This document discusses malnutrition in children under 5 years old. It begins by defining malnutrition as both undernutrition and overnutrition, caused by not enough or too much food, or the wrong types of food. The document then discusses the high burden of malnutrition in India, where 47% of children under 3 are malnourished. It presents different classifications of protein-energy malnutrition, including Gomez classification based on weight-for-age and Waterlow classification based on height-for-age and weight-for-height. The classifications define grades of mild, moderate, and severe malnutrition.

1. MALNUTRITION UNDER 5yr
Presented by – Ashwin Gobbur
Guide – Dr.Shashank

2. SUB - TOPICS
INTRODUCTION
DISEASE BURDEN
PROBLEM STATEMENT
CLASSIFICATION

3. INTRODUCTION
 Malnutrition essentially means “bad nourishment”. It
concerns not enough, as well as too much food, the
wrong types of food, or the inability to use nutrients
properly to maintain health.
 The World Health Organization cites malnutrition as
the greatest single threat to the world's public health.
 Malnutrition in all its forms is a considerable public
health concern and is associated with increased risk of
disease and early death.

4. MALNUTRITION
The WHO defines malnutrition as
"the cellular imbalance between supply of
nutrients & energy and the body's demand
for them to ensure growth, maintenance, and
specific functions”.
Malnutrition comprises both;
 Under nutrition
 Over nutrition

5. TYPES OF MALNUTRITION
 Under nutrition is depletion of energy (calories)
resulting form insufficient food intake over an extended
period of time.
 In extreme cases under-nutrition is called Starvation.
While Famine is severe food shortage of a whole
community.
 Specific Deficiency is the pathological state resulting
form a deficiency of an individual nutrient such as
vitamin A deficiency, iodine deficiency.

6. Over nutrition :
 Many tend to think malnutrition only in terms of
hunger, however, overeating is also a contributing
factor.
 “Over nutrition is the pathological state resulting
from the consumption of excessive quantity of food
over an extended period of time”.
 Overweight and obesity are very common conditions in
developed society and are becoming more common in
developing societies and those in transition.

7. PROBLEM STATEMENT
 47 % of India’s children below 3yr are malnourished
(underweight). The world bank puts the number – at 60
million. This is out of a global estimated total of 146
million.
 27% of indian children under 5yr are categorised as
moderately or severely manourised.
 South Asia has the highest rates- and by far the largest
number – of malnourished children in the world .
 32 babies out of every 1000 born alive - die before their
first birthday.

8. CONTINUED…
At least half of Indian infant deaths are related
to malnutrition, often associated with
infectious diseases.
 Malnutrition impedes cognitive, social,
sensory and motor development - he will be
poor learner and later lower income earner.
 Worst effect occurs during pregnancy and
infancy, here its effects are irreversible.

9. GLOBAL BURDEN

10. Malnutrition Contributing to U 5
Mortality, 2008 (percent)

11. MALNUTRITION IN CHILDREN
Protein energy malnutrition
In children, protein–energy malnutrition is defined
by “measurements that fall below 2 standard
deviations under the normal weight for age
(underweight), height for age (stunting) and
weight for height (wasting)”.
Protein– energy malnutrition usually manifests
early, in children between 6 months and 2 years of
age and is associated with early weaning, delayed
introduction of complementary foods, a low-
protein diet and severe or frequent infections.

12. CLASSIFICATION OF PEM
a. Gomez’ classification : (weight for age)
The child’s weight is compared with a normal child
of same age.
WFA = weight of the child X 100
(%) weight of normal child of same age
Has prognostic value

13. Gomez contd …
• 90–110 % : normal nutritional status
• 75-89 % : mild malnutrition
• 60-74 % : moderate malnutrition
• <60 % : severe malnutrition
Drawbacks :
1. Cut-off of 90% of reference is high, Some
normal children may be classified into mildly
malnourished .
2. Difficult to know if low weight is due to acute
cause or chronic undernutrition.

14. b. Waterlow’s classification :
Waterlow’s classifies two groups for PEM
I. Malnutrition with retarded growth H/A
shortness or stunting
II. Malnutrition with low weight W/A
wasting
W/H
H/A
> M -2 SD <M -2 SD
> M -2 SD NORMAL WASTED
< M -2 SD STUNTED WASTED AND STUNTED

15. CLASSIFICAION DEFINITION GRADING
GOMEZ Weight below %
median WFA
Mild (grade 1) 75%–90% WFA
Moderate (grade 2) 60%–74% WFA
Severe (grade 3) <60% WFA
WATERLOW z-scores (SD) below
median WFH
Mild 80%–90% WFH
Moderate 70%–80% WFH
Severe <70% WFH
WHO (wasting) z-scores (SD) below
median WFH
Moderate -3%</= z-score < -2
Severe z-score < -3
WHO (stunting) z-scores (SD) below
median HFA
Moderate -3%</= z-score < -2
Severe z-score < -3
KANAWATI MUAC divided by
occipitofrontal head
circumference
Mild <0.31
Moderate <0.28
Severe <0.25
COLE z-scores of BMI for
age
Grade 1 BMI for age z-score < -1
Grade 2 BMI for age z-score < -2
Grade 3 BMI for age z-score < -3

16.  Mid arm circumference (MAC):
- Mid pont between olecranon and
acroian process
- Cross tape method
(cm)
- >13.5 ----- satisfactory nutrition
12.5 – 13.5 ----- mild-moderate
<12.5 ----- severely malnourished

17. AWARENESS RIBBON FOR
MALNUTRITION

18. THANK YOU