Defining Pediatric Malnutrition

TLDR

Pediatric malnutrition is an imbalance of nutrient intake that impairs growth and development, yet a lack of a uniform definition causes underrecognition of its prevalence and impact, and it is classified as illness‑related, non‑illness‑related, or both. The study proposes a new classification scheme for pediatric malnutrition that incorporates chronicity, etiology, mechanisms of nutrient imbalance, severity, and outcomes, and calls for future research on inflammation’s role in illness‑related malnutrition. A workgroup reviewed English‑language pediatric literature from 1955 to 2011 across five domains—anthropometry, growth, chronicity, etiology/pathogenesis, and developmental outcomes—and through iterative multidisciplinary consensus developed a new definition that incorporates these domains and proposes a classification scheme. The authors anticipate that the definition will evolve as understanding of underlying processes improves, and that a uniform definition will enable research on functional outcomes and strengthen evidence‑based nutrition practices.

Abstract

Lack of a uniform definition is responsible for underrecognition of the prevalence of malnutrition and its impact on outcomes in children. A pediatric malnutrition definitions workgroup reviewed existing pediatric age group English‐language literature from 1955 to 2011, for relevant references related to 5 domains of the definition of malnutrition that were a priori identified: anthropometric parameters, growth, chronicity of malnutrition, etiology and pathogenesis, and developmental/ functional outcomes. Based on available evidence and an iterative process to arrive at multidisciplinary consensus in the group, these domains were included in the overall construct of a new definition. Pediatric malnutrition (undernutrition) is defined as an imbalance between nutrient requirements and intake that results in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. A summary of the literature is presented and a new classification scheme is proposed that incorporates chronicity, etiology, mechanisms of nutrient imbalance, severity of malnutrition, and its impact on outcomes. Based on its etiology, malnutrition is either illness related (secondary to 1 or more diseases/injury) or non–illness related , (caused by environmental/behavioral factors), or both. Future research must focus on the relationship between inflammation and illness‐related malnutrition. We anticipate that the definition of malnutrition will continue to evolve with improved understanding of the processes that lead to and complicate the treatment of this condition. A uniform definition should permit future research to focus on the impact of pediatric malnutrition on functional outcomes and help solidify the scientific basis for evidence‐based nutrition practices.