Malnutrition in children can be measured in several ways: 1) Low birth weight indicates intra-uterine undernutrition from maternal malnutrition. 2) Childhood malnutrition has severe consequences if it occurs early in life, negatively impacting growth, health, development and productivity. 3) Common anthropometric indicators used to measure nutritional status in children under 5 include height-for-age, weight-for-age, weight-for-height, and mid-upper arm circumference. Stunting, wasting and underweight are classifications based on these measures.

1. Nutritional Status of Children
Measures, Estimates and
Explanations

2. Malnutrition Indicators
• Malnutrition indicators: Differ with respect
to the stage in one’s life cycle.
Nutritional Status of Children 2

3. Intra-uterine Undernutrition: Low
Birth Weight (LBW)
• Cause: Maternal malnutrition:
• Effect:
Malnutrition during intra-uterine life.
Retards the growth and development of the foetus
during pregnancy.
 The foetus is born with birth weight lower than
normal.
The cut-off value for birth weight is 2.5 kg(WHO).
 Babies born with birth weight <2.5 kg are LBW
babies.
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4. Childhood Malnutrition
• Severe consequences if it occurs early in life.
– Adverse impact on subsequent
growth, morbidity, cognitive
development, educational attainment and
productivity in adulthood.
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5. Nutrition status: Children U5
• Anthropometric Indicators:
 Height-for-age (HFA),
 Weight-for-age (WFA),
 Weight-for-height (WFH), and
 MUAC-for-age.
 Most sensitive indicators of food security, vulnerability
and overall socio-economic development of a country.
 Stunting, Wasting and Underweight.
 Z-score classification.
Nutritional Status of Children 5

6. Malnutrition Indicators
 Measure the clinical phenomena of malnutrition.
 Standard cutoff points are used internationally to define
under nutrition in children 6-59 months.
 The cutoff points for nutrition indicators are derived
from the WHO child growth standard population
(WHO standards) or NCHS reference population
(NCHS population).
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7. Stunting (low height-for-age)
• Cause: Chronic under nutrition retards growth of
a child by height.
• Stunting: child is shorter for its age.
• Information requirement: Estimates of height and
age.
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8. Stunting (low height-for-age)
• Low HFA identifies past or chronic under nutrition
(stunting)
• Stunting indicates reduced linear growth
 Cannot measure short-term changes in malnutrition
 For children <2 yrs of age, the term is length-for-
age/LA
 For children > 2 yrs age, the index is referred to as
height-for-age/HA
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9. Stunting: Classification
• Height-for-age up to -2SD = Normal
• Height-for-age <-2SD to -3SD = Moderate
• Height-for-age <-3SD = Severe
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10. Wasting (low weight–for-height)
• Cause: Acute, short-run malnutrition
Affects only body weight.
 “Wasting” of the body, i.e. loss of body mass
compared to the body size.
 Indicator: Weight-for-height.
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11. Wasting (low weight–for-height)
Weight for-height:
Low WFH identifies current or acute under
nutrition (wasting)
Useful when exact age is difficult to
determine
• - Weight for-length (< 2 yrs) or weight for-
height (in > 2 yrs)
- Appropriate for examining short-term effects
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12. Wasting: Classification
• Normal weight-for-height: If its weight-for-height is
within 2 standard deviations (-2SD) of the median
weight-for-height of a reference population.
• Moderately wasted: If the weight-for-height falls
below 2SD (<-2SD) but within 3 SD below the
reference median (-3SD).
• Severely wasted: If the weight-for-height falls below
3SD of the reference median (<-3SD).
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13. Wasting: Classification
• Weight-for-height up to –2SD = Normal
• Weight-for-height <-2SD to –3SD = Moderate
• Weight-for-height <-3SD = Severe
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14. Underweight (low weight-for-age)
Composite indicator of long-term and acute
short-term malnutrition.
The body weight may be lost from malnutrition
for a long time => low weight-for-age.
Weight may also be lost from acute, short-term
malnutrition => low weight-for-age.
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15. Underweight: Classification
• Normal weight-for-age: If weight-for-age is within 2
standard deviations (-2SD) of the median weight-
for-age of a reference population.
• Moderately underweight: If the weight-for-age falls
below 2SD (<-2SD) but within 3 SD below the
reference median (-3SD).
• Severely underweight: If the weight-for-age falls
below 3SD of the reference median (<-3SD).
Nutritional Status of Children 15

16. Underweight: Classification
• Weight-for-age up to -2SD = Normal
• Weight-for-age <-2SD to -3SD = Moderate
• Weight-for-age <-3SD = Severe
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17. Nutritional Status of Children 17

18. Mid- Upper Arm Circumference
(MUAC)
Low MUAC (<12.5 cm) indicates acute
malnutrition among children 6-59 months.
Is relatively easy to measure and a good
predictor of immediate risk of death.
Is used for rapid screening of acute
malnutrition.
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19. Nutritional Status of Children 19

20. Nutritional Status of Children 20

21. Undernutrition trends among <5 children in Bangladesh
80
65.8 68.3
70
60 64.6 57.4
64.2
51
50
51.4 47.8
Percent
43 44.6
48.3
40 43.1
42.4 41
30
20 16.7 16.6
14.4
12 12.7 17
13
10
1989/90 1992 1995 2000 2005 2007 2009
Underweight <5 Stunting <5
Wasting <5 MDG target for underweight
Source: 1990-2005 CMNS; 2007 BDHS; 2009 HFSNA
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22. Food consumption, energy and nutrient
intake and nutritional status in rural
Bangladesh: Changes from 1981 – 1982
to 1995 – 96
Source: Hels et al. (2003) 22

23. Nutritional Status of Children 23

24. Nutritional Status of Children 24

25. Nutritional Status of Children 25

26. Nutritional Status of Children 26

27. Nutritional Status of Children 27

28. Thank You