PE9.1-7,PE10.1-6,PE11.1-4 | Nutrition Assessment and Support — Glossary

A dietary assessment method in which the caregiver is asked to describe all food and beverages consumed by the child in the preceding 24 hours, with estimation of quantities using household measures; the standard quantitative dietary intake method in clinical practice.

Waist circumference >90th percentile for age and sex on reference charts; indicates excess visceral adiposity; a component criterion of paediatric metabolic syndrome (IDF).

Velvety, hyperpigmented thickening of the skin, typically at the neck nape, axillae, and groin, caused by hyperinsulinaemia driving epidermal proliferation; a key cutaneous marker of insulin resistance.

Cytokines secreted by adipose tissue, including leptin (satiety signal), adiponectin (insulin sensitiser), resistin, and TNF-α; imbalance in obese adipose tissue drives insulin resistance and systemic inflammation.

An eating disorder characterised by significantly low body weight, intense fear of weight gain, and disturbed body perception; associated with amenorrhoea, bradycardia, prolonged QTc, osteoporosis, and the highest mortality rate of any psychiatric disorder (~5-10%).

A practical bedside test for SAM management eligibility: the child is offered RUTF (approximately 1/4 sachet); if consumed enthusiastically, the child passes and is eligible for outpatient/community-based management; failure indicates medical complication or severe anorexia requiring inpatient care.

Surgical interventions (Roux-en-Y gastric bypass, sleeve gastrectomy) for morbid obesity; rarely indicated in paediatrics; criteria include BMI ≥40, physiological maturity (Tanner ≥4), failure of lifestyle therapy, and no uncontrolled psychiatric illness.

The minimum energy expenditure required to maintain basic physiological functions at rest in a thermoneutral environment; scales with lean body mass and body surface area.

Triangular, grey-white, foamy plaques on the temporal bulbar conjunctiva; pathognomonic of vitamin A deficiency; composed of desquamated keratinised epithelium colonised by xerophthalmia-associated bacteria.

Progressive tibia vara (medial bowing of the tibia) caused by excessive mechanical load on the medial proximal tibial growth plate; associated with obesity and leads to knee pain and gait abnormality.

A standardised index of adiposity for children and adolescents that plots BMI against age-sex-specific z-scores or percentiles; the WHO 2007 Reference classifies overweight as ≥+1 SD and obesity as ≥+2 SD; adult BMI cut-offs (25/30) must NOT be applied to individuals under 18 years.

An eating disorder characterised by recurrent binge-eating episodes followed by compensatory behaviours (purging, laxative use, excessive exercise); associated with hypokalaemia, dental erosion, parotid enlargement, and Russell's sign; weight may be normal.

The accelerated rate of weight gain and linear growth achieved by a previously malnourished child during nutritional rehabilitation; requires 150-200% of estimated average energy requirement per kilogram per day to achieve.

A structured psychological therapy that targets dysfunctional thought patterns and behaviours; the first-line evidence-based psychotherapy for bulimia nervosa; also used as a component of eating disorder management in adolescents.

The first breast-milk secreted in the first 3-5 days postpartum; protein- and immunoglobulin-rich (particularly sIgA), lower in fat than mature milk, with specific neonatal immunoprotective properties.

The introduction of solid or semi-solid foods alongside continued breastfeeding at 6 months of age, necessary because breast milk alone can no longer meet all nutritional needs after this point.

A long-chain omega-3 polyunsaturated fatty acid essential for brain and retinal development in infancy; present in breast milk and added to infant formulas; the most abundant fatty acid in cerebral cortex membranes.

The co-existence of under-nutrition (anaemia, stunting, micronutrient deficiencies) and over-nutrition (obesity, metabolic syndrome) within the same population, household, or individual; characteristic of rapidly urbanising low- and middle-income countries including India.

The caloric content of a food per unit weight (kcal/100g); high-energy-density foods (fats, oils, dried cereals) provide more calories per gram than low-density foods (fruits, vegetables, watery porridges).

Feeding an infant only breast milk (no water, formula, or solid foods) for the first 6 months of life, as recommended by WHO and IAP.

A rehabilitation-phase therapeutic formula providing 100 kcal/100 mL with higher protein (2.9 g/100 mL); given at 150-220 mL/kg/day to achieve catch-up weight gain of 10-15 g/kg/day.

A stabilisation-phase therapeutic formula providing 75 kcal/100 mL with low protein (0.9 g/100 mL); given at 100-130 mL/kg/day in 8-12 divided feeds to prevent refeeding syndrome while correcting metabolic derangements.

Alternating bands of depigmented and normally pigmented hair seen in kwashiorkor; each band of depigmentation corresponds to a period of protein deficiency, and the return to normal colour reflects periods of nutritional recovery.

