Letter to the Editor Introduction
D
r Jo M. Wilmshurst was the guest editor of the Seminars in Pediatric Neurology issue about Child Neurology in Africa (2014;21:1-58). In it, Kerac et al (pages 42-49) reviewed the topic “The Interaction of Malnutrition and Neurologic Disability in Africa.” They emphasized the high frequency of malnutrition and associated neurologic disability. Specifically, they reviewed the consequences of
global malnutrition and deficits of macronutrients and micronutrients. Mechanisms include decreased food intake, increased nutrient losses, and increased nutrient requirements. The authors concluded highlighting the high frequency and severity of the problem and the need to implement multidisciplinary programs at regional and international levels to solve the problem. Agustin Legido, MD, PhD, MBA Editor
Malnutrition and Neurologic Problems Among Children in the Developing World
M
alnutrition is a big challenge to most of developing and low-income countries. It not only results in death of people, and especially children, but also those who survive face severe mental and other physical health problems. In addition, malnutrition brings not only sufferings to families but also great loss to the economy of the country as malnourished people develop brain and other health disorders, and therefore, they cannot be productive individuals of society.1 The worldwide prevalence of severe malnutrition in children is very high and results in approximately 1 million deaths each year. Some Asian countries, including India, Pakistan, Afghanistan, Bangladesh, Indonesia, and Yemen, have approximately 12 million children suffering from severe malnutrition (Table). Across Africa, approximately 3% children younger than 5 years suffer from this disease, which causes death of several hundred thousand children each year.2 At a global level, the number of children suffering from severe malnutrition is Table Prevalence of Severe Malnutrition in Representative Asian Countries No.
Country
1 2 3 4 5 6
India Pakistan Indonesia Bangladesh Afghanistan Yemen Total
SAM, severe acute malnutrition.
SAM Cases (Million) 8 1.4 1.2 0.6 0.6 0.6 12.4
approximately 20 million,3 and they are 10 times more likely to die compared with well-nourished children.4 The effects of global severe malnutrition on the nervous system are diverse, most frequently causing neurodevelopment delay.5,6 Furthermore, specific disabilities include blindness due to deficiency of vitamin A, intractable epilepsy due to deficiency of vitamin B6, and cognitive impairment due to iodine and iron deficiencies.7 The neurologic impairment due to severe malnutrition in children ranges from 19-61 per 1000 children.8 Maternal malnutrition also results in a number of neurologic problems like neural tube defects, impaired cognitive functions, birth asphyxia, cerebral palsy, etc, which cause life-long neurologic disabilities.7 Furthermore, the neurologic disabilities further lead to malnutrition as they are associated with difficulties in swallowing and impairment of consciousness, which impairs effective nutrition.9 Besides neurologic disorders, severe malnutrition makes the population more prone to suffering from infectious diseases.10 To decrease the frequency and severity of malnutrition in developing countries, there is a need for government and nongovernment organizations to focus on effective strategies. This should include vitamin A supplementation, salt iodization, water fluoride supplementation, and provision of enough food in hunger-struck areas, among others. The use of nutrient-dense, lipid-based, ready-to-use therapeutic food in patients with severe malnutrition has proved very useful in reducing mortality.2 The severely malnourished population around the world needs immediate attention and corrective actions.
Letter to the Editor
74 Malnourishment is catastrophic for health and a frequent cause of death. However, severe malnutrition is one of the most avoidable conditions if attention and priority are given to the problem. Aftab Ahmad, PhD, and Shoji Komai, PhD Nara Institute of Science and Technology (NAIST), Ikoma, Nara, Japan E-mail address: [email protected] (A. Ahmad)
References 1. Drake RE, Binagwaho A, Martell HC, et al: Mental healthcare in low and middle income countries. Br Med J 349:g7086, 2014 2. Briend A, Collins S: Therapeutic nutrition for children with severe acute malnutrition: Summary of African experience. Indian Pediatr 47:655-659, 2010 3. Ahmed T, Hossain M, Mahfuz M, et al: Severe acute malnutrition in Asia. Food Nutr Bull 35:S14-S26, 2014 4. Uauy R, Desjeux J-F, Ahmed T, et al: Global efforts to address severe acute malnutrition. J Pediatr Gastroenterol Nutr 55:476-481, 2012
5. Grantham-McGregor S, Cheung YB, Cueto S, et al: Developmental potential in the first 5 years for children in developing countries. Lancet 369:60-70, 2007 6. Gladstone M, Mallewa M, Alusine Jalloh A, et al: Assessment of neurodisability and malnutrition in children in Africa. Semin Pediatr Neurol 21:50-57, 2014 7. Kerac M, Postels DG, Mallewa M, et al: The interaction of malnutrition and neurologic disability in Africa. Semin Pediatr Neurol 21:42-49, 2014 8. Gladstone M: A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings. Ann Trop Paediatr 30:181-196, 2010 9. Li F, Liu Y, Wang X, et al: Evaluation of malnutrition in patients with nervous system disease. Expert Rev Neurother 14:1229-1237, 2014 10. Schaible UE, Kaufmann SHE: Malnutrition and infection: Complex mechanisms and global impacts. PLoS Med 4:e115, 2007
Address reprint requests to Aftab Ahmad, Nara Institute of Science and Technology (NAIST), Ikoma, Nara, Japan.
