Table 2

Severe malnutrition definition

SEVERE MALNUTRITION
= ‘Any form of malnutrition (undernutrition) associated with high risk of severe adverse outcomes’
This encompasses different:
Criteria
(manifestations/forms of malnutrition)		Cut-offsCauses

  • Stunting: low height-for-age

  • Underweight: low weight-for-age

  • Wasting: low weight-for-length/ height

  • Low MUAC (mid-upper arm circumference)

  • CONCURRENCE of above

Also included are:

  • Oedematous malnutrition (kwashiorkor)

  • Micronutrient malnutrition*

In most contexts, standard anthropometric cut-offs apply:

  • <−3z=severe deficit=high risk

  • <−2z=moderate deficit=moderate risk but could be high risk in some settings (eg, humanitarian) and for some children (eg, those with underlying illness)

 Imbalance of nutrients vs requirements is key, but cause(s) must also be considered:

  •  ⇩ availability of food


 eg, seasonal variation; humanitarian crisis

  •  In-utero insults


 eg, reflected by low birth weight

  •  Underlying disease causing:


 ⇩ intake (eg, disability causing swallow problems) and/or
 ⇩ absorption (eg, gut disorders) and/or
 ⇧ utilisation (eg, acute infection, chronic infection like TB or HIV or heart disease)

  •  Prevention and care services

  • MUAC (for ages 6–59 months): <125mm=low; <115mm=very low

There is also flexibility to use other cutoffs, determined by severity of outcome.

  • *Space does not allow full discussion of micronutrients, but these are common alongside other forms of malnutrition and should always be considered.