Macronutrient Malnutrition

What is macronutrient deficiency?

Macronutrient deficiency refers to a lack of the nutrients required in large amounts for normal growth and development. Macronutrients include:

  • Carbohydrates
  • Protein
  • Fat

Protein-Energy Malnutrition (PEM) is a common macronutrient deficiency that occurs when children consume insufficient amounts of protein and energy (carbohydrates and fat) to meet the body’s needs.

Conditions that can result from PEM include:

  • Wasting (very low weight-for-length/height)
  • Stunting (very low length/height-for-age)

Children may be at increased risk for PEM for several reasons, including:

  • Lack of food
  • Poor quality food
  • Gastrointestinal illness (e.g. parasites)
  • Illnesses which cause malabsorption
  • Poor sanitation
  • Chronic illness, including hepatitis, kidney disease, lung disease and heart defects


Stunting affects 178 million children worldwide, nearly 1/3 of children in the developing world. The prevalence of stunting and low weight-for-age is highest in Asia, affecting one in every two children. Additionally, an estimated 55 million children worldwide suffer from wasting. The prevalence of stunting and wasting in orphanages has been understudied but preliminary results suggest that both conditions are common. Learn more about child malnutrition.

What is Wasting?

Wasting is defined as very low weight for length/height. It typically results from acute malnutrition that occurs due to a calorie deficit. This can be due to low calorie intake and/or poor quality of food. Wasting results from a rapid weight loss or failure to gain weight due to infection or inadequate dietary intake. When a child experiences a severe calorie deficit, the first body compartment to be affected is fat stores, before length or head growth. This results in a child who is much too light for his or her frame and obviously undernourished-looking. In extreme cases of wasting, children are at an increased risk of death.


Wasting is a major indicator of malnutrition. Children with wasting may present the following symptoms:

  • Recent, drastic weight loss
  • “Thinness”
  • Low muscle and fat mass
  • Fatigue
  • Non-healing wounds

Children who are underweight due to chronic malnutrition may exhibit both stunting and wasting.


Wasting may be a result of short or long term conditions such as:

  • Acute starvation
  • Poor food quality
  • Infection resulting in weight loss
  • Chronic food shortage


Wasting is measured by the weight-for-height index. It is considered to be present when weight-for-height is more than two standard deviations below the World Health Organization standard.


Wasting is readily reversible once conditions improve. Recovering a normal body composition requires the intake of larger quantities of energy, proteins, and nutrients needed for the synthesis of muscle and fat tissue. However, if children with acute or severe malnutrition are re-fed too fast, they may develop a life-threatening condition called “refeeding syndrome.”

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What is Stunting?

Stunting is very low height for age. It is the failure to reach one’s genetic potential for height. The lack of nutrients – often combined with chronic infection and/or stress – can affect the child’s length more than weight. In these cases, kids will be small but might look chubby because their fat stores are disproportionately distributed across an even shorter body frame.


Children with stunting may present the following symptoms:

  • Short for age
  • Child appears young for his or her age
  • Low weight for age
  • Appears chubby (disproportionate fat mass related to height)
  • Bone growth is delayed

Wasting and stunting can present in mixed forms.


Stunting develops over a long period due to a combination of some or all of the following factors:

  • Not enough protein in proportion to total calorie intake
  • Hormone changes triggered by stress (cortisol, for example)
  • Frequent infections early in life

The development of stunting is a slow, cumulative process and does not necessarily mean that the current dietary intake is inadequate. The growth failure may have occurred in the past.


Stunting is measured by the height-for-age index. A child is considered to be “stunted” when height-for-age is more than two standard deviations below the World Health Organization standard.


Children who are stunted may benefit from additional quantities of nutrients needed for both bone and lean tissue growth; however, a specific nutritional plan should be developed in conjunction with a child’s pediatrician and dietitian.

Learn more about macronutrient malnutrition, stunting and wasting in the Orphan Nutrition Library.

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