question_text: who played lex luthor in lois and clark

question_tokens: who played lex luthor in lois and clark

text: Overview[edit]

text: On May 17, 1966, Jonathan and Martha Kent (Eddie Jones and K Callan) witness the crash-landing of a small spaceship in Shuster's Field outside of Smallville, Kansas. When they investigate, they discover the baby Kal-El and decide to raise him as their own naming him, Clark Jerome Kent (Dean Cain). Throughout the series, Clark proudly states his mother made his Superman costume for him. Clark often consults his parents either by telephone or in person, after impromptu Superman flights to Smallville, about personal and moral concerns and dilemmas.

text: The series opens twenty-seven years later, on the day Clark moves to Metropolis after leaving his position as a newspaper editor of Smallville Press, interviews for a job at the Daily Planet under editor Perry White (Lane Smith). Clark becomes acquainted with photographer Jimmy Olsen (Michael Landes in season 1, Justin Whalin thereafter) and gossip columnist Cat Grant (Tracy Scoggins). Soon after being hired, Clark is partnered with star reporter Lois Lane (Teri Hatcher). Clark falls in love with Lois at first sight. When Superman saves Lois from a space shuttle disaster, she instantly becomes infatuated with Clark's alter-ego and named him Superman.

text: Superman's first mission interferes with the illegal dealings of Lex Luthor (John Shea), a Metropolis business giant and benefactor. After Luthor's plot was stopped, Superman let Luthor know he is watching him and the two become arch-enemies. However, Clark respects Luthor's life, even surreptitiously using his superpowers to save Lex from bleeding to death. Luthor sees Superman as a worthy opponent; he ultimately discovers his weakness to kryptonite and realizes he has a secret identity, vowing to learn it in hopes of making the hero's life difficult.

text: Development[edit]

text: DC Comics president Jenette Kahn had been working for several years to sell the concept of a Superman television series. The series would be different. In 1991 Leslie Moonves and Deborah Joy LeVine helped sell the series to ABC television network with a new title, Lois and Clark: The Adventures of Superman.[5]

text: The series mirrored John Byrne's retcon of Superman, making Clark Kent more assertive and less clumsy. A few episodes directly emphasized that Clark was the unequivocal "dominant" personality, not Superman. Following this theme, an innovation unique to the series was the depiction of Clark Kent and Superman's traditional hairstyles being reversed—here it is Superman whose hair is slicked-back, and Clark whose fringe falls more naturally. An additional element that reflected the post-Byrne comics was the portrayal of Lex Luthor (at least initially) as a corrupt corporate tycoon, rather than the traditional mad scientist.

text: Many of the stories in season one involved normal human criminals using advanced and powerful technology or involved in large and dangerous conspiracies—most, if not all, of the Lex Luthor stories of season one. After season one, series creator Deborah Joy LeVine left the show as a producer, and a new production team took over the series. Episode plots gradually shifted from those in which Lois, Clark, and Superman only became involved with criminal elements or dangerous situations through their own initiative to more fantastic plots. Often centered on comic-style villains who specifically targeted Lois, Superman, or Clark from the beginning, rather than endangering the protagonists as a reactionary measure when they became threats to other criminal plans. Later plots frequently revolved around villains with special superhuman powers and abilities.

text: A fifth season of the series was initially announced by ABC. When the network unexpectedly canceled plans for season five, the producers and writers of the show were unprepared. The series ended on a cliffhanger where Clark and Lois finds an infant in their home with a note saying the child belongs to them. This mystery was never solved on the series.

text: Series history[edit]

text:
Season
Episodes
Originally aired

First aired
Last aired

1
21
September 12, 1993 (1993-09-12)
May 8, 1994 (1994-05-08)

2
22
September 18, 1994 (1994-09-18)
May 21, 1995 (1995-05-21)

3
22
September 17, 1995 (1995-09-17)
May 12, 1996 (1996-05-12)

4
22
September 22, 1996 (1996-09-22)
June 14, 1997 (1997-06-14)

text: Season one[edit]

text: Teri Hatcher and Dean Cain received critical praise for their performances.[6] Lane Smith was a huge success,[citation needed] breathing life and humor into the Daily Planet editor-in-chief Perry White. John Shea also received positive reviews[citation needed] for his portrayal of Lex Luthor. Michael Landes' modern-day portrayal of Jimmy Olsen gained a cult following,[citation needed] as did[citation needed] Tracy Scoggins' comedic portrayal of Cat Grant, at the time a recent addition to the Superman mythos. Lex Luthor's death in the season finale occurred after disagreements between Shea and the producers over the actor's strenuous commute between New York and Los Angeles. No longer a regular cast member, he reappeared once in season two, twice in season three, and once in season four.[7]

text: Luthor develops an interest in Lois Lane and through most of the first season tries to woo her; although Lois is receptive to his romantic advances, she remains infatuated with Superman. Lois also develops feelings for Clark, but represses or denies them. Luthor eventually proposes marriage to Lois. Clark, seeing he may lose Lois, attempts to convince her of Luthor's true nature, but fails. In a last-ditch attempt, Clark tells Lois that he is in love with her; she replies that she does not return his feelings but cares for him deeply as a friend. Later, Lois asks Superman if there is any chance of a romance between the two of them. Superman turns her down and Lois accepts Luthor's proposal. Luthor decides to coincide his nuptials with the death of Superman, who he traps in a kryptonite cage in the wine cellar of Luthor Tower, which also contains the chapel where the wedding will occur. As the wedding approaches, Lois realizes she loves Clark and says no to Lex at the altar.

text: Clark had been working with Perry and Jimmy to expose Lex and they have enough evidence for the police to interrupt the wedding. Lex eludes the police and jumps from his penthouse office to his apparent death. Superman has escaped the cage and, as Clark, rejoins Lois. However, his powers have been diminished by kryptonite and he cannot stop the villain from falling to the pavement. Newspapers report that Lex's body has been stolen from the morgue and hint he may not be dead. Clark, fearing his unrequited love for Lois may damage their relationship, tells her his profession of love was only out of a desire to protect her from Lex. Lois, who was about to tell Clark that she loves him too, instead keeps it to herself and their relationship remains a friendship.

text: Season two[edit]

text: In season two, the character of Cat Grant was dropped, and Michael Landes was replaced with Justin Whalin as Jimmy Olsen. The official reason, according to Landes, was that he looked too similar to Dean Cain.[8] On the show, the explanation is that he has changed with age. Series creator Deborah Joy LeVine and the entire first-season writing team were also dismissed. The new producer, Robert Singer, planned a stronger focus on action;[9] the show also shifted its focus onto the budding romance between Lois and Clark.

text: Lex Luthor returned in one episode and other villains from the comics, such as The Prankster, Metallo, the Toyman and the criminal group known as Intergang, began to appear. The show featured new love interests for the ace reporters: Dan Scardino (Jim Pirri), a government agent interested in Lois, and D. A. Mayson Drake (Farrah Forke). This season also featured the debut of fan-favorite villain Tempus (Lane Davies) and H. G. Wells appeared as a time-traveler. Wells' younger self was played by Terry Kiser, and the older Wells was played by Hamilton Camp. Season two became a success and garnered higher ratings in its initial airings, ending the season in 58th place.

text: In season two, Clark and Lois begin to date but are interrupted by Mayson Drake (Farrah Forke), a district attorney who takes a romantic interest in Clark but has a total lack of regard for Superman. Mayson dies as Lois and Clark have their first date. In the next episode, a federal agent named Dan Scardino (Jim Pirri) becomes a rival to Clark for Lois' affections. Lois decides she likes Clark more than Dan, and they begin dating more seriously. In the season finale, Clark comes close to telling Lois his secret but does not because of his uncertainty about her reaction and interruptions by people plotting to expose his identity to the world. At the end of the final episode, Clark proposes to Lois.

text: Season three[edit]

text: Season three averaged around 15 million viewers per episode and ranked 44th for the season. In the premiere episode, Lois reveals that she knows Clark's secret identity, and in the seventh episode, "Ultra Woman", she accepts Clark's proposal. ABC announced that the wedding would occur on Valentine's Day weekend; with ABC sending heart-shaped "wedding invitations" to ABC News staff. A controversy erupted, when ABC presents the viewers with a bogus wedding, with Clark unwittingly married to a clone of Lois.[10] This was the start of a five-part story, in which Lois is kidnapped by Lex Luthor, replaced by a clone, the real Lois suffering from amnesia, and Clark trying to find the real Lois Lane.

