Definition and Classification of Malnutrition in Children

Definition and Classification

Malnutrition in children is defined as a state resulting from lack of intake or uptake of nutrition that leads to altered body composition, diminished physical and mental function, and impaired clinical outcomes, which can be classified based on etiology, chronicity, and severity, according to Clinical Nutrition 1
The European Society for Clinical Nutrition and Metabolism (ESPEN) criteria diagnose malnutrition by either BMI <18.5 kg/m² or combined weight loss with reduced BMI or reduced gender-dependent fat-free mass index (FFMI) 1, 6
Disease-related malnutrition (DRM) with inflammation can be chronic, associated with conditions like cancer, chronic infections, or acute, characterized by a strong inflammatory response 1, 2
Disease-related malnutrition (DRM) without inflammation is caused by conditions that limit food intake or nutrient absorption without significant inflammation, such as dysphagia, neurological disorders, or malabsorption syndromes 1, 3
Malnutrition/undernutrition without disease can be hunger-related, caused by food deprivation, or socioeconomic and psychological related, due to poverty, poor care, or self-neglect 1, 4, 5

Growth failure is a critical manifestation of malnutrition in children, seen in 15-40% of children with inflammatory conditions like IBD, and micronutrient deficiencies are common in malnourished children 7
Assessment of malnutrition in children should include anthropometric measurements, growth velocity assessment, clinical evaluation for signs of micronutrient deficiencies, evaluation of dietary intake, and laboratory assessment for nutritional deficiencies and inflammatory markers when appropriate 7
Regular nutritional screening is recommended for all children, especially those with chronic diseases, as early detection and treatment of malnutrition are essential to prevent adverse outcomes 7, 8
Documented malnutrition should be treated promptly as it worsens prognosis, complication rates, mortality, and quality of life 7