Nutritional Assessment And Indices

Ideal Way of Assessment

A person's approach should be workable, affordable, and extremely sensitive.  No single test can meet every need of the perfect evaluation.
It is more sensitive than the nutritional index when there is an increase in the rate of height and weight due to frequent visits, which are represented in charts.  Using growth charts, the pace at which a child's height and weight increase provides the most accurate indicator of their nutritional status.

Commonly used parameters

• Weight for age
• Weight for height
• Height for age
• Body Mass Index
• Mid-upper arm circumference is usually used in children under 5 years.
• Head circumference used for children <2 years of life.

Weight for Age

Frequently used, most straightforward, and compatible with several classification schemes: the Gomez and Indian Academy of Pediatrics categories both make use of it.  To determine the percentage weight for an age, divide the child's actual weight by their ideal weight for that age. Then, multiply the result by 100. 
Weight for Age is not regarded as a sensitive index since it cannot differentiate between acute and chronic Protein Energy Malnutrition; if a child's weight is less than 80% of anticipated, they are underweight.  In cases of acute or chronic protein energy malnutrition, weight for age can be reduced.  In children with oedema, weight for age might be misleadingly high, making it insensitive. For instance, Kwashiorkor.

Also Read: DYSLEXIA – Types, Clinical features and Management

Weight for Height

For this parameter, age is not necessary. It is therefore regarded as an age-independent index.  The Waterlow Classification and the WHO Classification both use it. The Z score or Standard Deviation (SD)/Percentile might be used to interpret it.  The child has wasted if the weight for height is less than -2 SD or -2 Z score. 
The child exhibits severe wasting if the weight for height is less than -3 SD.  Acute Protein Energy Malnutrition is indicated by Wasting.  Severe malnutrition has no effect on weight for height.  It's an extremely sensitive marker for acute malnutrition of protein and energy. Plotting on the chart allows for the interpretation of weight for height.

Also Read: Navigating the Developmental Journey of Children: Significant Events and Beyond

Height for Age

The Waterlow Classification and the WHO Classification both use this age-dependent characteristic.  Stunting results when height for age is less than 90% of predicted or falls below a -2 S.D. or -2 Z score. 
• Chronic protein and energy malnutrition is indicated by stunting.
• A youngster is considered stunted if their SD falls between -2 and -3.
• A youngster is considered severely stunted if their height is less than -3 SD.

Growth velocity and Growth velocity index

High Velocity is another name for Growth Velocity.  To calculate Growth Velocity, take the current height and remove the previous height. Then, divide the result by the number of years.  To calculate the Growth Velocity Index, divide the current child's growth velocity by the growth velocity of a typical child of the same age, then multiply the result by 100.  These measures, which are uncommon, point to persistent protein and energy deficiency.

Body mass index for Age

Weight in kilos divided by height in meters squared yields the BMI.  The BMI is defined using percentiles.  A youngster with a BMI between -2 and -3 Z score is classified as having moderate protein-energy malnutrition.  A youngster is severely malnourished in protein and calories if their BMI is less than the -3 Z score.  An elevated BMI over 95 centiles indicates obesity.

Age Independent Index

• Weight for height
• Mid-upper arm circumference
• Shakir's tape
• Bangle method
• Rao and Singh Index
• Dugdale Index 
• Kanawati and MacLaren Index
• Jeliffe's ratio
• Quac Stick Method

MID Upper ARM Circumference

Children aged six months to five years old are used for measurement.  It doesn't change from six months to five years of age.  The range of 15 to 17 cm is typical.  It indicates mild protein energy malnutrition if it is less than 12.5 cm. 

A measurement of less than 11.5 cm indicates severe malnourishment.
This is referred to as the WHO or Arnold's categorization. The Shakir Tape Method is predicated on the MUAC Principle.  Shakir's tape is draped in a hanging fashion over the middle of the left upper arm. A measurement is made at the midway, which is between the olecranon and acromion processes. 

This is what the updated WHO classification indicates:
• Severe malnutrition is indicated if the measurement falls under the red zone (MUAC < 11.5 cm).
• A measurement that falls between 11.5 and 12.5 centimeters, called the yellow zone, suggests borderline malnutrition.
• If the measurement is in the green zone (MUAC > 12.5 cm), the infant is nourished appropriately. 

Bangle Test

A specific metallic bracelet with an interior diameter of 4 cm that is supplied by ICMR. We take this bangle and attempt to thread it through the elbow.It is a sign of severe protein energy deficiency if it crosses the elbow.  A extremely unpopular and rudimentary test.

Obsolete Indices

• Normal values of Dugdale's Index range between 0.88-0.97.
• The normal values of Rao's index are 0.15-0.16.
• The normal value of the Kanawati index is 0.32-0.33.

Jelliffe Ratio

The computation involves dividing the head circumference in centimeters by the chest circumference.  Because the chest circumference is less than the head circumference in newborns under a year old, the JELIFFE'S RATIO is greater than 1. As head circumference grows greater than chest circumference after one year of life, the ratio falls below 1.  The child is malnourished if the ratio remains greater than one after post-infancy age.

Quac Stick Method

The MUAC estimate for a specific height serves as its foundation.  Following that, a chart is produced, and the percentage is determined.  It indicates that the youngster may be malnourished if it is less than 70% of what is predicted.  If the child's results are over 80%, they are considered normal.  It is an outdated approach; results between 70 and 80% suggest that the child has borderline malnutrition.

Suggested Growth Monitoring in Children of Different Ages

All newborns must have their weight, length, head circumference, and ponderal index measured using the IUGR.  Infants need to have their height, weight, and head circumference measured. It is mandatory to measure an infant's height, weight, and head circumference every six months between the ages of six months and three years.
• Children aged 3 to 5.5 years old must have their height and weight measured every six months.
• Children aged 6 to 8 years old must have their height, weight, and BMI measured every six months.
• For children aged 9 to 18, annual measurements of height, weight, BMI, and sexual maturity rating are required.

Also Read: NEET SS Pediatrics Growth and Development Questions

Hope you found this blog helpful for your Growth and Development NEET SS pediatrics preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.