text: In the third season premiere, Lois has discovered Superman's secret identity. Initially, she resents Clark not telling her. After they separate for a time, Lois dates Patrick Sullivan, an antique dealer who is plotting to kill her in a sacrificial druid ritual, and she and Clark carry out assignments where they either pose as a married couple or are alone together for an entire weekend. Lois finally accepts Clark's engagement ring after acquiring his powers and temporarily becoming a superhero named Ultra Woman. Lois suffers a bout of amnesia and hallucinates their wedding. Once she recovers, Lois and Clark are still engaged when two other Kryptonians come to Earth, one of whom is Clark's wife. They insist Clark go with them to save their world, New Krypton, from domination by an evil tyrant named Lord Nor; Clark leaves Lois, taking her wedding ring to remember her and as a promise to return as quickly as possible. While committed to each other, they both doubt he will ever return.

text: Season four[edit]

text: The final season had several two-part episodes. It began with the resolution of a cliffhanger involving a previously unknown colony of Kryptonians. Lois and Clark finally wed in the third episode of the season entitled "Swear To God, This Time We're Not Kidding". The same week, DC Comics released Superman: The Wedding Album, featuring the long-awaited marriage of Lois and Clark. The series ended on a cliffhanger in which Lois and Clark find an infant in Clark's old bassinet, along with a note that claimed the child belonged to them. This mystery was never resolved in the television series; however Brad Buckner, executive producer, and writer for the third and fourth seasons, later said that the infant was Kryptonian royalty hidden with Lois and Clark so they could protect him from assassins.[11]

text: During the fourth season, ABC had announced a fifth season of the show; its producers and writers were unprepared when ABC later decided that no new episodes would be produced. The series had weakened in its Sunday 8:00 pm timeslot and had been shifted to 7:00 pm in January, and was moved to Saturdays in the spring.[12] The ratings dropped even further, and the show finished its last season in 104th place. It was removed from the schedule in May 1997.[12] ABC made up for its commitment to Warner Bros. by ordering thirteen episodes of a Debra Messing drama, Prey.

text: The fourth season starts with Clark heading toward New Krypton, while the evil tyrant Nor has instead invaded Earth, so Clark returns just as Nor takes over Smallville. He and Lois defeat the tyrant and persuade the New Kryptonians to allow Clark to stay on Earth. After another failed wedding ceremony, Lois and Clark get married. Evil forces continue to assault them, delaying their honeymoon, but eventually, the couple moves into a new home. Throughout the season they strengthen their bond, despite some disagreements and villains trying to destroy them. The newlywed reporters discover that Clark cannot father a child with Lois, but at the end of the last episode, a child mysteriously appears. In an interview, series writer and executive producer Brad Buckner said the planned story was that the child "was Kryptonian royalty, stashed by his mother to keep him safe from assassins."[13]

text: Cast[edit]

text: Main cast[edit]

text:
Actor[14]
Character
Seasons

1
2
3
4

Dean Cain
Clark Kent/Kal-El/Superman
Main

Teri Hatcher
Lois Lane
Main

Lane Smith
Perry White
Main

Michael Landes[15][16]
Jimmy Olsen
Main

Justin Whalin[17]

Main

Tracy Scoggins
Catherine "Cat" Grant
Main

K Callan
Martha Kent
Main

Eddie Jones
Jonathan Kent
Main

John Shea
Lex Luthor
Main
Guest
Guest Voice

text: Recurring cast[edit]

text:
Kenneth Kimmins as Dr. Bernard Klein (16 episodes)
Ben McCain news anchor/reporter (9 episodes)
Tony Jay as Nigel St. John (7 episodes)
Beverly Garland as Ellen Lane (6 episodes)
Shaun Toub as Asabi (6 episodes)
Harve Presnell as Sam Lane (5 episodes)
Sal Viscuso as Bobby Bigmouth (5 episodes)
Lane Davies as Tempus (5 episodes)
Chris Demetral as Jack (4 episodes)
Farrah Forke as Mayson Drake (4 episodes)
Justine Bateman as Sarah/Zara (4 episodes)
Olivia Brown as Star McAdams (4 episodes)
Elizabeth Barondes as Lucy Lane (3 episodes)
Simon Templeman as Lord Nor (2 episodes)

text: Special guest stars[edit]

text:
Richard Belzer as Inspector Henderson (4 episodes)
Bruce Campbell as Bill Church Jr. (3 episodes)
Fred Willard as President Garner (3 episodes)
Denise Crosby as Dr. Gretchen Kelly (3 episodes)
Peter Boyle as Bill Church Sr. (2 episodes)
Harold Gould as Edwin Griffin (2 episodes)
Jasmine Guy as Angela Winters (2 episodes)
Robert Culp as Mr. Darryl (2 episodes)
Bronson Pinchot as Prankster/Kyle Griffin (2 episodes)
Rick Overton as Victor (2 episodes)
Sonny Bono as Mayor Frank Berkowitz (1 episode)
Tony Curtis as Dr. Isaac Mamba (1 episode)
Roger Daltrey as an alien assassin, Tez (1 episode)
Shelley Long as Lucille Newtrich (1 episode)
Morgan Fairchild as Miranda (1 episode)
Jonathan Frakes as Tim Lake (1 episode)
Sherman Hemsley as Toyman/Winslow Schott (1 episode)
Penn Jillette as Darrin Romick, Illusions of Grandeur (1 episode)
James Earl Jones as Franklin W. Stern (1 episode)
Howie Mandel as Mister Mxyzptlk (1 episode)
Dwight Schultz as Garret Grady (1 episode)
Dean Stockwell as Preston Carpenter (1 episode)
David Warner as Jor-El (1 episode)
Raquel Welch as Diana Stride (1 episode)
Adam West as tabloid TV reporter (1 episode)
Frank Gorshin as Kill, Kill, Kill lawyer (1 episode)

text: Novels and collected edition[edit]

text: Lois & Clark: A Superman Novel by author C. J. Cherryh, based on the television series, was released in 1996. The novel was published in a Science Fiction Book Club hardcover edition and a paperback edition by Prima Publishing.[18] The book is an example of superhero/romantic fantasy.

text: Other novels based on the series include:

text:
Lois & Clark: The New Adventures of Superman: Heat Wave[19]
Lois & Clark: The New Adventures of Superman: Exile [20]
Lois & Clark: The New Adventures of Superman: Deadly Games [21]

text: DC Comics published a comic book collected edition, Lois & Clark, The New Adventures of Superman, in 1994, which featured a selection of modern era stories by John Byrne and other writers and artists. The collection includes an introduction by Byrne, with the show's star Dean Cain and Teri Hatcher as Lois and Clark on the cover.

text: Lois & Clark, The New Adventures of Superman – collects The Man of Steel #2, Superman Annual vol. 2 #1, Superman vol. 2 #9 and 11, Action Comics #600 and 655, Adventures of Superman #445, 462, and 466.

text: Broadcasts[edit]

text: United States[edit]

text:
Network
Season
Time slot
Premiered date
Ended date

ABC

1 (1993–94)
Sunday 8:00 pm
September 12, 1993
May 8, 1994

2 (1994–95)
Sunday 8:00 pm
September 18, 1994
May 21, 1995

3 (1995–96)
Sunday 8:00 pm
September 17, 1995
May 12, 1996

4 (1996–97)
Sunday 8:00 pm (Sept. 22 - Dec. 15)
Sunday 7:00 pm (Jan. 5 - Mar. 23)
Saturday 8:00 pm (Apr. 12 - Jun. 14)
September 22, 1996
June 14, 1997

text: United Kingdom[edit]

text: The series premiered on BBC One on Saturday, January 8, 1994, with repeat showings until 2002. In the UK the series was retitled The New Adventures of Superman. The BBC held the rights to premiere the first three seasons. It also aired on CBBC's Saturday Aardvark strand (later known as Planet Saturday) at 8:30 am. BBC Two has also repeated the series at tea times alongside The Simpsons, The Fresh Prince of Bel-Air and many others. Sky One held the premiere rights to the fourth season in 1997 and broadcast the show under the original full title. The BBC broadcast the episodes a few weeks later. Sky One broadcast seasons one, two and three just before the premiere of season four in early 1997. UK Gold, Sky Living, and ITV2 have also repeated the series. BBC2 last repeated season one in late 2005. Satellite channel Syfy repeated the first two seasons and the first half of season three in 2012, before replacing it with another similar show, Smallville.

