Malnutrition and Growth

JPGN Volume 51, S M alnutrition may be defined as ‘‘a state of nutrition in which a deficiency, excess or imbalance of energy, protein, or other nutrients, including minerals and vitamins, causes measurable adverse effects on body function and clinical outcome.’’ In children, impairment of growth is clearly an adverse effect and is easily measurable by simple anthropometry. Because malnutrition can also be regarded as a continuum starting with a nutrient intake inadequate to meet physiological requirements, followed by metabolic and functional alterations, and ultimately by changes in body composition, classification based solely on commonly used growth criteria is not just arbitrary—it tells only part of the story. Definitions in common usage for inpatients were developed by field workers in resource-poor countries attempting to determine the effect of food availability on local populations. How valid these are when considering the effect of nutritional status on disease outcomes in hospitalised children in developed countries is at least open to question. For example, where food is scarce, children between 1 and 2 SD deviations below the mean of weight for height (equivalent to Waterlow malnutrition grade 1) (1) may well be a vulnerable group (with increased risk of death from infection), but for many hospitalised children in developed countries with acute, short-term illness, this may indicate no more than having a thin physique or a temporary weight loss that will be made good within days of recovery and discharge home. For them to be classified as ‘‘at risk’’ (2) begs the question, ‘‘at risk for what?’’