The intersection of chronic diseases and food security presents a significant public health challenge that affects millions of vulnerable individuals in Pakistan. Chronic disease including cancer, cardiovascular diseases (CVD), chronic kidney disease (CKD), and type-2 diabetes mellitus (T2DM) are contributing to a rising healthcare burden which has direct food and nutritional implications. As per the Economic Survey of Pakistan, non-communicable diseases (NCDs) account for about 58% of all deaths in the country in 2023, CVD alone was responsible for 31% of the deaths. Furthermore, according to the International Diabetes Federation (IDF), Pakistan has over 33 million diabetes patients, the third highest globally.
How Food Insecurity Complicates Chronic Disease Management
Food insecurity further complicates disease management, especially for households with low incomes. According to Global Hunger Index, Pakistan ranked 109 out of 127 countries in 2024 with a score of 27.9 which indicates a ‘serious’ level of hunger. Economic instability and rising food prices have worsened the access to essential nutrients through a diverse food intake, affecting the dietary intake of individuals suffering from chronic diseases. For example, CKD patients require protein-controlled diets, while diabetes management depends on balanced carbohydrate intake, both of which are difficult to maintain in low-income households.
Malnutrition is one of the major concerns among the patients of CKD, particularly those who are at pre-dialysis stage. A recent study at Jinnah Hospital Lahore found that 46% of the pre-dialysis patients were malnourished, having a risk of increased malnourishment due to renal function decline. Protein energy wasting is common in CKD patients due to dietary restrictions, inflammation and metabolic imbalances. As many patients cannot afford specialized renal diets which worsens the situation. In addition, the restriction of fluid intake further complicates nutrient intake that increases the risk of deficiencies of essential vitamins and minerals.
Nutritional Challenges Faced by Cancer Patients
Cancer patients also face increased nutritional risks. According to a report of Pakistan Oncology, 40% of cancer patients experiences malnutrition, significantly impacted treatment outcomes in 2023. The limited access to nutrient-rich foods deteriorates immune responses and increases complications in treatment. Cancer patients often face considerable nutritional challenges that affect their treatment outcomes adversely and reduce the quality of life. A 2024 study conducted in Faisalabad found that more than half of the cancer patients experience food insecurity due to financial constraints. High costs associated with cancer treatment often force families to prioritize medical expenses over nutritious food further compromising the patients’ health. Patients undergoing chemotherapy faced the issue as poor food intake weakens the immune system, delays recovery and reduces treatment efficiency.
Similarly, individuals with T2DM face significant nutritional risks. A research study from Lady Reading Hospital, Peshawar, reported that about 48% of T2DM patients experience mild to moderate level of malnutrition, while about 11% suffered from fever malnutrition. Economic constraints and poor dietary lead to imbalanced carbohydrate consumption, worsening glycemic control. Most of the patients in the lower income group rely on cheap, high caloric foods rather than nutrient rich options. This increases the risk of obesity and generates further complications like CVD.
Micronutrient Deficiencies and Risk of CVD
Likewise, iron and zinc play vital roles in oxidative stress reduction and immune function, both are linked to CCVD risk. Among macronutrients, dietary fats, fiber and protein composition significantly influence lipid profiles, inflammation, and metabolic health. A recent study from Faisalabad showed a transitional dietary situation where traditional food intake is experiencing a shift towards processed food and higher consumption of saturated fats, refined carbohydrates and sodium rich diets. This transition is linked to an increased chance of CVD.
The broader issue of food insecurity in Pakistan compounds the challenges faced by patients with chronic diseases. As per the Global Alliance for Improved Nutrition (GAIN), Pakistan has one of the highest malnutrition burdens in the world. Furthermore, according to the National Nutrition Survey (NNS) 2018, over 40% of the children under five were stunted, 18% were wasted, and 10% were overweight. This highlights the widespread impact of inadequate nutrition. Furthermore, 43% of the reproductive aged women were anemic and suffered significant micronutrient deficiencies including vitamin D and iron. Such deficiencies not only affect growth and cognitive development but also weakens immunity, making populations more vulnerable to chronic illnesses.
Even though the country is food self-sufficient in staple crops (wheat, rice and maize), about 40% of Pakistan’s population faces food insecurity, primarily due to economic barriers and unequal food distribution. The situation worsened due to the 2022 floods that affected around 33 million people and caused significant disruptions to food supply chains. According to a report of World Food Program (WFP) over 8 million people in Pakistan required immediate food assistance especially in flood affected provinces of Sindh and Balochistan. Furthermore, the rising food inflation worsened the situation.
Economic Costs of Malnutrition for Pakistan’s Future
The economic implication of food and nutritional insecurity are quite high. The Food and Agriculture Organization (FAO) estimates that malnutrition may cost Pakistan’s GDP to 3% to 4% annually due to increased healthcare costs, reduced productivity and higher mortality rates. Chronic malnutrition results in lower cognitive development and educational outcomes among children, eventually reducing workforce efficiencies and national economic growth. Various studies have indicated that malnourished children suffer from lifelong health complications which reduce their earning capacity by up to 10%.
Tackling food insecurity in Pakistan requires a multisectoral interventions, including agricultural reforms, targeted food assistance programs, and nutrition-focused healthcare policies. Regular nutritional evaluations should be integrated into routine medical care patients with chronic diseases such as cancer, CKD, T2DM And CVD. Hospitals and clinics must adopt standardized screening tools to identify malnutrition early and provide tailored dietary interventions.
Patients often must choose between medical treatments and nutritious food due to their economic situations. Expanding government initiatives such as Benazir Income Support Program (BISP) to include food assistance for chronically ill patients may help reduce financial burdens. In addition, subsidies on essential food items e.g. fortified wheat, pulses and dairy products may be planned for the lower Income patients, ensuring sustainable access to a balanced diet.
A structured counseling services may be incorporated into healthcare facilities to educate patients about disease-specific nutrition. Furthermore, nutrition helplines and mobile applications and games can also be helpful in this regard.
A coordinated effort between government agencies, NGOs, and academic & research institutions is very important to address the menace of food insecurity. Policies must promote local food production, reduce post-harvest losses and ensure stable food prices should be prioritized through public-private partnerships.
Role of Pak-Korea Nutrition Center (PKNC) in Combating Malnutrition
A practical and successful example of such coordinated efforts is the Pak-Korea Nutrition Center (PKNC) of the University of Agriculture, Faisalabad, which is playing a crucial role in developing assessment protocols and training healthcare professionals on best practices in clinical nutrition across the country. Furthermore, the PKNC is playing a lead role in designing evidence-based dietary guidelines and conducting community outreach programs to improve nutritional literacy.
Authors: Imran Pasha Professor and Dean, Faculty of Food, Nutrition and Home Sciences and Central Project Director/PI of PKNC, University of Agriculture, Faisalabad
Muhammad Khalid Bashir, Associate Professor (Tenured), Institute of Agricultural and Resource Economics and Co-Chair, Policy, Advocacy, and Outreach, PKNC, University of Agriculture, Faisalabad