text: DVD releases[edit]

text: Warner Home Video has released all four seasons of Lois & Clark: The New Adventures of Superman on DVD in Regions 1, 2, and 4.

text:
Complete Season
Episodes
Release dates

Region 1
Region 2
Region 4

1
21
June 7, 2005[22]
July 5, 2006[23]
June 14, 2006[24]

2
22
January 17, 2006[25]
July 5, 2006[26]
June 14, 2006[27]

3
22
June 20, 2006[28]
September 6, 2006[29]
November 1, 2006[30]

4
22
November 14, 2006[31]
December 6, 2006[32]
November 1, 2006[33]

text: Soundtrack[edit]

text:
Lois & Clark: The New Adventures of Superman (Original Television Soundtrack)

Soundtrack album by Jay Gruska

Released
November 4, 1997

Length
57:58

Label
Sonic Images

text: All music composed by Jay Gruska.

text:
Track listing

No.
Title
Length

1.
"Main Title Theme"
1:06

2.
"Mothership"
2:02

3.
"Lois & Clark Courting"
3:13

4.
"Final Proposal"
2:02

5.
"Clark in the Country"
1:45

6.
"Final Battle"
4:36

7.
"Lois' Big Band"
1:14

8.
"Clark's Salsa"
1:47

9.
"Superman Says Goodbye"
4:25

10.
"Lois & Clark's New Home"
2:53

11.
"Baby Dreams"
3:12

12.
"Villains"
7:27

13.
"Superman Flies Home"
1:26

14.
"Lois & Clark's First Love Theme"
1:36

15.
"Virtual Reality"
2:37

16.
"Tez Arrives"
1:06

17.
"Zarah & Ching"
3:51

18.
"Tempus"
2:46

19.
"Clark Fun"
1:25

20.
"Playing the Game"
1:19

21.
"Main Title Theme (Extended Mix)"
5:38

Total length:
57:26

text:
Mastered at Capitol Records, Hollywood
Digital editing, pre-mastering: Bruno Coon
Engineers:

Greg Townley (all orchestral recording)
Michael Eric Hutchinson
Bobby Fernandez ("Main Title Theme" — recording & mixing)
Ray Pyle ("Main Title Theme extended mix" — recording & mixing)

Art Direction: Doerte Lau
Design: Andreas Adamec

text: Awards and nominations[edit]

text:
Year
Award
Category
Result

1994
Primetime Emmy Award
Outstanding Individual Achievement in Main Title Theme Music: Jay Gruska
Nominated

1994
Primetime Emmy Award
Outstanding Individual Achievement in Directing in a Drama Series: Robert Butler (pilot episode)
Nominated

1994
Saturn Award
Best Genre Television Series
Won

1994
Directors Guild of America Award
Outstanding Directorial Achievement in Dramatic Specials: Robert Butler (pilot episode)
Nominated

1994
Viewers for Quality Television Awards
Best Actress in a Quality Drama Series: Teri Hatcher
Nominated

1995
Primetime Emmy Award
Outstanding Sound Mixing for a Drama Series (episode: "Wall Of Sound")
Nominated

1995
Primetime Emmy Award
Outstanding Individual Achievement in Costuming for a Series (episode: "That Old Gang Of Mine")
Nominated

1996
Primetime Emmy Award
Outstanding Sound Mixing for a Drama Series (episode: "Don't Tug On Superman's Cape")
Nominated


document_title: Malnutrition

question_text: in developed countries the major cause of malnutrition is

question_tokens: in developed countries the major cause of malnutrition is

root

text: Malnutrition

text: Definitions[edit]

text: Unless specifically mentioned otherwise, the term malnutrition refers to undernutrition for the remainder of this article. Malnutrition can be divided into two different types, SAM and MAM. SAM refers to children with severe acute malnutrition. MAM refers to moderate acute malnutrition.[25]

tag: p

text: Undernutrition and overnutrition[edit]

text: Malnutrition is caused by eating a diet in which nutrients are not enough or are too much such that it causes health problems.[26] It is a category of diseases that includes undernutrition and overnutrition.[27] Overnutrition can result in obesity and being overweight. In some developing countries, overnutrition in the form of obesity is beginning to present within the same communities as undernutrition.[28]

text: However, the term malnutrition is commonly used to refer to undernutrition only.[29] This applies particularly to the context of development cooperation. Therefore, "malnutrition" in documents by the World Health Organization, UNICEF, Save the Children or other international non-governmental organizations (NGOs) usually is equated to undernutrition.

text: Protein-energy malnutrition[edit]

text: Undernutrition is sometimes used as a synonym of protein–energy malnutrition (PEM).[2] While other include both micronutrient deficiencies and protein energy malnutrition in its definition.[12] It differs from calorie restriction in that calorie restriction may not result in negative health effects. The term hypoalimentation means underfeeding.[30]

text: The term "severe malnutrition" or "severe undernutrition" is often used to refer specifically to PEM.[31] PEM is often associated with micronutrient deficiency.[31] Two forms of PEM are kwashiorkor and marasmus, and they commonly coexist.[26]

text: Kwashiorkor[edit]

text: Kwashiorkor is mainly caused by inadequate protein intake.[26] The main symptoms are edema, wasting, liver enlargement, hypoalbuminaemia, steatosis, and possibly depigmentation of skin and hair.[26] Kwashiorkor is further identified by swelling of the belly, which is deceiving of actual nutritional status.[32] The term means ‘displaced child’ and is derived from a Ghana language of West Africa, means "the sickness the older one gets when the next baby is born," as this is when the older child is deprived of breast feeding and weaned to a diet composed largely of carbohydrates.[33]

text: Marasmus[edit]

text: Marasmus (‘to waste away’) is caused by an inadequate intake of protein and energy. The main symptoms are severe wasting, leaving little or no edema, minimal subcutaneous fat, severe muscle wasting, and non-normal serum albumin levels.[26] Marasmus can result from a sustained diet of inadequate energy and protein, and the metabolism adapts to prolong survival.[26] It is traditionally seen in famine, significant food restriction, or more severe cases of anorexia.[26] Conditions are characterized by extreme wasting of the muscles and a gaunt expression.[32]

text: Undernutrition, hunger[edit]

text: Undernutrition encompasses stunted growth (stunting), wasting, and deficiencies of essential vitamins and minerals (collectively referred to as micronutrients). The term hunger, which describes a feeling of discomfort from not eating, has been used to describe undernutrition, especially in reference to food insecurity.[34]

text: Definition by Gomez[edit]

text: In 1956, Gómez and Galvan studied factors associated with death in a group of malnourished (undernourished) children in a hospital in Mexico City, Mexico and defined categories of malnutrition: first, second, and third degree.[35] The degrees were based on weight below a specified percentage of median weight for age.[36] The risk of death increases with increasing degree of malnutrition.[35] An adaptation of Gomez's original classification is still used today. While it provides a way to compare malnutrition within and between populations, the classification has been criticized for being "arbitrary" and for not considering overweight as a form of malnutrition. Also, height alone may not be the best indicator of malnutrition; children who are born prematurely may be considered short for their age even if they have good nutrition.[37]

text:
Degree of PEM
 % of desired body weight for age and sex

Normal
90%-100%

Mild: Grade I (1st degree)
75%-89%

Moderate: Grade II (2nd degree)
60%-74%

Severe: Grade III (3rd degree)
<60%

SOURCE:"Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition"[32]

tag: table

text: Definition by Waterlow[edit]

text: John Conrad Waterlow established a new classification for malnutrition.[38] Instead of using just weight for age measurements, the classification established by Waterlow combines weight-for-height (indicating acute episodes of malnutrition) with height-for-age to show the stunting that results from chronic malnutrition.[39] One advantage of the Waterlow classification over the Gomez classification is that weight for height can be examined even if ages are not known.[38]

