Protein energy malnutrition classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2], Syed Hassan A. Kazmi BSc, MD [3]

Overview

Protein energy malnutrition may be classified according to the ‘Gomez classification’ based on weight for age, or the ‘Waterlow’s classification’ based on stunting and wasting, or the ‘Welcome classification’ based on the presence or absence of edema.

Classification

The three different classification schemes of protein-energy malnutrition are described below:^[1]^[2]

(i) Gomez classification

General scheme

Definitions of general terms that are used in the classification of protein-energy malnutrition include the following:

Terminology	Meaning
Undrweight	Underweight for one’s age (Weight for age )
Stunted	Too short for one’s age (Height for age )
Wasted	Dangerously thin (Weight for height )
Micronutrient malnutrition	Deficient in vitamins and minerals (Hidden Hunger )

Grading

Grade of PEM	Weight for age (%)	General considerations and formula
Normal	90-100	Normal reference child is the 50th centile of the Boston standard Weight for age (%) = (Weight of the child / Weight of the normal child of same age ) X100
Mild malnutrition, Grade I	75-89
Moderate malnutrition, Grade II	60-74
Severe malnutrition, Grade III	Less than 60

(ii) Waterlow’s classification

General scheme

Feature	Basic definition
Stunting	Drop in height for age (< 90%)
Wasting	Drop in weight for height (<80%)
Under weight	Drop in Weight for Age (<80%)

Grading

Grade of PEM	Stunting (low height for age)	Wasting (low weight for height)
Normal	95	90
Mild malnutrition	87.5-95	80-90
Moderate malnutrition	80-87.5	70-80
Severe malnutrition	Less than 80	Less than 70

(iii) Welcome’s classification

Weight for age	With edema	Without edema	General considerations
60-80%	Kwashiorkor	Undernutrition	Weight for age +/- oedema Reference standard (50th percentile)
<60%	Marasmic kwashiorkor	Marasmus

References

↑ Bhattacharyya AK (1986). “Protein-energy malnutrition (Kwashiorkor-Marasmus syndrome): terminology, classification and evolution”. World Rev Nutr Diet. 47: 80–133. PMID 3088855.
↑ Waterlow JC (1976). “Classification and definition of protein-energy malnutrition”. Monogr Ser World Health Organ (62): 530–55. PMID 824854.

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[pmid3088855-1] Bhattacharyya AK (1986). “Protein-energy malnutrition (Kwashiorkor-Marasmus syndrome): terminology, classification and evolution”. World Rev Nutr Diet. 47: 80–133. PMID 3088855.

[pmid824854-2] Waterlow JC (1976). “Classification and definition of protein-energy malnutrition”. Monogr Ser World Health Organ (62): 530–55. PMID 824854.

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