A skin change in kwashiorkor characterised by hyperpigmented plaques that peel to leave pale or erythematous areas; most pronounced in pressure areas and skin folds; reflects protein deficit and micronutrient deficiency affecting skin integrity.

A dietary assessment tool that quantifies how often a child consumes specific food groups over a defined period (daily, weekly, monthly); assesses dietary diversity and usual pattern rather than precise caloric intake.

The horizontal anatomical reference plane defined by the lower orbital margin and the upper border of the external auditory meatus; the head is held in the Frankfurt plane during height measurement to ensure reproducibility.

A nutritional classification based on weight-for-age as a percentage of the reference median: Grade I (75-90%), Grade II (60-75%), Grade III (<60%); an older system now largely replaced by WHO z-scores in research but still used in clinical practice.

A hepatic peptide hormone that regulates iron absorption and recycling; upregulated by inflammation and adiposity; in obese adolescents, elevated hepcidin suppresses intestinal iron absorption, contributing to the co-existence of anaemia and obesity.

Circumference of the pelvis measured at the widest point of the buttocks, approximately at the level of the greater trochanters; used with waist circumference to calculate the waist-hip ratio.

A formula for calculating daily maintenance caloric requirements based on body weight: 100 kcal/kg for the first 10 kg, plus 50 kcal/kg for the next 10 kg (10-20 kg), plus 20 kcal/kg for each kilogram above 20 kg.

India-specific growth reference charts for children 0-18 years published by the Indian Academy of Pediatrics; recommended for clinical use in India because they better reflect the growth potential of Indian children than the WHO Standards.

The Recommended Dietary Allowances for Indians (2020) published by the Indian Council of Medical Research - National Institute of Nutrition; the current national reference for nutrient requirements by age, sex, and physiological state.

Reduced responsiveness of target tissues (muscle, liver, adipose) to insulin, leading to compensatory hyperinsulinaemia; the central metabolic derangement linking obesity to type 2 diabetes and metabolic syndrome.

A spectrum of conditions caused by inadequate iodine intake, including goitre, hypothyroidism, cretinism, and impaired cognitive development; prevented by universal use of iodised salt under the NIDDCP in India.

Skin-to-skin contact between a mother and her infant, typically with the infant positioned on the mother's chest; the most effective non-pharmacological warming method for hypothermic SAM children; also promotes breastfeeding and bonding.

Spoon-shaped deformity of the fingernails, a clinical sign of chronic iron-deficiency anaemia; nails become soft, thin, and concave rather than convex.

A clinical type of SAM characterised by bilateral pitting oedema, flaky-paint dermatosis, hair discolouration and laxity, moon face, hepatomegaly, and apathy; caused predominantly by protein deficit with relatively preserved carbohydrate intake; hypoalbuminaemia drives oedema.

Fine, soft, downy body hair that appears in patients with severe anorexia nervosa as a thermoregulatory response to loss of subcutaneous insulating fat; a clinical sign of severe nutritional depletion.

The most severe form of SAM combining severe wasting (WHZ < −3 SD) and bilateral oedema; indicates combined energy and protein depletion; carries the highest mortality risk.

A clinical type of SAM characterised by severe wasting (weight-for-height < −3 SD or MUAC <11.5 cm), loss of subcutaneous fat and muscle, 'old-man face', loose skin folds, and absence of oedema; caused by severe energy-protein deficit.

A cluster of cardiometabolic risk factors — central obesity, hypertriglyceridaemia, low HDL, hypertension, impaired fasting glucose — in adolescents; driven by insulin resistance from visceral obesity; predicts adult cardiovascular disease and type-2 diabetes.

Waist circumference >90th percentile for age/sex PLUS ≥2 of: triglycerides ≥150 mg/dL, HDL <40 (boys)/<50 (girls) mg/dL, BP ≥130/85 mmHg, fasting glucose ≥100 mg/dL; applies to children ≥10 years.

A vitamin or mineral required in small quantities (milligrams to micrograms per day) for essential metabolic functions; deficiency causes specific clinical syndromes even when energy intake is adequate.

A measurement of the circumference of the left upper arm at the midpoint between the acromion and olecranon processes; the primary community-level screening tool for acute malnutrition, with cut-offs <11.5 cm (SAM) and 11.5-12.5 cm (MAM) for children aged 6-59 months.

A less severe but clinically significant form of acute malnutrition defined by weight-for-height z-score −2 to −3 SD or MUAC 11.5-12.5 cm, without oedema; managed at community level with RUTF or supplementary feeding.

A patient-centred counselling technique that strengthens intrinsic motivation for behaviour change by exploring and resolving ambivalence; particularly effective for adolescent obesity counselling because it avoids shaming and respects autonomy.

Non-alcoholic fatty liver disease: excess hepatic fat deposition (>5% of hepatocytes) in the absence of alcohol use; presents with elevated ALT and hepatomegaly; a common complication of childhood obesity.

