Malnutrition presents a serious social problem in Bulgaria

It is well known that deviations from the normal body nutritional status leads to various socially important diseases as, for example, obesity, hyper- and hypotension, diabetes mellitus type 2, metabolic syndrome and anorexia. According to a strategic document published by the World Bank (2006), malnutrition leads to indirect losses in productivity from poor cognitive development and schooling. The negative effects of malnutrition need to be prevented from early childhood on, so with the present note we would like to draw the attention to the malnutrition that appears to be a serious social problem in Bulgaria.

What has been done?

One of the aims of the cross-sectional anthropometric investigation carried out in the period 2001-2002 was to establish the frequencies of various stages of malnutrition (thinness grades I, II and III) and of overnutrition (overweight and obesity) in children and adolescents in the city of Sofia. For this purpose, we measured the height and weight of 569 girls and 573 boys at the age from 9 to 15 years. In such investigations, a widely accepted measure for the nutritional status is the body mass index>

What show the results?

From the histograms for both sexes (Fig. 1 and Fig. 2) it is clearly evident that heavy (III) and medium (II) grade thinness occur very rarely (in 1-4 schoolchildren), mainly in girls. The frequency of first grade thinness (I) in 9-15-year-old schoolchildren, increase 6 times in boys and 3.5 times in girls. Worrying is the fact, that malnutrition affect one fifth (20.5%) of the measured 15-year-old boys and girls, while the opposite tendency has been observed in both overnutrition categories. From the 9th to the 15th year, the frequency of overweight decreases almost 2.5 times in boys, while in the girls the decrease is almost 10 times. Obesity was found in 1-3 boys from every age-group, while the obese girls are predominantly found among these aged 9 and 10. Surprising is also the fact, that in children at the age of 15, the malnutrition occurs more frequently than overnutrition. The average frequency of malnutrition in schoolchildren (13.5%) is similar to the frequency of overweight (13.0%), while the average frequency of obesity is only 2.5%. Compared to the global WHO data for overweight (7.6%) and obesity (2.7%) in adolescent individuals, the measured schoolchildren in Sofia show a 5.0% increase of overweight, while compared to the corresponding mean values measured throughout Europe (15% and 4.6%), the frequency of overweight and obesity in the measured schoolchildren is 2.0% lower.

What surprised us?

Compared to the WHO data the frequency of malnutrition in the beginning of the 21st century turned out to be at average almost 5 times higher among the schoolchildren from Sofia, than in the developed countries (1.1-2.7%), and 5-6% higher than the corresponding frequency in some other European countries (as Russia with 8.1%) which experience the same conditions in their economical transition.

Compared with the scarce data from Bulgaria obtained on the basis of the same cut off values, the malnutrition in 9-15-year-old schoolchildren from Sofia appears more frequently than in children of the same age in Plovdiv (9.7%) and some of the smaller towns (7.5%) as Haskovo, Lyubimets, and Svilengrad.

These results outline a serious social problem, that has been neglected by the researchers, institutions, and the society as a whole, because of the fact that most attention has been drawn to the overweight and obesity. The need to conduct widespread screening activities for adequate prevention and investigation of the reasons for the comparatively high frequency of malnutrition among the Bulgarian population is beyond doubt, not only as it has been shown that even the lowest malnutrition grade is connected with a high health risk, but also because the needs that have to be met by the science and medical practice in order to create an up-to-date national anthropometrical standards about the physical development of the human.

Source: World Bank