This document discusses different methods used to classify malnutrition, including their strengths and limitations. It describes Gomez's classification, which is based on weight-for-age and has the strengths of being simple and easy to measure but assumes all children of the same age have the same weight. Waterlow's classification uses weight-for-height and height-for-age to identify stunted, wasted, or stunted and wasted children. Mid-upper arm circumference is a quick field measurement of muscle mass but is not applicable for children under 1 year or over 5 years. The WHO classification uses z-scores to define levels of malnutrition but its standard values may not be appropriate for low- and middle-income countries.

1. METHODS TO CLASSIFY MALNUTRITION
STRENGTH AND LIMITATION
PBL 6

2. OBJECTIVES
Strengths and limitations of
• Gomez’ Classification
• Waterlow’s Classification
• Mid Arm Circumference
• WHO classification

3. METHODS OF CLASSIFICATION OF MALNUTRITION
Classification of malnutrition help to
identify the correct nutritional status
help in planning appropriate response
Most common Methods : Gomez’ Classification
Waterlow’s Classification
Mid Upper Arm Circumference
WHO classification

4. GOMEZ CLASSIFICATION
• Based on Weight retardation
• Calculated as
Weight for age : (wt. of child / wt. of normal child of same age )*100
Strength
• Based on only two simple parameters i.e. weight and age
• Relatively simple and easy to practice due to the easily measurable
parameters
• Easy to understand and interpret the result

5. Limitations
• It assume that all the children of a particular age will have same
weight
• It may be misleading in a sudden acute episode of malnutrition
• A cut off point of 90 % of reference is high
• In some situations (e.g. Orphan child) child age may be difficult to
determine
Modified Gomez classification lowers the cut off point and suggest
children up to 80% or more for weight for age is Normal.

6. WATERLOW’S CLASSIFICATION
It uses weight for height(recent alteration of nutritional status) and
height for age (nutrition over a long period)

8. Strength
• More informative about the process leading to malnutrition
• More comprehensive as it measure weight, height and
age
• Normal, Stunted , wasted or wasted and stunted child can
be identified easily

9. Limitations
• It requires standards of weight for age ratio
• Difficult to use in field as it requires measurement
of height or length

10. MID UPPER ARM CIRCUMFERENCE
(MUAC)
Benefits
• Relatively reliable for estimation of body’s muscle mass
• Quick and useful tool in field practice in community
• Useful in 1 to 5 year old child and in situations when exact age of
child is not known
• Less mathematical and technical skill needed.
Limitations
• Is not used in less than 1y and more than 5 year child
• Not applicable in generalized edema patient

11. WHO CLASSIFICATION
• Use of Z-score or SD score
SD score : (Observed value – median reference value )/ SD of
reference population
-2 to +2 : Normal
-2 to -3 : moderate malnutrition
< -3 : severe malnutrition
+2 to +3 : overweight
> +3 : obesity

12. Benefits
Usually prevalence of malnutrition of world population is
presented by this system
Limitations
Standard values of this system may be not appropriate for low
and middle income country (LMIC)

13. REFERENCES
• Park’s textbook of preventive and social medicine,23e
• Child nutrition and health, Ramesh k adhikari,Miriam E.
Krantz

14. Thank you