More Than Just Skinny

When you think of malnutrition in Indonesia, what do you think of? What kind of image comes to mind? Probably some hungry child that is skinny to the bone, without any food to eat, right? Maybe similar to something that is portrayed in the image above. Before I was educated on this topic, I would’ve thought the same thing.

For many years now, the term “malnutrition” was used only to mean undernutrition, which means that an individual is not receiving the sufficient amount of food intake in their bodies. I personally was familiar with malnutrition as this definition for a long time as well. However, malnutrition actually refers to both the excess and deficiency in nutritional intake, or other words, undernutrition and over nutrition.

Indonesia is mainly referred to as a low, middle-income country, and they continue to struggle with combating malnutrition. With this said, there are many health outcomes and consequences that come with malnutrition in Indonesia. Many instances of malnutrition are seen in maternal and young child undernutrition in Indonesia especially during the infant period where the effects can be very severe and considerable. In childhood undernutrition, it is estimated that it is associated with 1/2- 1/3 of all global child deaths. The thing, however, is that these deaths aren’t just results of undernutrition, but because of the variances of diseases that develop due to the lack of necessary nutrients for the human body. In this specific case, undernutrition contributes to child mortality is the highest for diarrheal diseases at around 73% and around 50% for pneumonia, measles, and severe neonatal infections. Because the child is not receiving the sufficient nutrients to live a healthy and active life, they are prone to developing different kinds of vitamin or micronutrient deficiencies like Vitamin A deficiency, which was commonly found in Indonesia. At least half of the population was considered to be suffering from a deficiency of at least one micronutrient. This can then also lead to stunting, or low height, especially within children. Stunting is a huge problem in Indonesia, which will be discussed in another post.

Anemia, or iron deficiency, is also associated with malnutrition in pregnant women, where it affects around 40% of that specific population. In urban areas, 20% of non-pregnant women over the age of 14, 13% of men, and 10% of children were found to be anemic. Iron deficiency still continues to be a serious problem in Indonesia mainly due to the level of consumption of salt or iodine.

With these deficiencies come even more diseases that are developed due to the fact that their bodies are not functioning to its potential and therefore is more prone to other physical complications. It’s mind-blowing how many more diseases that can connected to all of these deficiencies!

On the other hand, malnutrition can also mean over nutrition, where overweight or obesity can be developed. Obesity is associated with energy imbalance and is related to alternations in a person’s metabolic system. An individual may not be receiving the right variance of foods and may only be consuming foods high in fat, sugar, and salt, which then lead to overweight and obesity. This is usually found in adults and in individuals later on in life. Many non-communicable (NCDs), or long-term, diseases can be consequences of malnutrition in Indonesia. Some NCDs that are seen in the country are hypertension, diabetes, cancer, stroke, and ischemic heart disease.

In Indonesia, type 2 diabetes was also strongly associated with central obesity. It was found that 5.7% of the population over 15 years of age had diabetes and 10.2% of the population was pre-diabetic with an impaired glucose tolerance. In addition, as mentioned earlier, hypertension, is also prevalently seen in Indonesia. Hypertension is known as having high blood pressure and around 45.8% of men and 53.4% of women over the age of 45 have hypertension in Indonesia. It is in fact, worse in women than men, and it also increases considerably with age. Hypertension has been found to affect the majority of Indonesian adults over the age of 45, but only 40% of women and 20% of men had any knowledge of their own condition.

A big concern with all of these risks of developing these diseases associated with over nutrition is that the risks are that much more amplified across a person’s life course and even more increasingly over time. Which basically means that the health outcomes can get more and more severe with time, in the case of over nutrition and obesity.

As you can see, there is an innumerable number of diseases and deficiencies that are associated with malnutrition, both within undernutrition and over nutrition, in Indonesia. Who would’ve thought…

 

Written by Hannah

Caulfield, L.E., de Onis, M., Blössner M., Black, R.E.. (2004). Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. 80(1):193-8.

Shrimpton R. and C. Rokx. (2013). The Double Burden of Malnutrition in Indonesia, World Bank Jakarta, Report 76192-ID. Retrieved from http://documents.worldbank.org/curated/en/955671468049836790/pdf/761920WP0P12640Box0379884B00PUBLIC0.pdf.