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Defining Undernutrition for Public Health Purposes in the United States^1,2,

Bureau of Parent, Child and Adolescent Health, Massachusetts Department of Public Health, Boston, MA 02111 ^* Department of Population Sciences, Harvard School of Public Health, Boston, MA 02115

Lack of consistency among definitions of undernutrition used for different public health purposes in the United States hinders an effective diagnosis of the problem and the design of interventions to prevent and treat undernutrition. No single-case definition of undernutrition is appropriate for all purposes. These purposes include surveillance of the prevalence of undernutrition in the population, epidemiological research on risk factors and consequences of undernutrition within population subgroups and communities, and screening, monitoring and evaluation of nutritional programs. We recommend that a cut-off of -2.0 SD (2.3 percentile) for weight-for-age, height-for-age, and weight-for-height on National Center for Health Statistics (NCHS) reference growth charts be used to estimate and monitor the prevalence of undernutrition in the United States, in accordance with guidelines of the World Health Organization. Epidemiological research on population-based risk factors for undernutrition and its functional consequences is required to identify the appropriate nutritional indicator and cut-off for screening and monitoring and evaluation of interventions.

KEY WORDS: • malnutrition • children • nutritional status • United States

¹ Presented as part of the "Symposium on the Identification and Prevalence of Undernutrition in the United States" during the joint meeting of the American Institute of Nutrition and the American Society for Clinical Nutrition held in conjunction with the 73rd Annual Meeting of the Federation of American Societies for Experimental Biology, New Orleans, LA, March 20, 1989. Supported in part by cooperative agreement HPU 880004-02-1 with the Office of Disease Prevention and Health Promotion, Public Health Service, Department of Health and Human Services.

² Guest editors for this symposium were William H. Dietz, New England Medical Center, Boston, MA, and Frederick L. Trowbridge, Centers for Disease Control, Atlanta, GA.

Manuscript received 6 December 1989. Revision accepted 6 April 1990.

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