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Protein energy malnutrition classification

Introduction

Overview

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

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

References

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

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]