Six-year old Ayaan was pale and lean. He was slow in studies and less active in sports. His parents were alarmed when one day the child fainted. Initial checkup and tests were enough to reveal the child as severely anemic. "I was surprised to find out his diet pattern, he ate well; but only junk", says Dr Nosheen Naz, a nutritionist and a dietitian at a hospital in Lahore. "Discussing Ayaan’s diet with his mother, I realised she was unaware of the nutritional value of various foods." This is not the dilemma of only Ayaan as every third person in the world is unaware of nutritional requirements of the body, says Dr Naz.

According to World Health Organization (WHO), 462 million people are malnourished worldwide, and it is responsible for 45 per cent of deaths of children under five. In addition, it is causing growth problems in 159 million children worldwide. Malnutrition has been declared as one of the greatest global health challenge. It has resulted in global alliance for improved nutrition (GAIN). The situation has become so grim that UN general assembly has called the next decade (2016 -2025), the decade of action against malnutrition. "It seriously is a hidden culprit in prosperity of the country as it increases the health burden in hospitals," says Dr Nosheen. Moreover, it increases economic pressures and entraps one in vicious cycle of poverty.

Malnutrition means lack of vital nutrients in diet; it can be lack of vitamins, minerals, protein, or carbohydrates leading to insufficient energy to perform body’s essential functions like growth, maintenance and movement. Malnutrition results in retarded physical and mental growth.

According to Dr Fiza Saeed, a registered nutritionist and dietitian at a hospital in Faisalabad, "Lack of nutrients lowers immune defenses of body, making it more vulnerable to chronic diseases and infections." Reasons of malnutrition are diverse; lack of food and low purchasing power are the most common ones in developing country like ours. There are cases also where there is enough food available but lack of awareness about balanced diet is causing malnutrition. "Such type of malnutrition is resulting in increasing obesity and diabetes and hypertension." In elderly people, dental health is also responsible for malnutrition as they cannot chew well, says Dr Fiza.

There are certain health conditions, which stop body from absorbing nutrients, like celiac disease in which damaged intestine lining does not allow proper absorbance. Cystic fibrosis, effects pancreas ability to produce digestive enzymes and hence affects proper absorbance. Food allergies, Gastroenteritis and parasitic infections also affect absorption of nutrients. "General illness like cold, cough, flu can also cause malnutrition as we eat and drink less when we are ill," says Dr Fiza. Poor water and sanitation is also responsible for malnutrition as it causes illness in humans, crops and cattle as well.

Symptoms of malnutrition depend on the nutrient, which is lacking, but common symptoms include tiredness, irritability, longer healing time for wounds and infections, dry pale skin, reduced sex drive, and reduced fertility, dry falling hair, numbness. "In children malnutrition can result in drastic situations; as its effects are life long, and the damage done in infancy cannot be reversed. For example, slow brain development can result in delayed cognitive abilities and permanent abnormalities," says Dr Nosheen.

Every nutrient has its unique function and deficiency of even one causes the body to suffer. Common nutrient deficiencies are iron, calcium, vitamin A, vitamin B Complex, iodine and zinc. Calcium deficiency leads to poor teeth and bone health. Vitamin D is vital for immune system and bones. Iodine is important for neurological and psychological development. "In pregnancy and infancy, its deficiency leads toward poor wound healing and weakened immune system." Vitamin A deficiency can lead towards eyesight problems and poor growth. Iron deficiency causes frequent headaches and fatigue. Vitamin B12 is very important for brain functions, dementia, memory loss, dizziness, shortness of breath, depression, muscle weakness are to name a few of its vital functions.

Malnutrition in pregnancy can cause severe consequences, so a pregnant girl should take care of her nutritional needs for herself and her family. "A woman needs more calcium then men. Early marriages, close birth spacing and breast-feeding can cause malnutrition," says gynecologist Dr Rahat Lateef from Gujranwala. Breast-feeding newborn provides them with vital nutrients. The two-year span of exclusive breastfeeding can prevent them from getting malnourished. "Eat a balanced diet including dairy, meat, pulses, beans, fruits, vegetables all in your diet, if you want yourself and your baby healthy," says Dr Rahat.

Nowadays dietitian and nutritionists are working with hospitals to provide diet charts and essential nutrition information to various patients, to help them improve their life by changing their diet, life style and sleeping patterns. "Morning sun and fresh air promotes hormonal balance, which ensures maximum absorbance of nutrients," says Dr Nosheen.

"I must say we are buying malnutrition ourselves by giving boom to toxic food culture. Our changing life styles have given fatty and sugary foods a precedence over healthy nutrition," says Dr Nosheen. "Low costing, affordability and easy access to fast food has made this high caloric, nutrient deficient food our love, but believe me, it is taking our loved ones far away from us." Fizzy drinks also disrupt body’s hormonal balance and severely affect absorbance of nutrients. "Traditional foods and simple homemade dishes are full of energy and nutrition. However, our dilemma is that our children do not like to eat them. Instead they love fast food."

Schoolchildren’s nutrition is very important. Recently, University of Agriculture Faisalabad has started a teacher-training programme about nutrition. This can be very helpful in creating awareness in teachers and students. Mother education is also important, as she is the one who prepares food.

"Insecticides, pesticides and use of artificial fertilizers also rob food of its nutritional value and hence we get the nutrient deficient fruits, vegetables, wheat, rice, etc.", says Dr Hassan Munir, assistant professor, Department of Agronomy, University of Agriculture, Faisalabad. "We need to improve our nutritional structure by improving our agricultural system. Crops that are more nutritious should be encouraged. Export based agricultural policies with focus on increasing yields of traditional crops, can result in increased income for farmers."

Dr Munir says scientific research and use of technology can help produce better quality products and improve food system. "Circulation of cash and circulation of food should be monitored strictly to ensure food safety and availability to all." There is also lack of political commitment over the issue. "Subsidies to farmers coupled with their modern agricultural training can make a huge difference.