PROTEIN ENERGY MALNUTRITIONANTHROPOMETRY

• It is a valuable index for assessment of nutritional status of children

• Anthropometric parameters can be classified in to two group

I. Age dependent criteriaII. Age independent criteria when child`s age is not

known .

I. Age dependent criteria(a) Weight for age: – serial weight for age chart is most useful, most sensitive

and commonly applied method for supervising growth and identifying those with nutrition and health problems.

Classification of PEM (I.A.P)

Grade of malnutrition Weight for age standard (mean)%

Severity

Normal >80%

Grade 1 71-80% Mild

Grade 2 61-70% Moderate

Grade 3 51-60% Severe

Grade 4 <51% Very severe

b) Height for age :- compare child height with expected height/length

for a healthy reference child of the same age. It is not useful for early diagnosis as changes in

height occurs slowly.

II. Age independent criteria :- 1) Mid upper arm circumference(MUAC):-

Widely used and requires minimum equipments. Useful in screening large number of child during

medical emergency. Less useful in long term growth monitoring

programs.

• It is measured conventionally over the left upper arm (midway b/w acromian and olecranon in children b/w 1-5yr old)

• As MUAC increases rapidly in first yr of life (11-16cm)• Remain stable in 1-5yr (16-17cm)

Methods:-(a)Shakir`s tape :– fiber glass tape of accuracy 0.1cm

Red <12.5cm wasted Severe PEM

yellow 12.5-13.5cm borderline Mild-moderate

green >13.5cm normal normal

b) Bangle`s test :- In this test bangle of 4cm diameter is used If it passes above the elbow then upper arm circumference

is <12.5 cm, child is malnourishedc)QUAC stick test :- QU- quacker, A-arm,

C-circumference It is a rod with two sets of marking , one indicates the height and other indicates MUAC for corresponding height. If height is more than expected height for measured arm

circ. Then child is considered as malnourished.

c)Kanawati and Mc laren index:-It is a ratio b/w MUAC and Head circ.(HC)Measured in children b/w 3 month to 5yr old.

PEM RANGE

normal >0.31

mild 0.31-0.28

moderate 0.279-0.25

severe <0.25

d) MUAC and Height ratio:-In normal child 0.32-0.33In PEM <0.292) Ratio of chest circumference (CC) and head circumference(HC):- Jeliffe`s ratio:-

NORMAL P.E.M

HC=CC at 1 yr <1

CC>HC after 2 yr CC<HC

• 2) Skin fold thickness:- • It is an indicator of available calorie store in body in form of subcutaneous fat.• Sites : triceps , sub scapular region• Measured by: Herpenden`s caliper with an accuracy of

0.1mm• Value based on Tanner`s chart

PEM Skin fold thickness

Mild 6-10 mm

Moderate to severe <6 mm

Normal >10 mm in children age 1-6 yr

3) Weight for Height index:- (a) Rao`s and singh:- weight in kg divided by square of height in cm multiplied

by 100 Normal :- 0.14- 0.16 PEM :- 0.12 - 0.14 (b) Dugdale`s index:- Normal 0.88-0.97 ; PEM <0.79 (c) Body mass index :- weight in kg divided by square of height in m. Normal 18.5-24.99 PEM <16

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THANKS Presented by:- Shaan Ahmed 20 th batch Department of paediatrics KATIHAR MEDICAL COLLEGE KATIHAR