text:
Degree of PEM
Stunting (%) Height for age
Wasting (%) Weight for height

Normal: Grade 0
>95%
>90%

Mild: Grade I
87.5-95%
80-90%

Moderate: Grade II
80-87.5%
70-80%

Severe: Grade III
<80%
<70%

SOURCE: "Classification and definition of protein-calorie malnutrition." by Waterlow, 1972[38]

text: These classifications of malnutrition are commonly used with some modifications by WHO.[36]

text: Effects[edit]

text: Malnutrition increases the risk of infection and infectious disease, and moderate malnutrition weakens every part of the immune system.[40] For example, it is a major risk factor in the onset of active tuberculosis.[41] Protein and energy malnutrition and deficiencies of specific micronutrients (including iron, zinc, and vitamins) increase susceptibility to infection.[40] Malnutrition affects HIV transmission by increasing the risk of transmission from mother to child and also increasing replication of the virus.[40] In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem. Lower energy and impaired function of the brain also represent the downward spiral of malnutrition as victims are less able to perform the tasks they need to in order to acquire food, earn an income, or gain an education.

text: Vitamin-deficiency-related diseases (such as scurvy and rickets).

text: Hypoglycemia (low blood sugar) can result from a child not eating for 4 to 6 hours. Hypoglycemia should be considered if there is lethargy, limpness, convulsion, or loss of consciousness. If blood sugar can be measured immediately and quickly, perform a finger or heel stick.

text: Signs[edit]

text: In those with malnutrition some of the signs of dehydration differ.[42] Children; however, may still be interested in drinking, have decreased interactions with the world around them, have decreased urine output, and may be cool to touch.[42]

text:
Site
Sign

Face
Moon face (kwashiorkor), simian facies (marasmus)

Eye
Dry eyes, pale conjunctiva, Bitot's spots (vitamin A), periorbital edema

Mouth
Angular stomatitis, cheilitis, glossitis, spongy bleeding gums (vitamin C), parotid enlargement

Teeth
Enamel mottling, delayed eruption

Hair
Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia

Skin
Loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry, follicular hyperkeratosis, patchy hyper- and hypopigmentation, erosions, poor wound healing

Nail
Koilonychia, thin and soft nail plates, fissures or ridges

Musculature
Muscles wasting, particularly in the buttocks and thighs

Skeletal
Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies

Abdomen
Distended - hepatomegaly with fatty liver, ascites may be present

Cardiovascular
Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy

Neurologic
Global development delay, loss of knee and ankle reflexes, poor memory

Hematological
Pallor, petechiae, bleeding diathesis

Behavior
Lethargic, apathetic

Source: "Protein Energy Malnutrition"[36]

text: Cognitive development[edit]

text: Protein-calorie malnutrition can cause cognitive impairments. For humans, "critical period varies from the final third of gestation to the first 2 years of life".[43] Iron deficiency anemia in children under two years of age likely affects brain function acutely and probably also chronically. Folate deficiency has been linked to neural tube defects.[44]

text: Malnutrition in the form of iodine deficiency is "the most common preventable cause of mental impairment worldwide."[45][citation needed] "Even moderate deficiency, especially in pregnant women and infants, lowers intelligence by 10 to 15 I.Q. points, shaving incalculable potential off a nation's development. The most visible and severe effects — disabling goiters, cretinism and dwarfism — affect a tiny minority, usually in mountain villages. But 16 percent of the world's people have at least mild goiter, a swollen thyroid gland in the neck."[45]

text: Causes[edit]

text: Major causes of malnutrition include poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors. Clinical malnutrition, such as: cachexia, is a major burden also in developed countries. Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community that is within poor governments, may be at risk if the area lacks health-related services, but on a smaller scale certain households or individuals may be at an even higher risk due to differences in income levels, access to land, or levels of education.[46]

text: Diseases[edit]

text: Malnutrition can be a consequence of health issues such as gastroenteritis[47] or chronic illness,[48] especially the HIV/AIDS pandemic.[49] Diarrhea and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss.[50] Parasite infections, in particular intestinal worm infections (helminthiasis), can also lead to malnutrition.[50] A leading cause of diarrhea and intestinal worm infections in children in developing countries is lack of sanitation and hygiene.

text: People may become malnourished due to abnormal nutrient loss (due to diarrhea or chronic illness affecting the small bowel).[36][51] This conditions may include Crohn's disease or untreated coeliac disease.[4][9][52] Malnutrition may also occur due to increased energy expenditure (secondary malnutrition).[36][51]

text: Dietary practices[edit]

text: Undernutrition[edit]

text: A lack of adequate breastfeeding leads to malnutrition in infants and children, associated with the deaths of an estimated one million children annually. Illegal advertising of breast milk substitutes continues three decades after its 1981 prohibition under the WHO International Code of Marketing Breast Milk Substitutes.[53]

text: Deriving too much of one's diet from a single source, such as eating almost exclusively corn or rice, can cause malnutrition. This may either be from a lack of education about proper nutrition, or from only having access to a single food source.[54]

text: It is not just the total amount of calories that matters but specific nutritional deficiencies such as vitamin A deficiency, iron deficiency or zinc deficiency can also increase risk of death.[55]

text: Overnutrition[edit]

text: Overnutrition caused by overeating is also a form of malnutrition. In the United States, more than half of all adults are now overweight — a condition that, like hunger, increases susceptibility to disease and disability, reduces worker productivity, and lowers life expectancy.[56] Overeating is much more common in the United States, where for the majority of people, access to food is not an issue. Many parts of the world have access to a surplus of non-nutritious food, in addition to increased sedentary lifestyles. Yale psychologist Kelly Brownell calls this a "toxic food environment" where fat and sugar laden foods have taken precedence over healthy nutritious foods.[56]

text: The issue in these developed countries is choosing the right kind of food. More fast food is consumed per capita in the United States than in any other country. The reason for this mass consumption of fast food is its affordability and accessibility. Often fast food, low in cost and nutrition, is high in calories and heavily promoted. When these eating habits are combined with increasingly urbanized, automated, and more sedentary lifestyles, it becomes clear why weight gain is difficult to avoid.[57]

text: Not only does obesity occur in developed countries, problems are also occurring in developing countries in areas where income is on the rise.[56] Overeating is also a problem in countries where hunger and poverty persist. In China, consumption of high-fat foods has increased while consumption of rice and other goods has decreased.[56]

text: Overeating leads to many diseases, such as heart disease and diabetes, that may result in death.

text: Poverty and food prices[edit]

text: In Bangladesh, poor socioeconomic position was associated with chronic malnutrition since it inhibits purchase of nutritious foods such as milk, meat, poultry, and fruits.[58] As much as food shortages may be a contributing factor to malnutrition in countries with lack of technology, the FAO (Food and Agriculture Organization) has estimated that eighty percent of malnourished children living in the developing world live in countries that produce food surpluses.[56] The economist Amartya Sen observed that, in recent decades, famine has always been a problem of food distribution and/or poverty, as there has been sufficient food to feed the whole population of the world. He states that malnutrition and famine were more related to problems of food distribution and purchasing power.[59]

text: It is argued that commodity speculators are increasing the cost of food. As the real estate bubble in the United States was collapsing, it is said that trillions of dollars moved to invest in food and primary commodities, causing the 2007–2008 food price crisis.[60]

text: The use of biofuels as a replacement for traditional fuels raises the price of food.[61] The United Nations special rapporteur on the right to food, Jean Ziegler proposes that agricultural waste, such as corn cobs and banana leaves, rather than crops themselves be used as fuel.[62]

text: Agricultural productivity[edit]

text: Local food shortages can be caused by a lack of arable land, adverse weather, lower farming skills such as crop rotation, or by a lack of technology or resources needed for the higher yields found in modern agriculture, such as fertilizers, pesticides, irrigation, machinery and storage facilities. As a result of widespread poverty, farmers cannot afford or governments cannot provide the resources necessary to improve local yields. The World Bank and some wealthy donor countries also press nations that depend on aid to cut or eliminate subsidized agricultural inputs such as fertilizer, in the name of free market policies even as the United States and Europe extensively subsidized their own farmers.[63][64] Many, if not most, farmers cannot afford fertilizer at market prices, leading to low agricultural production and wages and high, unaffordable food prices.[63] Reasons for the unavailability of fertilizer include moves to stop supplying fertilizer on environmental grounds, cited as the obstacle to feeding Africa by the Green Revolution pioneers Norman Borlaug and Keith Rosenberg.[65]

text: Future threats[edit]

text: There are a number of potential disruptions to global food supply that could cause widespread malnutrition.

