Pediatric Nutrition in Practice

Clinical Evaluation and Anthropometry 11

1

have intrauterine growth retardation (IUGR) or
be within the normal 10% of the population who
fall below this line. Long-standing IUGR results
in low weight, head circumference and length
(‘symmetrically’ small); catch-up growth is un-
likely. Infants with late IUGR are thin but may
have head circumference and length on a higher
centile, and subsequently show catch-up in
weight. It should be noted that rates of growth
vary in young children, and assessments should
be based on serial measurements. A short-term
energy deficit will make a child thin (low weight-
for-height = wasting). A long-term energy deficit
limits height gain (and head/brain growth), caus-
ing stunting. Children who are chronically un-
dernourished may be both thin and short.
Assessment of linear growth potential:

• Plot the height of both parents at the 18-year-
  old end of the centile chart


• Add together parental heights and divide by 2


• Add 7 cm (male child) or subtract 7 cm (fe-
  male) = mid parental height; mid parental
  height ± 8.5 cm (girl) or ± 10 cm (boy) = target
  height centile range

Anthropometric Indices and Definitions of
Malnutrition

Weight-for-height compares a child’s weight
with the average weight of children of the same
height, i.e. the actual weight/weight-for-height at
the 50th centile – for example, a 2.5-year-old girl
with height = 88 cm and weight = 9 kg: the 50th-

centile weight of a child who, at 88 cm, is on the

50th centile for height = 12 kg; therefore, weight-

for-height = 9/12 = 75% (‘moderate’ malnutri-

tion).

Weight-for-height can be expressed either as

percent expected weight or as z score. The z score

is commonly used when statistical comparisons

are made as it enables children of different sexes

and ages to be compared. A value on the 50th

centile would have a z score of 0, whereas values

on the 3rd and 97th centiles would be –2 and +2

SD, respectively. Mid-upper-arm circumference

(MUAC) provides a quick population screening

tool for malnutrition; reference charts are avail-

able [6]. MUAC may also be more appropriate for

some children in whom body weight is mislead-

ing (e.g. childhood cancer with large tumour

mass, liver disease with oedema). WHO stan-

dards show that in a well-nourished population

there are very few children aged 6–60 months

with an MUAC <115 mm; children below this

Ta b l e 1. Criteria for malnutrition

Obese Overweight Normal Mild

malnutrition

Moderate

malnutrition

Severe

malnutrition

Height-for-age, % 90 – 95 85 – 90 <85
Weight-for-height, % >120 110 – 120 90 – 100 80 – 90 70 – 80 <70
BMI >30 >25

Ta b l e 2. Wellcome classification of malnutrition

Marasmus <60% expected weight-for-age,

no oedema

Marasmic kwashiorkor <60% expected weight-for-age,

oedema present

Kwashiorkor <60 – 80% expected weight-for-

age, oedema present

Underweight <60 – 80% expected weigh-for-

age, no oedema

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 6–13
DOI: 10.1159/000360311