A new classification of acute protein-energy malnutrition

Abstract

Current schemes to classify protein-energy malnutrition (PEM) in hospitalized children below 5 years of age in developing countries are of limited usefulness, because age is often not known and wasted children are insufficiently discriminated. In this study, a newly proposed scheme, based on the presence of wasting (weight-for-height < or = -2 z scores) and oedema, was compared with clinical and the original Wellcome criteria to classify PEM in 538 under-fives hospitalized for PEM in a rural hospital in Nchelenge, Zambia. Wasting in the absence of oedema was clinically false-positively diagnosed in 34.0 per cent, whereas the Wellcome classification gave rise to 28.6 per cent false-positive and 39.9 per cent false-negative diagnosis. In the presence of oedema, clinical diagnosis of wasting was 44.7 per cent false-positive and 41.4 per cent false-negative, while the Wellcome scheme had a false-negative rate of 54.3 per cent. We conclude that the Wellcome classification did not add to the clinical diagnostic accuracy of PEM as opposed to the proposed scheme, which merits further study. In an Appendix the use and calculation of z scores of weight-for-height is further explained.

Persistent diarrhea: Risk factors and outcome

“…Use of Z-score to diagnose malnutrition has the advantage that unlike percentage of median, the interpretation is consistent across all ages. 10 Close association between diarrhea and malnutrition has been well recognized and PD had been rightly considered as a nutritional disorder. 9,11 The apparent association of malnutrition with PD could have been biased if children who were malnourished had an inherently increased risk for PD because of other risk factors.…”

Mechanisms of nutrient modulation of the immune response

“…30 The presentation of PCM, including the age of the child, is critical for severity of immune deficiency and mortality. 31 Many more children in developing countries have slow growth, low-grade infections, and low energy levels, without overt manifestations of malnutrition. 32 Primary malnutrition leads to atrophy of the lymphoid organs, profound T-lymphocyte deficiency, and increased susceptibility to pathogens, reactivation of viral infections, and development of opportunistic infections.…”

Low plasma ghrelin levels in children with severe protein energy malnutrition

“…5 The children were divided in to four groups namely marasmus, kwashiorkor, marasmic kwashiorkor and controls on the basis of the classification suggested by Gernaat and Voorhoeve, based on the presence or absence of edema and z-score of weight for height (as a measure of wasting). 15 Children were recruited from the inpatient department and nutrition clinic of their hospital as done in present study. They used radioimmunoassay (RIA) in contrary to enzyme immunoassay for plasma Ghrelin measurement in present study.…”