text: Climate change is of importance to food security, with 95 percent of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics. According to the latest IPCC reports, temperature increases in these regions are "very likely."[66] Even small changes in temperatures can lead to increased frequency of extreme weather conditions.[66] Many of these have great impact on agricultural production and hence nutrition. For example, the 1998–2001 central Asian drought brought about an 80 percent livestock loss and 50 percent reduction in wheat and barley crops in Iran.[67] Similar figures were present in other nations. An increase in extreme weather such as drought in regions such as Sub-Saharan Africa would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productivity of many crop species, also decreasing food security in these regions.[66][68]

text: Colony collapse disorder is a phenomenon where bees die in large numbers.[69] Since many agricultural crops worldwide are pollinated by bees, this represents a threat to the supply of food.[70]

text: An epidemic of wheat stem rust caused by race Ug99 is currently spreading across Africa and into Asia and, it is feared, could wipe out more than 80 percent of the world’s wheat crops.[71][72]

text: Prevention[edit]

text: Food security[edit]

text: The effort to bring modern agricultural techniques found in the West, such as nitrogen fertilizers and pesticides, to Asia, called the Green Revolution, resulted in decreases in malnutrition similar to those seen earlier in Western nations. This was possible because of existing infrastructure and institutions that are in short supply in Africa, such as a system of roads or public seed companies that made seeds available.[73] Investments in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces food prices.[63][74] For example, in the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced against World Bank strictures, farmers produced record-breaking corn harvests as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter.[63] This lowered food prices and increased wages for farm workers.[63] Such investments in agriculture are still needed in other African countries like the Democratic Republic of the Congo. The country has one of the highest prevalence of malnutrition even though it is blessed with great agricultural potential John Ulimwengu explains in his article for D+C.[75] Proponents for investing in agriculture include Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa’s farmers.[63][76]

text: New technology in agricultural production also has great potential to combat undernutrition.[77] By improving agricultural yields, farmers could reduce poverty by increasing income as well as open up area for diversification of crops for household use. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.

text: Breastfeeding[edit]

text: As of 2016 is estimated that about 821,000 deaths of children less than five years old could be prevented globally per year through more widespread breastfeeding.[78]

text: Fortified foods[edit]

text: Manufacturers are trying to fortify everyday foods with micronutrients that can be sold to consumers such as wheat flour for Beladi bread in Egypt or fish sauce in Vietnam and the iodization of salt.[79]

text: For example, flour has been fortified with iron, zinc, folic acid and other B vitamins such as thiamine, riboflavin, niacin and vitamin B12.[55]

text: World population[edit]

text: Restricting population size is a proposed solution. Thomas Malthus argued that population growth could be controlled by natural disasters and voluntary limits through "moral restraint."[80] Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth.[81] However, there are many who believe that the world has more than enough resources to sustain its population. Instead, these theorists point to unequal distribution of resources and under- or unutilized arable land as the cause for malnutrition problems.[82][83] For example, Amartya Sen advocates that, "no matter how a famine is caused, methods of breaking it call for a large supply of food in the public distribution system. This applies not only to organizing rationing and control, but also to undertaking work programmes and other methods of increasing purchasing power for those hit by shifts in exchange entitlements in a general inflationary situation."[59]

text: Food sovereignty[edit]

text: One suggested policy framework to resolve access issues is termed food sovereignty—the right of peoples to define their own food, agriculture, livestock, and fisheries systems, in contrast to having food largely subjected to international market forces. Food First is one of the primary think tanks working to build support for food sovereignty. Neoliberals advocate for an increasing role of the free market.

text: Health facilities[edit]

text: Another possible long term solution would be to increase access to health facilities to rural parts of the world. These facilities could monitor undernourished children, act as supplemental food distribution centers, and provide education on dietary needs. These types of facilities have already proven very successful in countries such as Peru and Ghana.[84][85]

text: Global initiatives[edit]

text: In April 2012, the Food Assistance Convention was signed, the world's first legally binding international agreement on food aid. The May 2012 Copenhagen Consensus recommended that efforts to combat hunger and malnutrition should be the first priority for politicians and private sector philanthropists looking to maximize the effectiveness of aid spending. They put this ahead of other priorities, like the fight against malaria and AIDS.[86]

text: The main global policy to reduce hunger and poverty are the Sustainable Development Goals. In particular Goal 2: Zero hunger sets globally agreed targets to end hunger, achieve food security and improved nutrition and promote sustainable agriculture.[87] The partnership Compact2025, led by IFPRI with the involvement of UN organisations, NGOs and private foundations develops and disseminates evidence-based advice to politicians and other decision-makers aimed at ending hunger and undernutrition in the coming 10 years, by 2025.[88][89]

text: The EndingHunger campaign is an online communication campaign aimed at raising awareness of the hunger problem. It has many worked through viral videos depicting celebrities voicing their anger about the large number of hungry people in the world. Another initiative focused on improving the hunger situation by improving nutrition is the Scaling up Nutrition movement (SUN). Started in 2010 this movement of people from governments, civil society, the United Nations, donors, businesses and researchers, publishes a yearly progress report on the changes in their 55 partner countries.[90]

text: Management[edit]

text: In response to child malnutrition, the Bangladeshi government recommends ten steps for treating severe malnutrition. They are to prevent or treat dehydration, low blood sugar, low body temperature, infection, correct electrolyte imbalances and micronutrient deficiencies, start feeding cautiously, achieve catch-up growth, provide psychological support, and prepare for discharge and follow-up after recovery.[91]

text: Among those patients who are hospitalized, nutritional support improves protein, colorie intake and weight.[92]

text: Food[edit]

text: The evidence for benefit of supplementary feeding is poor.[93] This is due to the small amount of research done on this treatment.

text: Specially formulated foods do however appear useful in those from the developing world with moderate acute malnutrition.[94] In young children with severe acute malnutrition it is unclear if ready-to-use therapeutic food differs from a normal diet.[95] They may have some benefits in humanitarian emergencies as they can be eaten directly from the packet, do not require refrigeration or mixing with clean water, and can be stored for years.[79]

text: In those who are severely malnourished, feeding too much too quickly can result in refeeding syndrome.[96] This can result regardless of route of feeding and can present itself a couple of days after eating with heart failure, dysrhythmias and confusion that can result in death.[96][97]

text: Micronutrients[edit]

text: Treating malnutrition, mostly through fortifying foods with micronutrients (vitamins and minerals), improves lives at a lower cost and shorter time than other forms of aid, according to the World Bank.[98] The Copenhagen Consensus, which look at a variety of development proposals, ranked micronutrient supplements as number one.[99][100]

text: In those with diarrhea, once an initial four-hour rehydration period is completed, zinc supplementation is recommended. Daily zinc increases the chances of reducing the severity and duration of the diarrhea, and continuing with daily zinc for ten to fourteen days makes diarrhea less likely recur in the next two to three months.[101]

text: In addition, malnourished children need both potassium and magnesium.[91] This can be obtained by following the above recommendations for the dehydrated child to continue eating within two to three hours of starting rehydration,[91][101] and including foods rich in potassium as above. Low blood potassium is worsened when base (as in Ringer's/Hartmann's) is given to treat acidosis without simultaneously providing potassium.[101] As above, available home products such as salted and unsalted cereal water, salted and unsalted vegetable broth can be given early during the course of a child's diarrhea along with continued eating.[101] Vitamin A, potassium, magnesium, and zinc should be added with other vitamins and minerals if available.[91]

text: For a malnourished child with diarrhea from any cause, this should include foods rich in potassium such as bananas, green coconut water, and unsweetened fresh fruit juice.[101]

