Protein energy malnutrition

CLASSIFICATION OF PEM

. Syndromal Classification

🔺Kwashiorkor
🔺Nutritional marasmus
🔺Marasmic kwashiorkor
🔺Prekwashiorkor
🔺Nutritional dwarfing (Stunting)

. Gomez Classification

According to this classification, PEM is graded with reference to the weight for age as percentage of the expected weight (Harward standard):

🔺First degree : Weight between 90 and 75% of
expected for age
🔺Second degree : Weight between 75 and 60% of
expected for age
🔺Third degree : Weight below 60% of expected.

. Wellcome or International Classification

Weight between 80 and 60% of expected for age:
🔺with edema:
kwashiorkor
🔺without edema: undernutrition

Weight below 60% of expected
🔺with edema:
marasmic kwashiorkor
🔺without edema:
nutritional marasmus

. Classification of the Indian Academy of
Pediatrics (IAP)
🔺First degree : Weight between 80 and 70% of
expected for age
🔺Second degree : Weight between 70 and 60% of
expected for age
🔺Third degree : Weight between 60 and 50% of
expected for age
🔺Fourth degree : Weight below 50% of expected
(In case the child has demonstrable pitting edema, the letter "K” is placed in front of the evaluated grade.)

. Jellife Classification
🔺First degree : Weight between 90 and 80% of
expected
🔺Second degree : Weight between 80 and 70% of
expected
🔺Third degree : Weight between 70 and 60% of
expected
🔺Fourth degree 2 Weight below 60% of expected

. McLaren Classification
🔺Mild : Weight between 90 and 80% of
expected
🔺Moderate : Weight between 80 and 70% of
expected
🔺Severe : Weight below 70% of expected
All these classifications recommended Harvard
standard as the reference standard (now obsolete).
☑CDC reference standards are the current
recommendation.

. Waterlow Classification
🔺Acute (wasted but
not stunted) : Weight for height low, height for age normal
🔺Acute/chronic (wasted and stunted) :Weight for height low, height for age low
🔺Nutritional dwarfing (stunted but not wasted) : Weight for height normal,  height for age low