TABLE 1.
Definitions and clinical features of malnutritiona
| Classification | Description | Criterion and/or grading |
|---|---|---|
| PEM | General term describing acute malnutrition resulting from inadequate dietary intake of protein and energy (calories); it probably has a spectrum of clinical manifestations but is typically classified as marasmus or kwashiorkor (severe acute malnutrition [see below]) | Not well defined except for clinical marasmus and kwashiorkor (see below) |
| Acute malnutrition | Malnutrition resulting from inadequate food intake leading to acute loss of body mass with respect to length/ht for age; it can be classified as MAM or SAM; it is reversible with adequate nutritional rehabilitation | WHO (WFH z scores below median); mild, z score between −1 and −2; moderate, z score between −2 and −3 or MUAC between 125 mm and 115 mm; severe, z score of <−3 or MUAC of <115 mm |
| SAM (kwashiorkor) | Severe from of malnutrition resulting from poor-quality diet and probably other environmental factors; children with kwashiorkor have pitting edema in both feet and lower extremities and in severe cases may have total body edema (anasarca); liver steatosis is common; sores develop on the skin and at the corner of the mouth; skin is pale and peels (“flaky-paint” dermatosis); these children are apathetic and have little appetite | Diagnosis of kwashiorkor does not rely upon anthropometric measures but only on the presence of bilateral pitting edema |
| SAM (wasting [marasmus]) | Acute malnutrition leading to overt loss of subcutaneous adipose tissue and muscle mass; the wasted child is thin for his/her ht but not necessarily short; children with marasmus have a thin face with wrinkled skin, sunken cheeks, and large eyes; the loss of normal subcutaneous adipose tissue gives the face an old appearance; the abdomen may be swollen; they have sagging skin on legs and buttocks; they are irritable and have increased appetite | WHO (WFH z scores below median); severe, z score of <−3 or MUAC of <115 mm |
| Chronic malnutrition (stunting) | Malnutrition resulting from chronic or recurrent inadequate food intake and, possibly, chronic systemic inflammation; it leads to chronic growth faltering, typically evident by short stature for age, neurocognitive impairment, and metabolic changes associated with chronic adult diseases like diabetes mellitus or hypertension; the effects of chronic malnutrition are largely irreversible after 24 mo of age | WHO (HFA z scores below median); mild, z score between −1 and −2; moderate, z score between −2 and −3; severe, z score of <−3 |
| Underweight | Faltering of linear growth (low ht for age), wt gain (low wt for age), or a combination of both (acute on chronic malnutrition) | Median WFAb; mild (grade 1), 75%–90% WFA; moderate (grade 2), 60%–74% WFA; severe (grade 3), <60% WFA |
| Micronutrient deficiency | Deficit of essential vitamins and minerals required for normal physiological function, growth, and development; micronutrient deficiencies may have no overt clinical signs or symptoms unless they are chronic or severec | Based on biochemical measurements with comparison to reference values derived from normal populations |