Deficit energy intake and negative energy balance can be acute or chronic . Acute energy deficiency results in short-term negative energy balance during which there is a progressive loss of body weight. Chronic energy deficiency reflects long-term inadequate food intake during which a steady state is achieved at a suboptimal nutritional status. Energy deficit in children leads to growth retardation, loss of fat and muscle, delayed motor, cognitive and behavioral development, diminished immunocompetence, and increased morbidity and mortality . Adaptations in metabolic rate and physical activity in response to chronic energy deficiency in children are difficult to assess for technical problems and mitigating geographical and social circumstances. The functional and behavioral consequences of energy deficiency are responsive to food supplementation. Food policies and nutrition programs aimed at meeting the energy requirements of children are clearly warranted, but their implementation should promote healthy diets with adequate, not excess, calories. Supplementation programs, especially in stunted populations, can contribute to obesity. Program targeting to undernourished children, growth monitoring and qualitative improvement in food provisions may be instrumental in preventing energy excess .
Excess energy intake and positive energy balance are promoted by readily available, energy-dense foods and sedentary lifestyles . The consequences of excess energy and obesity are well described in children . Obesity-related co-morbidities include type-2 diabetes, hyperlipidemia, hypertension, hyperandrogenism in girls, sleep disorders, respiratory difficulties, nonalcoholic fatty liver disease, gallbladder disease, orthopedic problems, and idiopathic intracranial hypertension. Serious psychosocial problems including poor self-esteem and depression also are common. Childhood obesity and its co-morbidities have a significant likelihood of persisting throughout adolescence and into adulthood.
Societies in transition are afflicted with the double burden of energy deficit and energy excess. As societies develop economically and adopt more Westernized food habits and sedentary lifestyles, there is a shift away from undernutrition towards overnutrition, as evidenced by the rise in the prevalence of childhood obesity worldwide in the past two decades [13, 14].
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