of these events
occur in developing countries.
LBW puts infants at greater risk of
neonatal death and is a major cause of
poor growth and development in later
childhood.
Undernutrition in utero is also associated
with certain chronic diseases in adult
life.
Although LBW can be due to a number
of factors, such as a woman’s small size,
uterine infections, smoking and malarial
infection, the most significant cause is
poor maternal nutrition.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 10
Nutritional status and low birth weight
The cycle of poor nutrition perpetuates itself across generations.
The following diagram by the Standing Committee on Nutrition shows the
intergenerational cycle of growth failure:
Child growth
failure
Low
Low birth Early weight
weight pregnancy and height
baby in
teenagers
Small adult
woman
Young girls who grow poorly become stunted women and are more likely to
give birth to LBW infants. If those infants are girls, they are likely to
continue the cycle by being stunted in adulthood, if something is not done to
break the cycle.
Adolescent pregnancy heightens the risk of LBW and the difficulty of
breaking the cycle.
Summary
Malnutrition refers to all deviations from adequate nutrition, including
undernutrition (and overnutrition) resulting from inadequacy (or
excess) of food.
Malnutrition carries heavy human and economic costs on individuals
and households, communities and nations. Malnutrition and
undernutrition are often used as synonyms. However, a clear
distinction needs to be made at all times.
The co-existence of undernutrition, micronutrient deficiencies,
overweight/obesity and other nutrition-related chronic diseases occurs
in the same countries, in the same communities and even in the same
households throughout the world today, posing one of the greatest
challenges to national policy makers. This phenomenon is referred to as
the “double burden” of malnutrition.
Even if poverty is the root cause of undernutrition, malnutrition has
multiple and interrelated causes. The direct causes of malnutrition can
be grouped under the broad categories of: food, health and care.
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 11
If you want to know more...
Nutrition and development: a global challenge - adapted from Nutrition and
development - a global assessment, written by FAO and WHO for the International
Conference on Nutrition, 1992.
United Nations Standing Committee on Nutrition/Administrative
Committee on Coordination (ACC/SCN) Second report on the World Nutrition
Situation: Vol.1: Global and Regional Results, ACC/SCN Geneva, 1992.
Conducting small-scale nutrition surveys: A field manual. FAO, 1990, 186p,
English, Spanish, French ISBN 202851.
The double burden of malnutrition – Case studies from six developing
countries. FAO Food and Nutrition Paper 84, Rome 2006.
http://www.fao.org/docrep/009/a0442e/a0442e00.htm
Measurement and Assessment of Food Deprivation and Undernutrition -
FIVIMS Proceedings, International Scientific Symposium held in FAO, Rome 26-28
June 2002. FAO 2003. http://www.fao.org/DOCREP/005/Y4249E/Y4249E00.HTM
Body mass index - A measure of chronic energy deficiency in adults. FAO
Food and Nutrition Paper 56, 1994.
http://www.fao.org/docrep/T1970E/T1970E00.htm
United Nations Standing Committee on Nutrition Issue No. 33 Diet-related
Chronic Diseases and the Double Burden of Malnutrition in West Africa, 2006, pages
18-20. http://www.unsystem.org/scn/Publications/SCNNews/scnnews33.pdf.
If you want to know more...
Incorporating Nutrition Considerations into Development Policies and
Programmes: Brief for Policy-Makers and Programme Planners in Developing
Countries, FAO 2004. http://www.fao.org/docrep/007/y5343e/y5343e00.htm
The State of Food Insecurity in the World (SOFI): monitoring progress towards
the World Food Summit and Millennium Development Goals (FAO-SOFI, 2004)
http://www.fao.org/docrep/007/y5650e/y5650e00.htm
Nutritional Status Assessment and Analysis - Lesson 1. Nutritional Status and Food Security
page 12