text: Diarrhea[edit]

text: The World Health Organization (WHO) recommends rehydrating a severely undernourished child who has diarrhea relatively slowly. The preferred method is with fluids by mouth using a drink called oral rehydration solution (ORS). The oral rehydration solution is both slightly sweet and slightly salty and the one recommended in those with severe undernutrition should have half the usual sodium and greater potassium. Fluids by nasogastric tube may be use in those who do not drink. Intravenous fluids are recommended only in those who have significant dehydration due to their potential complications. These complications include congestive heart failure.[42] Over time, ORS developed into ORT, or oral rehydration therapy, which focused on increasing fluids by supplying salts, carbohydrates, and water. This switch from type of fluid to amount of fluid was crucial in order to prevent dehydration from diarrhea.[102]

text: Breast feeding and eating should resume as soon as possible.[42] Drinks such as soft drinks, fruit juices, or sweetened teas are not recommended as they contain too much sugar and may worsen diarrhea.[103] Broad spectrum antibiotics are recommended in all severely undernourished children with diarrhea requiring admission to hospital.[42]

text: To prevent dehydration readily available fluids, preferably with a modest amount of sugars and salt such as vegetable broth or salted rice water, may be used. The drinking of additional clean water is also recommended. Once dehydration develops oral rehydration solutions are preferred. As much of these drinks as the person wants can be given, unless there are signs of swelling. If vomiting occurs, fluids can be paused for 5–10 minutes and then restarting more slowly. Vomiting rarely prevents rehydration as fluid are still absorbed and the vomiting rarely last long.[103] A severely malnourished child with what appears to be dehydration but who has not had diarrhea should be treated as if they have an infection.[42]

text: For babies a dropper or syringe without the needle can be used to put small amounts of fluid into the mouth; for children under 2, a teaspoon every one to two minutes; and for older children and adults, frequent sips directly from a cup.[101] After the first two hours, rehydration should be continued at the same or slower rate, determined by how much fluid the child wants and any ongoing diarrheal loses. After the first two hours of rehydration it is recommended that to alternate between rehydration and food.[91]

text: In 2003, WHO and UNICEF recommended a reduced-osmolarity ORS which still treats dehydration but also reduced stool volume and vomiting. Reduced-osmolarity ORS is the current standard ORS with reasonably wide availability.[104][105] For general use, one packet of ORS (glucose sugar, salt, potassium chloride, and trisodium citrate) is added to one liter of water; however, for malnourished children it is recommended that one packet of ORS be added to two liters of water along with an extra 50 grams of sucrose sugar and some stock potassium solution.[106]

text: Malnourished children have an excess of body sodium.[91] Recommendations for home remedies agree with one liter of water (34 oz.) and 6 teaspoons sugar and disagree regarding whether it is then one teaspoon of salt added or only 1/2, with perhaps most sources recommending 1/2 teaspoon of added salt to one liter water.[101][107][108][109]

text: Low blood sugar[edit]

text: Hypoglycemia, whether known or suspected, can be treated with a mixture of sugar and water. If the child is conscious, the initial dose of sugar and water can be given by mouth.[110] If the child is unconscious, give glucose by intravenous or nasogastric tube. If seizures occur after despite glucose, rectal diazepam is recommended. Blood sugar levels should be re-checked on two hour intervals.[91]

text: Hypothermia[edit]

text: Hypothermia can occur. To prevent or treat this, the child can be kept warm with covering including of the head or by direct skin-to-skin contact with the mother or father and then covering both parent and child. Prolonged bathing or prolonged medical exams should be avoided. Warming methods are usually most important at night.[91]

text: Economics[edit]

text: There is a growing realization among aid groups that giving cash or cash vouchers instead of food is a cheaper, faster, and more efficient way to deliver help to the hungry, particularly in areas where food is available but unaffordable.[111] The UN's World Food Program, the biggest non-governmental distributor of food, announced that it will begin distributing cash and vouchers instead of food in some areas, which Josette Sheeran, the WFP's executive director, described as a "revolution" in food aid.[111][112] The aid agency Concern Worldwide is piloting a method through a mobile phone operator, Safaricom, which runs a money transfer program that allows cash to be sent from one part of the country to another.[111]

text: However, for people in a drought living a long way from and with limited access to markets, delivering food may be the most appropriate way to help.[111] Fred Cuny stated that "the chances of saving lives at the outset of a relief operation are greatly reduced when food is imported. By the time it arrives in the country and gets to people, many will have died."[113] U.S. law, which requires buying food at home rather than where the hungry live, is inefficient because approximately half of what is spent goes for transport.[100] Cuny further pointed out "studies of every recent famine have shown that food was available in-country — though not always in the immediate food deficit area" and "even though by local standards the prices are too high for the poor to purchase it, it would usually be cheaper for a donor to buy the hoarded food at the inflated price than to import it from abroad."[114]

text: Ethiopia has been pioneering a program that has now become part of the World Bank's prescribed method for coping with a food crisis and had been seen by aid organizations as a model of how to best help hungry nations. Through the country's main food assistance program, the Productive Safety Net Program, Ethiopia has been giving rural residents who are chronically short of food, a chance to work for food or cash. Foreign aid organizations like the World Food Program were then able to buy food locally from surplus areas to distribute in areas with a shortage of food.[115] Ethiopia been pioneering a program, and Brazil has established a recycling program for organic waste that benefits farmers, urban poor, and the city in general. City residents separate organic waste from their garbage, bag it, and then exchange it for fresh fruit and vegetables from local farmers. As a result, the country's waste is reduced and the urban poor get a steady supply of nutritious food.[57]

text: Epidemiology[edit]

text:
no data
  <200
  200-400
  400-600
  600-800
  800-1000
  1000-1200

  1200-1400
  1400-1600
  1600-1800
  1800-2000
  2000-2200
  >2200

text: The figures provided in this section on epidemiology all refer to undernutrition even if the term malnutrition is used which, by definition, could also apply to too much nutrition.

text: People affected[edit]

text: There were 793 million undernourished people in the world in 2015. This was 216 million fewer people than in 1990 when it was 991 million undernourished people.[10] This is despite the world's farmers producing enough food to feed around 12 billion people – almost double the current world population.[117]

text: Malnutrition, as of 2010, was the cause of 1.4% of all disability adjusted life years.[21]

text:
Number of undernourished globally

Year
1970
1980
1990
1995
2005
2007/08
2014/16

Number in millions[10][118]

843
788
848
923
793

Percentage in the developing world[10][119][120]
37%
28%
20%

16%
17%
13.5%

text: Mortality[edit]

text: Mortality due to malnutrition accounted for 58 percent of the total mortality in 2006: "In the world, approximately 62 million people, all causes of death combined, die each year. One in twelve people worldwide is malnourished and according to the Save the Children 2012 report, one in four of the world’s children are chronically malnourished.[121] In 2006, more than 36 million died of hunger or diseases due to deficiencies in micronutrients".[122]

text: In 2010 protein-energy malnutrition resulted in 600,000 deaths down from 883,000 deaths in 1990.[123] Other nutritional deficiencies, which include iodine deficiency and iron deficiency anemia, result in another 84,000 deaths.[123] In 2010 malnutrition caused about 1.5 million deaths in women and children.[22]

text: According to the World Health Organization, malnutrition is the biggest contributor to child mortality, present in half of all cases.[124] Six million children die of hunger every year.[125] Underweight births and intrauterine growth restrictions cause 2.2 million child deaths a year. Poor or non-existent breastfeeding causes another 1.4 million. Other deficiencies, such as lack of vitamin A or zinc, for example, account for 1 million. Malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower education achievement. Their own children tend to be smaller. Malnutrition was previously[when?] seen as something that exacerbates the problems of diseases such as measles, pneumonia and diarrhea, but malnutrition actually causes diseases, and can be fatal in its own right.[124]

text: Society and culture[edit]

text: Roughly $300 million of aid goes to basic nutrition each year, less than $2 for each child below two in the 20 worst affected countries.[124] In contrast, HIV/AIDS, which causes fewer deaths than child malnutrition, received $2.2 billion—$67 per person with HIV in all countries.[124]

text: The International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), a member of the CGIAR consortium, partners with farmers, governments, researchers and NGOs to help farmers grow nutritious crops, such as chickpea, groundnut, pigeonpea, millet and sorghum. This helps their communities have more balanced diets and become more resilient to pests and drought. The Harnessing Opportunities for Productivity Enhancement of Sorghum and Millets in Sub-Saharan Africa and the Indian-Subcontinent (HOPE) project, for example, is increasing yields of finger millet in Tanzania by encouraging farmers to grow improved varieties. Finger millet is very high in calcium, rich in iron and fiber, and has a better energy content than other cereals. These characteristics make it ideal for feeding to infants and the elderly.[126]

text: Some organizations have begun working with teachers, policymakers, and managed food service contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university-level institutions. Health and nutrition have been proven to have close links with overall educational success.[127]

text: The verb form is "malnourish"; "malnourishment" is sometimes used instead of "malnutrition."

