The determinants of undernutrition can be categorized as being immediate, underlying, or basic (Figure 1). The immediate causes include dependence on a diet that is inadequate in quantity and/ or quality. This can be due to low food availability or anorexia from recurrent infections and also poor health status that can result in a vicious cycle of ill health and undernutrition. The underlying determinants are food insecurity, inadequate care for mothers and children, and poor sanitation. The basic determinants influence the underlying determinants and include the environmental, technological, and human resources available to a country or community. Access to and use of resources are influenced by both the political and the economic structures as well as cultural and social factors that affect how resources are used to maintain and improve food security, the provision of care, and sanitation. The following discussion is limited to the immediate causes of undernutrition.
Undernutrition is intergenerational, and a cycle of ill health and growth failure frequently occurs in which undernutrition in childhood leads to small body size in adulthood (Figure 2). Genetic and environmental influences also affect both maternal height and prepregnancy weight, both of which are important determinants of birth size and, to a lesser extent, later growth and size.
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