Nutritional Status of Children

Measures, Estimates and Explanations

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Malnutrition Indicators

• Malnutrition indicators: Differ with respect to the stage in one’s life cycle.

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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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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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Nutrition status: Children U5

• Anthropometric Indicators:Height-for-age (HFA),Weight-for-age (WFA), Weight-for-height (WFH), andMUAC-for-age. Most sensitive indicators of food security, vulnerability

and overall socio-economic development of a country. Stunting, Wasting and Underweight. Z-score classification.

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Malnutrition IndicatorsMeasure 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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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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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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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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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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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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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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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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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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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).

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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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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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Undernutrition trends among <5 children in Bangladesh

47.8

1713

44.6

57.4

68.3

41

51

65.8

43

43.1

51.4

64.264.6

48.3

42.4

14.4 16.7 16.612 12.7

10

20

30

40

50

60

70

80

1989/90 1992 1995 2000 2005 2007 2009

Source: 1990-2005 CMNS; 2007 BDHS; 2009 HFSNA

Perc

ent

Underweight <5 Stunting <5Wasting <5 MDG target for underweight

23

Food consumption, energy and nutrient intake and nutritional status in rural

Bangladesh: Changes from 1981 – 1982 to 1995 – 96

Source: Hels et al. (2003)

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