9.1  Anthropometric criteria for defining severe and moderate acute malnutrition

Table 9.1 overleaf shows the criteria (indicators) you need to use to decide the level of acute malnutrition. When the nutritional status of a child deteriorates in a relatively short period of time, the child can be said to have acute malnutrition. As you saw in Study Session 5, weight-for-height, MUAC and oedema are used to decide if someone is acutely malnourished or not. Oedema in children almost always signifies the presence of severe acute malnutrition. However, when using MUAC and weight-for height you need to use ‘cut-offs’ in order to determine whether a child has moderate acute malnutrition, severe acute malnutrition or no acute malnutrition.

Table 9.1  Indicators to classify the level of acute malnutrition.
IndicatorSevere acute malnutritionModerate acute malnutritionNo acute malnutrition
Children (6 months up to 18 years)
W/H (weight for height)Less than 70% of norm70-79.99%More than 80%
Oedema (bilateral and pittingPresent AbsentAbsent
MUAC (cm)Less than 11 cm11-11.99 cmMore than 12 cm
Adults (older than 18 years)
BMILess than 16Between 16-16.9918.5-24.99
MUAC (cm)

Less than 17 cm or

Less than 18 with recent weight loss or chronic illness

17-21 cm or

18-21 cm depending on presence of recent weight loss or chronic illness

No weight loss

As indicated in the table, there are different indicators for severe acute malnutrition and moderate acute malnutrition depending on whether you are measuring an adult or a child. If you look in the column ‘severe acute malnutrition’ (SAM) you will see that if a child’s weight/height measurement is less than 70% of the normal range for his age (which can also be written as <70%), then the child has an indicator of SAM. Another criterion is when the child’s MUAC is less than 11 cm (written as <11 cm).

The presence of one criterion is sufficient to categorise a patient as malnourished. If there is any one indicator from the severe acute malnutrition column, then the child or adult is classified as severely malnourished. If there is no indicator in the severe column, and there is at least one indicator in the moderate acute malnutrition column, then the child or adult is classified as moderately malnourished. If none of the indicators are in the severe acute malnutrition or moderate acute malnutrition column, that means all the indicators are in the normal range and the child or adult is classified as ‘no acute malnutrition’. You looked at how to measure oedema and MUAC in Study Session 5. Figure 9.1 overleaf reminds you how to do both of these measurements.

How to identify acute malnutrition in a child
Figure 9.1  How to identify acute malnutrition in a child. (Source: Federal Ministry of Health / UNICEF, 2007, EOS Poster)
  • What are the criteria used to classify someone as moderately malnourished?

  • Your answer will depend on whether you are classifying a child or an adult. For example, a child is classified as moderately malnourished if their MUAC is 11-11.99 cm, or if the weight-for-height is in the range of 70-79.99% of the normal range. Children who have oedema are suffering from severe acute malnutrition. For women, having a MUAC of 17-22 cm or a BMI of 16-16.99 indicates moderate malnutrition. However, women with a MUAC between 17-18 cm should be classified as severely malnourished if they have had recent weight loss or chronic illness.

Learning Outcomes for Study Session 9

9.2  Principles of management of moderate acute malnutrition