Malnutrition or malnourishment is a condition that results from eating a diet in which nutrients are not enough or are too much such that it causes health problems. This may include too much or too little: calories, protein, carbohydrates, vitamins or minerals. It is often used specifically to refer to undernutrition where there is not enough calories, protein or micronutrients; however, it also includes overnutrition. If undernutrition occurs during either pregnancy or before the age of two years of age it may result in permanent problems with physical and mental development. Extreme undernourishment, known as starvation, may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and abdomen. People also often get infections and are frequently cold. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking. Undernourishment is most often due to not enough high quality food available to eat. This is often related to high food prices and poverty. A lack of breast feeding may contribute, as may a number of infectious diseases such as: gastroenteritis, pneumonia, malaria and measles which increase nutrient requirements. There are two main types of undernutrition: protein-energy malnutrition and dietary deficiencies. Protein-energy malnutrition has two severe forms: marasmus (a lack of protein and calories) and kwashiorkor (a lack of just protein). Common micronutrient deficiencies include: a lack of iron, iodine and vitamin A. During pregnancy, due to increased demand, deficiencies become more common. In some developing countries overnutrition in the form of obesity is beginning to present within the same communities as undernutrition. Other causes of malnutrition include anorexia nervosa and bariatric surgery. In the elderly malnutrition becomes more common due to physical, psychological and social factors. Efforts to improve nutrition are some of the most effective forms of development aid. Breastfeeding can reduce rates of malnutrition and death in children, and efforts to promote the practice increase rates. In young children providing food in addition to breastmilk between six months and two years improves outcomes. There is also good evidence supporting the supplementation of a number of micronutrients during pregnancy and among young children in the developing world. To get food to people who need it most both delivering food and providing money so that people can buy food within local markets are effective. Simply feeding people at school is insufficient. Management of severe malnutrition within the person’s home with ready-to-use therapeutic foods is possible much of the time. In those who have severe malnutrition complicated by other health problems treatment within hospital is recommended. This often involves managing low blood sugar, body temperature, dehydration, and gradual feeding. Routine antibiotics are usually recommended due to the high risk of infection. Long term measures include: improving agricultural practices, reducing poverty, improving sanitation, and the empowerment of women. There were 925 million undernourished people in the world in 2010, an increase of 80 million since 1990. Another billion people are estimated to have a lack of vitamins and minerals. In 2013 protein-energy malnutrition was estimated to have resulted in 469,000 deaths down from 510,000 deaths in 1990. Other nutritional deficiencies, which include iodine deficiency and iron deficiency anemia, result in another 84,000 deaths. Undernutrition as of 2010 was the cause of 1.4% of all disability adjusted life years. About a third of deaths in children are believed to be due to undernutrition; however, the deaths are rarely labelled as such. In 2010 it was estimated to have contributed to about 1.5 million deaths in women and children though some estimate the number may be greater than 3 million. An additional 165 million children have stunted growth from the disease. Undernutrition is more common in developing countries.