Module 7 – 8 Nutrition

8 Nutrition

8.1 Background

„Good nutrition is a human right“ (UNHCR)

A vast majority of refugees are subjected to malnutrition over long periods of time, often starting already in their home country due to lack of available foodstuff. War, poverty and destroyed agricultural structure are often sources of those limitations. As a result, children and lactating mothers are most affected by malnutrition (Doocy et al., 2011).

For refugees and other migrants, nutritional problems often become even more serious after leaving their home countries.

Having arrived in secure countries, families initially often receive food vouchers or get their daily meals from different governmental or non-governmental organizations. However, after first resettlement they have to organize their meals by themselves.

From now on they are faced with a big plethora of unknown food products, loose their traditional habits of eating and are constrained to limited financial possibilities.

Driven by strong desire for better life, influenced by advertising and in lack of linguistic proficiency – many refugees are illiterate – they often start to consume very sugar intensive products. Then, malnutrition is often followed by adiposity (Heney et al., 2013).

8.2  Nutrition – basic evaluation

In order to detect and identify the sources of malnutrition and overweight, the following procedures are helpful:

Medical history of

  • daily nutrition habits in the home-country
  • change of nutrition habits after escape
  • nutrition diary
  • weakness
  • loss of hair
  • depressive mute
  • diarrhea / constipation
  • eczema, urticarial
  • frequency of consumption of fresh fruit and vegetables
  • amount of soft drinks
  • frequency of physical exercises
  • total time of TV and/or computer consumption
  • history of traumatic experience or sexual abuse


8.3  Diagnostic recommendations:  Malnutrition

Basic investigations

  • Weight, height, BMI (kg/m2)  – use gender specific percentile curves
  • Cave: BMI < 17,5 (Yager et al., 2012; DGPM et al., 2014) as hint of probably manifestation of an eating disorder (e.g. Anorexia)
  • Blood count,
  • Iron (Felber et al., 2014)
  • TSH
  • GOT, GPT
  • creatinine
  • LDH
  • CK
  • ECG
  • blood pressure
  • Urine sticks (ketone)


Optional investigations

  • coagulation testing: prothrombine time
  • Vitamin D
  • albumin, total protein
  • celiac disease:  tTG-IgA  antibodies,  EmA-IgA  antibodies, total IgA (Bilukha et al., 2014)
  • food allergy testing
  • stool worms
  • stool culture (clostridia, …)

Regarding Vitamin D-supplementation and Iron- deficiency anemia: see sub-chapter 6 Prevention in this Module. [Link to Sub-chapter 6 Prevention]

8.4 Diagnostic recommendations: Adiposity

Basic investigations

  • Weight, height – use gender specific percentile curves
  • BMI (kg/m2)  – gender specific percentile curves, Cave: BMI-Percentiles > 90-97 indicates overweight (Wabitsch and Kunze, 2015)
  • Blood count
  • dHbA1c
  • total cholesterol, HDL/LDL cholesterol
  • triglycerides
  • gGT
  • GOT, GPT
  • TSH
  • blood glucose
  • ECG
  • blood pressure
  • Urine sticks (glucose)

8.5 Recommendations to the families

  • sufficient drinking volume: 1-2 liters  per day,  fresh water preferred; inform about the good quality  of regional water sources
  • motivate to eat fruits and vegetables several times a day
  • limitation of fatty and salty crisps
  • limitation of soft drinks
  • motivate to do physical exercise regularly
  • when necessary: vitamin-D or iron substitution (NO vitamin substitutions without detected deficiency)
  • motivate to celebrate traditional meals
  • motivate mothers to do breast feeding

In case of suspect of illness (e.g. cystic fibrosis, ulcerative colitis), the family/child shall be sent to a specialized pediatrician or hospital.