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Protein Energy Malnutrition (PEM)

Under nutrition is widely prevalent health problem.

Indicators of malnutrition





Low height for age

Indicator of chronic malnutrition (Chronic illness, prolonged deprivation of foot)


Low weight for height

Suggest acute malnutrition (more recent illness and food deprivation)

Under weight

Low weight for age

Combined indicator of both acute and chronic malnutrition.



  1. Indian academic of Pediatrics (IAP)
    Weight of more than 80% - (N) of expected for age
    Grade I  71-80%
             II    61-70%
             III  51-60%
             IV    50% 

Alphabet K is post fixed in the presence of edema.


WHO: classification



Moderate malnutrition

Severe malnutrition

Symmetrical edema


Yes (Oedematous malnutrition)

Weight for height

SD score between -2 to -3

SD score < - 3 (Severe wasting)

Height for age

SD score between -2 to -3

SD score < - 3 (Severe stunting)


WHO classification:


WHO recommends three terms: Stunting, underweight and wasting (for children under five only)

  1. Stunting: Child below 2 standard deviation score from the median height for age of NCHS reference population.
  2. Underweight: Child weight below 2 SD from the median weight for age of NCHS Q reference population
  3. Wasting: Child weight below 2 SD from the median weight for height of NCHS reference population Q 

Welcome Classification-

  1. Kwashiorkor 60-80% of expected Weight with edema
  2. Under nutrition: 60-80% of expected weight for age without edema
  3. Marasmus : Wt < 60 without edema
  4. Marasmic -Kwashiorkor: Wt < 60 with edema

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