Undernutrition / Malnutrition is a condition in which there is inadequate consumption, poor absorption or excessive loss of nutrients. Overnutrition is caused by overindulgence or excessive intake of specific nutrients. The term malnutrition refers to both undernutrition as well as overnutrition. However, sometimes the terms malnutrition and protein energy malnutrition (PEM) are used interchangeably with undernutrition.

 

Indicators of Malnutrition

• Wasting: low weight-for-height is a sign of acute malnutrition :
  Indicator = prevalence of wasting
• Stunting: low height-for-age is a sign of chronic malnutrition :
  Indicator = prevalence of stunting
• Underweight: low weight-for-age is a sign of acute or chronic
  malnutrition or both :
  Indicator = prevalence of underweight

 

CLASSIFICATION OF protein energy malnutrition (PEM)

1. Syndromal Classification

• Kwashiorkor
• Nutritional marasmus
• Marasmic kwashiorkor
• Prekwashiorkor
• Nutritional dwarfing (Stunting)
• Under-weight
• Invisible PEM

 

2. Gomez Classification

According to this classification, Protein Energy Malnutrition is graded with reference to the weight for age as percentage of the expected weight (Harward standard):

• First degree : Weight between 90 and 75% of expected for age
• Second degree : Weight between 75 and 60% of expected for age
• Third degree : Weight below 60% of expected.

 

3. Wellcome or International Classification

• Weight between 80 and 60% of expected for age:
  with edema:  kwashiorkor
  without edema: undernutrition
• Weight below 60% of expected
  with edema: marasmic kwashiorkor
  without edema:  nutritional marasmus

 

4. Classification of the Indian Academy of Pediatrics (IAP)

• First degree : Weight between 80 and 70% of expected for age
• Second degree : Weight between 70 and 60% of expected for age
• Third degree : Weight between 60 and 50% of expected for age
• Fourth degree : Weight below 50% of expected(In case the child has demonstrable pitting edema, the letter “K” is placed in front of the evaluated grade.)

 

5. Jellife Classification

• First degree : Weight between 90 and 80% of expected
• Second degree : Weight between 80 and 70% of expected
• Third degree : Weight between 70 and 60% of expected
• Fourth degree 2 Weight below 60% of expected

 

6. McLaren Classification

• Mild : Weight between 90 and 80% of expected
• Moderate : Weight between 80 and 70% of expected
• Severe : Weight below 70% of expected

 

Note: All these classifications recommended Harvard standard as the reference standard (now obsolete).
CDC reference standards are the current recommendation.

 

7. Waterlow Classification

• Acute (wasted but not stunted) : Weight for height low, height for age normal
• Acute/chronic (wasted and stunted) :Weight for height low, height for age low
• Nutritional dwarfing (stunted but not wasted) : Weight for height normal,  height for age low