Severe acute malnutrition

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Causes of severe acute malnutrition

Severe acute malnutrition is a life threatening situation and requires immediate treatment.

Undernourishment occurs primarily in situations of extreme poverty, famine, drought, floods, wars and other natural calamities. The loss and disappearance of wherewithal of livelihood devastates individuals, communities, populations and nations.
In such conditions primarily children and also adolescents and adults have the grave risk of acute malnutrition.

Acute malnutrition is also seen in situations of total dependency as seen in elderly people, prisoners and people with mental illness.
All their nutritional needs are to be cared for by others.
Acute malnutrition is also found among people suffering chronic infections and illness, malabsorption in intestines, liver and renal diseases, autoimmune and endocrine diseases, drug abuse, alcohol dependence and HIV/AIDS.

In children severe acute malnutrition occurs, not only due one or more of the above causes, but also due to long standing emotional and nutritional deprivation by carers due to poverty, family problems and poor understanding.
Successful management of acute malnutrition requires seeking total cooperation from the carers and also educating them so that the malnutrition does not relapse.

The definition of severe malnutrition and aid criteria of WHO/UNICEF for children

WHO reference criteria for malnutrition is, "Severe malnutrition is defined as a weight for length or height of less than 70% of the WHO reference, equivalent to a SD Score of less than -3, and/or nutritional oedema."
These WHO criteria are established upon level of stunting or wasting and the presence or absence of edema.

The weight of the child for her or his height, and the for her or his age are referred as Z-scores, reckoned as the observed value minus the average (median) value of the population under reference divided by the standard deviation of the population under reference,

where x stands for the raw score under standardization, μ stands for the mean value of the population and σ stands for the standard deviation of the population.
The values are of significance when they are from the actual population parameters and not from samples. WHO MUAC (mid-upper arm circumference) is also considered for identifying severe acute malnutrition (SAM) in children, the recommended value being 115 mm.

Defining malnutrition in adolescents and adults

The Body mass index (BMI) is the main factor for indicating level of undernourishment in adults.
Body mass index is calculated by dividing the body weight by the square of height as shown in the table below for International System of Units (SI units) and Imperial units.

International system of unit BMI =	mass(kg)
	_________
	(height(m)2

Imperial units

Nutritional status with respect to BMI

BMI	Nutritional status
below 16.0	Severe malnutrition
16.0-16.99	Moderate undernourishment
17.0-18.49	Mild undernourishment
18.5-24.99	Normal
25.0-29.99	Overweight
30.0 and above	Obesity

In adults, who cannot stand due to weakness or deformity, half arm span of the both the arms is measured and greater value is taken.
"Half arm span is the distance from the middle of the sternal notch to the tip of the middle finger; the arm should be held out horizontally to the side."
By good management programme, severe acute malnutrition can be managed successfully with minimum life loss, by immediate resuscitation, treatment of infection and reversal of abnormalities in metabolism.

Related topics of interest:
What is malnutrition
Causes of malnutrition
Nutrition disorders
Balanced nutrition
Balanced healthy diet

Current topic: Severe acute malnutrition