text: Special populations[edit]

text: Undernutrition is an important determinant of maternal and child health, accounting for more than a third of child deaths and more than 10 percent of the total global disease burden according to 2008 studies.[34]

text: Children[edit]

text: The World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide,[31] about 1 million children.[128] Another estimate also by WHO states that childhood underweight is the cause for about 35% of all deaths of children under the age of five years worldwide.[129]

text: As underweight children are more vulnerable to almost all infectious diseases, the indirect disease burden of malnutrition is estimated to be an order of magnitude higher than the disease burden of the direct effects of malnutrition.[129] The combination of direct and indirect deaths from malnutrition caused by unsafe water, sanitation and hygiene (WASH) practices is estimated to lead to 860,000 deaths per year in children under five years of age.[129]

text: Women[edit]

text: Gender[edit]

text: Researchers from the Centre for World Food Studies in 2003 found that the gap between levels of undernutrition in men and women is generally small, but that the gap varies from region to region and from country to country.[130] These small-scale studies showed that female undernutrition prevalence rates exceeded male undernutrition prevalence rates in South/Southeast Asia and Latin America and were lower in Sub-Saharan Africa.[130] Datasets for Ethiopia and Zimbabwe reported undernutrition rates between 1.5 and 2 times higher in men than in women; however, in India and Pakistan, datasets rates of undernutrition were 1.5-2 times higher in women than in men. Intra-country variation also occurs, with frequent high gaps between regional undernutrition rates.[130] Gender inequality in nutrition in some countries such as India is present in all stages of life.[131]

text: Studies on nutrition concerning gender bias within households look at patterns of food allocation, and one study from 2003 suggested that women often receive a lower share of food requirements than men.[130] Gender discrimination, gender roles, and social norms affecting women can lead to early marriage and childbearing, close birth spacing, and undernutrition, all of which contribute to malnourished mothers.[58]

text: Within the household, there may be differences in levels of malnutrition between men and women, and these differences have been shown to vary significantly from one region to another, with problem areas showing relative deprivation of women.[130] Samples of 1000 women in India in 2008 demonstrated that malnutrition in women is associated with poverty, lack of development and awareness, and illiteracy.[131] The same study showed that gender discrimination in households can prevent a woman's access to sufficient food and healthcare.[131] How socialization affects the health of women in Bangladesh, Najma Rivzi explains in an article about a research program on this topic.[132] In some cases, such as in parts of Kenya in 2006, rates of malnutrition in pregnant women were even higher than rates in children.[133]

text: Women in some societies are traditionally given less food than men since men are perceived to have heavier workloads.[134] Household chores and agricultural tasks can in fact be very arduous and require additional energy and nutrients; however, physical activity, which largely determines energy requirements, is difficult to estimate.[130]

text: Physiology[edit]

text: Women have unique nutritional requirements, and in some cases need more nutrients than men; for example, women need twice as much calcium as men.[134]

text: Pregnancy and breastfeeding[edit]

text: During pregnancy and breastfeeding, women must ingest enough nutrients for themselves and their child, so they need significantly more protein and calories during these periods, as well as more vitamins and minerals (especially iron, iodine, calcium, folic acid, and vitamins A, C, and K).[134] In 2001 the FAO of the UN reported that iron deficiency afflicted 43 percent of women in developing countries and increased the risk of death during childbirth.[134] A 2008 review of interventions estimated that universal supplementation with calcium, iron, and folic acid during pregnancy could prevent 105,000 maternal deaths (23.6 percent of all maternal deaths).[135]

text: Frequent pregnancies with short intervals between them and long periods of breastfeeding add an additional nutritional burden.[130]

text: Educating children[edit]

text: According to the FAO, women are often responsible for preparing food and have the chance to educate their children about beneficial food and health habits, giving mothers another chance to improve the nutrition of their children.[134]

text: Elderly[edit]

text: Malnutrition and being underweight are more common in the elderly than in adults of other ages.[136] If elderly people are healthy and active, the aging process alone does not usually cause malnutrition.[137] However, changes in body composition, organ functions, adequate energy intake and ability to eat or access food are associated with aging, and may contribute to malnutrition.[138] Sadness or depression can play a role, causing changes in appetite, digestion, energy level, weight, and well-being.[137] A study on the relationship between malnutrition and other conditions in the elderly found that malnutrition in the elderly can result from gastrointestinal and endocrine system disorders, loss of taste and smell, decreased appetite and inadequate dietary intake.[138] Poor dental health, ill-fitting dentures, or chewing and swallowing problems can make eating difficult.[137] As a result of these factors, malnutrition is seen to develop more easily in the elderly.[139]

text: Rates of malnutrition tend to increase with age with less than 10 percent of the "young" elderly (up to age 75) malnourished, while 30 to 65 percent of the elderly in home care, long-term care facilities, or acute hospitals are malnourished.[140] Many elderly people require assistance in eating, which may contribute to malnutrition.[139] Because of this, one of the main requirements of elderly care is to provide an adequate diet and all essential nutrients.[141]

text: In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission.[142] Malnutrition and weight loss can contribute to sarcopenia with loss of lean body mass and muscle function.[136] Abdominal obesity or weight loss coupled with sarcopenia lead to immobility, skeletal disorders, insulin resistance, hypertension, atherosclerosis, and metabolic disorders.[138] A paper from the Journal of the American Dietetic Association noted that routine nutrition screenings represent one way to detect and therefore decrease the prevalence of malnutrition in the elderly.[137]


document_title: Infant visual development

question_text: when does a baby's vision fully develop

question_tokens: when does a baby 's vision fully develop

text: Infant visual development

text: Development[edit]

text: Acuity[edit]

text: Visual acuity, the sharpness of the eye to fine detail, is a major component of a human’s visual system. It requires not only the muscles of the eye – the muscles of orbit and the ciliary muscles – to be able to focus on a particular object through contraction and relaxation, but other parts of the retina such as the fovea to project a clear image on the retina. The muscles that initiate movement start to strengthen from birth to 2 months, at which point infants have control of their eye. However, images still appear unclear at two months due to other components of the visual system like the fovea and retina and the brain circuitry that are still in their developmental stages. This means that even though an infant is able to focus on a clear image on the retina, the fovea and other visual parts of the brain are too immature to transmit a clear image. Visual acuity in newborns is very limited as well compared to adults – being 12 to 25 times worse than that of a normal adult.[3] It is important to note that the distance from the cornea at the front of the infant’s eye to the retina which is at the back of eye is 16–17 mm at birth, 20 to 21 mm at one year, and 23–25 mm in adolescence and adulthood.[1] This results in smaller retinal images for infants. The vision of infants under one month of age ranges from 6/240 to 6/60 (20/800 to 20/200).[4] By two months, visual acuity improves to 6/45 (20/150). By four months, acuity improves by a factor of 2 – calculated to be 6/18 (20/60) vision. As the infant grows, the acuity reaches the healthy adult standard of 6/6 (20/20) at six months.[5]

