Malnutrition or malnourishment is a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals.
When a person is not getting enough food or not getting the right sort of food, malnutrition is just around the corner. Even if people get enough to eat, they will become malnourished if the food they eat does not provide the proper amounts of micronutrients – vitamins and minerals – to meet daily nutritional requirements.
Disease and malnutrition are closely linked. Sometimes disease is the result of malnutrition, sometimes it is a contributing cause. In fact, malnutrition is the largest single contributor to disease in the world, according to the UN’s Standing Committee on Nutrition (SCN).
When infected with the HIV virus the body’s defence system – the immune system – works harder to fight infection. This increases energy and nutrient requirements. Further infection and fever also increase the body’s demand for food. Once people are infected with HIV they have to eat more to meet these extra energy and nutrient needs. Such needs will increase even further as the HIV/AIDS symptoms develop.
People with HIV/AIDS often do not eat enough because:
Food, once eaten, is broken down by digestion into nutrients. These nutrients pass through the gut walls into the bloodstream and are transported to the organs and tissues in the body where they are needed. One of the consequences of HIV and other infections is that since the gut wall is damaged, food does not pass through properly and is consequently not absorbed.
Diarrhoea is a common occurrence in people with HIV/AIDS. When a person has diarrhoea the food passes through the gut so quickly that it is not properly digested and fewer nutrients are absorbed.
Reduced food intake and absorption lead to weight loss and malnutrition.
When a person does not eat enough food, or the food eaten is poorly absorbed, the body draws on its reserve stores of energy from body fat and protein from muscle. As a result, the person loses weight because body weight and muscles are lost.
The weight loss may be so gradual that it is not obvious. There are two basic ways to discover whether weight is being lost.
If a person loses weight he or she needs to take action to increase weight to the normal level.
Weight is gained by eating more food, either by eating larger portions and/or eating meals more frequently, using a variety of foods as described in the previous chapter. Here are some suggestions for gaining weight:
If poor appetite persists or the person is ill, it is a good idea to spread the food intake throughout the day. Snacks should be included in the daily meal plan.
Regular exercise makes a person feel more alert, helps to relieve stress and stimulates the appetite. Exercise is the only way to strengthen and build up muscles. The body uses muscles to store energy and protein that the immune system can draw upon when required. Exercise is therefore especially important for maintaining the health of people with HIV/AIDS.
It may be that everyday activities such as cleaning, working in the field and collecting firewood and water provide enough exercise. If a person’s work does not involve much exercise, an enjoyable exercise programme should be found that can be part of his or her daily life. Exercise should not be tiring or stressful; gentle muscle-building exercise is recommended. Walking, running, swimming or dancing are all suitable. People living with HIV/AIDS need to make an effort to find the exercise that they enjoy and that suits their situation.
Infection increases the body’s requirements for nutrients. Illness also reduces the appetite and the ill person will eat less food, causing weight loss. Recommendations for dealing with poor appetite, diarrhoea, vomiting, sore mouth and nausea are given in Chapter six.
Early treatment of infection is important to maintain body weight. If infection persists and cannot be cured by nutritional management within a couple of days, advice and treatment should be sought from a doctor, nutritionist, nurse or local health worker.
Once the infection is over and the person is feeling better, he or she should start eating normally again. It is important to regain the weight lost as soon as possible and to restore the body’s nutritional reserves.
Try to eat three good meals daily with frequent snacks in between.