D
r Jo M. Wilmshurst was the guest editor of the Seminars in Pediatric Neurology issue about Child Neurology in Africa (2014;21:1-58). In it, Kerac et al (pages 42-49) reviewed the topic “The Interaction of Malnutrition and Neurologic Disability in Africa.” They emphasized the high frequency of malnutrition and associated neurologic disability. Specifically, they reviewed the consequences of
global malnutrition and deficits of macronutrients and micronutrients. Mechanisms include decreased food intake, increased nutrient losses, and increased nutrient requirements. The authors concluded highlighting the high frequency and severity of the problem and the need to implement multidisciplinary programs at regional and international levels to solve the problem. Agustin Legido, MD, PhD, MBA Editor
Malnutrition and Neurologic Problems Among Children in the Developing World
M
alnutrition is a big challenge to most of developing and low-income countries. It not only results in death of people, and especially children, but also those who survive face severe mental and other physical health problems. In addition, malnutrition brings not only sufferings to families but also great loss to the economy of the country as malnourished people develop brain and other health disorders, and therefore, they cannot be productive individuals of society.1 The worldwide prevalence of severe malnutrition in children is very high and results in approximately 1 million deaths each year. Some Asian countries, including India, Pakistan, Afghanistan, Bangladesh, Indonesia, and Yemen, have approximately 12 million children suffering from severe malnutrition (Table). Across Africa, approximately 3% children younger than 5 years suffer from this disease, which causes death of several hundred thousand children each year.2 At a global level, the number of children suffering from severe malnutrition is Table Prevalence of Severe Malnutrition in Representative Asian Countries No.
Country
1 2 3 4 5 6
India Pakistan Indonesia Bangladesh Afghanistan Yemen Total
SAM, severe acute malnutrition.
SAM Cases (Million) 8 1.4 1.2 0.6 0.6 0.6 12.4
approximately 20 million,3 and they are 10 times more likely to die compared with well-nourished children.4 The effects of global severe malnutrition on the nervous system are diverse, most frequently causing neurodevelopment delay.5,6 Furthermore, specific disabilities include blindness due to deficiency of vitamin A, intractable epilepsy due to deficiency of vitamin B6, and cognitive impairment due to iodine and iron deficiencies.7 The neurologic impairment due to severe malnutrition in children ranges from 19-61 per 1000 children.8 Maternal malnutrition also results in a number of neurologic problems like neural tube defects, impaired cognitive functions, birth asphyxia, cerebral palsy, etc, which cause life-long neurologic disabilities.7 Furthermore, the neurologic disabilities further lead to malnutrition as they are associated with difficulties in swallowing and impairment of consciousness, which impairs effective nutrition.9 Besides neurologic disorders, severe malnutrition makes the population more prone to suffering from infectious diseases.10 To decrease the frequency and severity of malnutrition in developing countries, there is a need for government and nongovernment organizations to focus on effective strategies. This should include vitamin A supplementation, salt iodization, water fluoride supplementation, and provision of enough food in hunger-struck areas, among others. The use of nutrient-dense, lipid-based, ready-to-use therapeutic food in patients with severe malnutrition has proved very useful in reducing mortality.2 The severely malnourished population around the world needs immediate attention and corrective actions.
Letter to the Editor
74 Malnourishment is catastrophic for health and a frequent cause of death. However, severe malnutrition is one of the most avoidable conditions if attention and priority are given to the problem. Aftab Ahmad, PhD, and Shoji Komai, PhD Nara Institute of Science and Technology (NAIST), Ikoma, Nara, Japan E-mail address: [email protected] (A. Ahmad)
References 1. Drake RE, Binagwaho A, Martell HC, et al: Mental healthcare in low and middle income countries. Br Med J 349:g7086, 2014 2. Briend A, Collins S: Therapeutic nutrition for children with severe acute malnutrition: Summary of African experience. Indian Pediatr 47:655-659, 2010 3. Ahmed T, Hossain M, Mahfuz M, et al: Severe acute malnutrition in Asia. Food Nutr Bull 35:S14-S26, 2014 4. Uauy R, Desjeux J-F, Ahmed T, et al: Global efforts to address severe acute malnutrition. J Pediatr Gastroenterol Nutr 55:476-481, 2012
5. Grantham-McGregor S, Cheung YB, Cueto S, et al: Developmental potential in the first 5 years for children in developing countries. Lancet 369:60-70, 2007 6. Gladstone M, Mallewa M, Alusine Jalloh A, et al: Assessment of neurodisability and malnutrition in children in Africa. Semin Pediatr Neurol 21:50-57, 2014 7. Kerac M, Postels DG, Mallewa M, et al: The interaction of malnutrition and neurologic disability in Africa. Semin Pediatr Neurol 21:42-49, 2014 8. Gladstone M: A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings. Ann Trop Paediatr 30:181-196, 2010 9. Li F, Liu Y, Wang X, et al: Evaluation of malnutrition in patients with nervous system disease. Expert Rev Neurother 14:1229-1237, 2014 10. Schaible UE, Kaufmann SHE: Malnutrition and infection: Complex mechanisms and global impacts. PLoS Med 4:e115, 2007
Address reprint requests to Aftab Ahmad, Nara Institute of Science and Technology (NAIST), Ikoma, Nara, Japan.