text: One major method used to measure visual acuity during infancy is by testing an infant’s sensitivity to visual details such as a set of black strip lines in a pictorial image. Studies have shown that most one-week-old infants can discriminate a gray field from a fine black stripped field at a distance of one foot away.[6] This means that most infants will look longer at patterned visual stimuli instead of a plain, pattern-less stimuli.[7] Gradually, infants develop the ability to distinguish strips of lines that are closer together. Therefore, by measuring the width of the strips and their distance from an infant’s eye, visual acuity can be estimated, with detection of finer strips indicating better acuity. When examining an infants preferred visual stimuli, it was found that one-month-old infants often gazed mostly at prominent, sharp features of an object – whether it is a strong defined curve or an edge.[8] Beginning at two months old, infants begin to direct their saccades to the interior of the object, but still focusing on strong features.[9][10] Additionally, infants starting from one month of age have been found to prefer visual stimuli that are in motion rather than stationary.[11]

text: Faces[edit]

text: Newborns are exceptionally capable of facial discrimination and recognition shortly after birth.[12][13] Therefore, it is not surprising that infants develop strong facial recognition of their mother. Studies have shown that newborns have a preference for their mothers' faces two weeks after birth. At this stage, infants would focus their visual attention on pictures of their own mother for a longer period than a picture of complete strangers.[14] Studies have shown that infants even as early as four days old look longer at their mothers’ face than at those of strangers only when the mother is not wearing a head scarf. This may suggest that hairline and outer perimeter of the face play an integral part in the newborn’s face recognition.[15] According to Maurer and Salapateck, a one-month-old baby scans the outer contour of the face, with strong focus on the eyes, while a two-month-old scans more broadly and focuses on the features of the face, including the eyes and mouth.[10]

text: When comparing facial features across species, it was found that infants of six months were better at distinguishing facial information of both humans and monkeys than older infants and adults. They found that both nine-month-olds and adults could discriminate between pictures of human faces; however, neither infants nor adults had the same capabilities when it came to pictures of monkeys. On the other hand, six-month-old infants were able to discriminate both facial features on human faces and on monkey faces. This suggests that there is a narrowing in face processing, as a result of neural network changes in early cognition. Another explanation is that infants likely have no experience with monkey faces and relatively little experience with human faces. This may result in a more broadly tuned face recognition system and, in turn, an advantage in recognizing facial identity in general (i.e., regardless of species). In contrast, healthy adults due to their interaction with people on a frequent basis have fine tuned their sensitivity to facial information of humans – which has led to cortical specialization.[16]

text: Depth perception[edit]

text: To perceive depth, infants as well as adults rely on several signals such as distances and kinetics. For instance, the fact that objects closer to the observer fill more space in our visual field than farther objects provides some cues into depth perception for infants. Evidence has shown that newborns' eyes do not work in the same fashion as older children or adults – mainly due to poor coordination of the eyes. Newborn’s eyes move in the same direction only about half of the time.[17] The strength of eye muscle control is positively correlated to achieve depth perception. Human eyes are formed in such a way that each eye reflects a stimulus at a slightly different angle thereby producing two images that are processed in the brain. These images provide the essential visual information regarding 3D features of the external world. Therefore, an infant’s ability to control his eye movement and converge on one object is critical for developing depth perception.

text: One of the important discoveries of infant depth perception is thanks to researchers Eleanor J. Gibson and R.D. Walk.[18] Gibson and Walk developed an apparatus called the visual cliff that could be used to investigate visual depth perception in infants. In short, infants were placed on a centerboard to one side which contained an illusory steep drop (“deep side”) and another which contained a platform of the centerboard (“shallow side”). In reality, both sides, covered in glass, was safe for infants to trek. From their experiment, Gibson and Walk found that a majority of infants ranging from 6–14 months-old would not cross from the shallow side to the deep side due to their innate sense of fear to heights. From this experiment, Gibson and Walk concluded that by six months an infant has developed a sense of depth. However, this experiment was limited to infants that could independently crawl or walk.[18] To overcome the limitations of testing non-locomotive infants, Campos and his colleges devised an experiment that was dependent on heart rate reactions of infants when placed in environments that reflected different depth scenarios. Campos and his colleagues placed six week-old infants on the “deep end” of the visual cliff, the six week-old infants' heart rate decreased and a sense of fascination was seen in the infants. However, when seven month-old infants were lowered down on the same “deep end” illusion, their heart rates accelerated rapidly and they started to whimper. Gibson and Walk concluded that infants had developed a sense of visual depth prior to beginning locomotion. Therefore, it could be concluded that sometime at the spark of crawling around 4–5 months, depth perception begins to strongly present itself.[19]

text: Cues[edit]

text: From an infant's standpoint, depth perception can be inferred using three means: binocular, static, and kinetic cues. As mentioned previous, humans are binocular and each eye views the external world with a different angle – providing essential information into depth. The convergence of each eye on a particular object and the stereopsis, also known as the retinal disparity among two objects, provides some information for infants older than ten weeks. With binocular vision development, infants between four and five months also develop a sense of size and shape constancy objects, regardless of the objects location and orientation in space.[20] From static cues based upon monocular vision, infants older of five month of age have the ability to predict depth perception from pictorial position of objects.[21] In other words, edges of closer objects overlap objects in the distance.[22] Lastly, kinetic cues are another factor in depth perception for humans, especially young infants. Infants ranging from three to five months are able to move when an object approaches them in the intent to hit them – implying that infants have depth perception.[20]

text: Color sensitivity[edit]

text: Color sensitivity improves steadily over the first year of life for humans due to strengthening of the cones of the eyes. Like adults, infants have chromatic discrimination using three photoreceptor types: long-, mid- and short-wavelength cones. These cones recombine in the precortical visual processing to form a luminance channel and two chromatic channels that help an infant to see color and brightness. The particular pathway used for color discrimination is the parvocellular pathway.[23] There is a general debate among researchers with regards to the exact age that infants can detect different colors/chromatic stimuli due to important color factors such as brightness/luminance, saturation, and hue. Regardless of the exact timeline for when infants start to see particular colors, it is understood among researcher that infants' color sensitivity improves with age.

text: It is generally accepted across all current research that infants prefer high contrast and bold colors at their earlier stages of infancy, rather than saturated colors.[24] One study found that newborn infants looked longer at checkered patterns of white and colored stimuli (including red, green, yellow) than they did at a uniform white color. However, infants failed to discriminate blue from white checkered patterns.[25] Another study – recording the fixation time of infants to blue, green, yellow, red, and gray at two difference luminance levels – found that infants and adults differed in their color preference. Newborns and one month did not show any preference among the colored stimuli. It was found that three-month-old infants preferred the longer wavelength (red and yellow) to the short-wavelength (blue and green) stimuli, while adults had the opposite. However, both adults and infants preferred colored stimuli over non-colored stimuli. According this study, it was suggest that infants had a general preference for colored stimuli over non-colored stimuli at birth; however, infants were not able to distinguish between the different colored stimuli until after three months of age.[26]

text: Research into the development of color vision using infant monkeys indicates that color experience is critical for normal vision development. Infant monkeys were placed in a room with monochromatic lighting limiting their access to a normal spectrum of colors for a one-month period. After a one-year period, the monkey’s ability to distinguish colors was poorer than that of normal monkey exposed to a full spectrum of colors. Although this result directly pertains to infant monkeys and not humans, they strongly suggest that visual experience with color is critical for proper, healthy vision development in humans as well.[27]

text: Light sensitivity[edit]

text: The threshold for light sensitivity is much higher in infants compared to adults. From birth, the pupils of an infant remain constricted to limit the amount of entering light. In regards to pupil dimensions, newborn's pupil grow from approximately 2.2 mm to an adult length of 3.3  mm.[2] A one-month-old infant can detect light thresholds only when it is approximately 50 times greater than that of an adult. By two months, the threshold decreases measurably to about ten times greater than that of an adult. The increase in sensitivity is the result of lengthening of the photoreceptors and further development of the retina. Therefore, postnatal maturation of the retinal structures has led to strong light adaptations for infants.[28]

text: Vision abnormalities in infants[edit]

text: Vision problems in infants are both common and easily treatable if addressed early by an ophthalmologist.

text: Critical warning signs[edit]

text:
Excessive tearing
Red or encrusted eyelids
White pupils
Extreme sensitivity to bright light
Constant eye turning

tag: ul

text: Vision problems[edit]

text:
Strabismus
Nystagmus
Amblyopia
Photophobia
Tumor in the eye
Cataract