Classification of acute malnutrition in children 6 to 59 months of age

Clinical term	Clinical measure	Classification
Clinical term	Clinical measure	Moderate acute malnutrition	Severe acute malnutrition
Wasting*	Mid-upper arm circumference (MUAC)	11.5 to 12.4 cm	<11.5 cm
Wasting*	Weight-for-height Z-score (WHZ)^¶	–2 to –3	<–3
Kwashiorkor	Symmetrical pitting edema	Absent	Present^Δ

Children should be classified based on their most "severe" criterion. For example, if a child has moderate acute malnutrition by WHZ but severe acute malnutrition by MUAC, the child should be classified as having severe acute malnutrition. In 2023, the WHO proposed changes in nomenclature, such that severe acute malnutrition will be termed "severe wasting and/or nutritional edema" and moderate acute malnutrition will be termed "moderate wasting."

WHO: World Health Organization.

* Severe wasting is also known as marasmus. Either WHZ or MUAC criteria can be used independently to diagnose moderate or severe acute malnutrition.

¶ The Z-score (standard deviation score) is defined as the deviation of the value for an individual from the median value of the reference population, divided by the standard deviation of the reference population. In this case, the reference population is defined by WHO growth standards.

Δ All children with kwashiorkor (edematous malnutrition) are considered to have severe acute malnutrition regardless of other anthropometric measurements. The edema can be further classified as 1⁺ if it is only located in the feet or lower legs, 2⁺ if edema extends to the arms or upper body, or 3⁺ if it extends to the face.

Adapted from: WHO child growth standards and the identification of severe acute malnutrition in infants and children. A Joint Statement by the World Health Organization and the United Nations Children's Fund. World Health Organization and UNICEF, 2009. Copyright © 2009.

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Classification of acute malnutrition in children 6 to 59 months of age