Hepatic steatosis in the absence of alcohol use; increasingly common in obese adolescents in India; driven by insulin resistance and visceral adiposity; can progress to NASH (non-alcoholic steatohepatitis) and cirrhosis.

The predominant form of iron in plant foods (cereals, legumes, vegetables); has lower bioavailability (2-10%) compared to haem iron from animal sources (15-35%); absorption is enhanced by vitamin C and inhibited by phytates and tannins.

A dedicated inpatient facility (typically integrated within district/sub-district hospitals under NHM) providing WHO-protocol-based management of SAM with caregiver education, F-75/F-100 feeding, and community follow-up linkage.

BMI-for-age ≥95th percentile per IAP/WHO growth charts; indicates excess body fat with clinically significant health risk.

Episodic upper-airway obstruction during sleep leading to apnoeas, oxygen desaturation, and fragmented sleep; present in up to 40% of severely obese children; causes daytime somnolence and may lead to pulmonary hypertension.

Pancreatic lipase inhibitor that reduces dietary fat absorption by ~30%; the only pharmacological agent approved for obesity management in adolescents ≥12 years in India; adverse effects include steatorrhoea and fat-soluble vitamin malabsorption.

BMI-for-age ≥85th and <95th percentile per IAP/WHO growth charts; indicates excess body weight relative to age and sex peers.

Blood pressure classified by age-, sex-, and height-specific percentile tables: <90th = normal; 90th–94th = elevated; ≥95th = stage 1 hypertension; >99th + 12 mmHg = stage 2 hypertension.

An endocrine disorder in adolescent girls characterised by hyperandrogenism (hirsutism, acne), oligo/anovulation (irregular periods), and often polycystic ovaries on ultrasound; strongly associated with obesity and insulin resistance.

The maximum bone mineral density an individual attains, typically reached in early adulthood; 40-60% of peak bone mass is accumulated during adolescence; insufficient calcium and vitamin D during this window permanently reduces peak bone mass and increases lifetime osteoporosis risk.

Moderate-to-vigorous physical activity; WHO/IAP recommends ≥60 minutes of MVPA daily for children ≥5 years; assessed in the clinical history alongside sedentary screen time.

The ratio of total daily energy expenditure to basal metabolic rate; increases with age and physical activity, and is a key determinant of daily caloric requirements beyond infancy.

An anti-nutritional factor in cereals and legumes that chelates divalent minerals (iron, zinc, calcium), reducing their absorption; its effect can be partially overcome by fermentation, germination, or concurrent vitamin C intake.

A genetic syndrome (deletion/imprinting defect at chromosome 15q11-q13) causing neonatal hypotonia, hyperphagia, obesity, short stature, hypogonadism, and intellectual disability; a classic secondary cause of severe early-onset obesity.

Obesity arising from a positive energy balance due to excessive dietary intake and/or insufficient physical activity in a genetically predisposed child; accounts for >95% of paediatric obesity.

Breast enlargement in obese males due to excess adipose tissue deposition in the breast region without true glandular hypertrophy; must be distinguished from true gynaecomastia (glandular tissue palpable as a firm disc) by clinical examination.

The period of accelerated height velocity during adolescence: peak ~11-12 years in girls (8-9 cm/year), ~13-14 years in boys (9-10 cm/year); associated with increased demand for energy, protein, iron, and calcium.

The daily dietary intake level sufficient to meet the nutrient requirements of 97-98% of healthy individuals in a specific age and sex group, as defined by the ICMR-NIN for Indian populations.

A potentially fatal metabolic complication of rapid nutritional rehabilitation after prolonged starvation; characterised by hypophosphataemia, hypokalaemia, and fluid shifts triggered by insulin surge after carbohydrate loading; prevented by gradual initiation of feeding with F-75 in the stabilisation phase.

Rehydration Solution for Malnutrition — a modified ORS with low sodium (45 mmol/L vs 75 in standard ORS), high potassium (40 mmol/L), and magnesium; used for rehydration in SAM to avoid hypernatraemia and worsening of oedema.

A childhood bone disorder caused primarily by vitamin D deficiency (or calcium deficiency), characterised by impaired mineralisation of growing bone, presenting as craniotabes, rachitic rosary, bow-legs, and growth retardation.

Calluses or abrasions on the dorsum of the dominant hand caused by repeated contact with teeth during self-induced vomiting; a clinical sign of bulimia nervosa.

An energy-dense, micronutrient-fortified paste (usually peanut-based) providing 500 kcal/92g sachet, used for community-based management of uncomplicated SAM; does not require water for preparation, reducing infection risk.

Obesity caused by an identifiable underlying medical condition such as hypothyroidism, Cushing syndrome, growth-hormone deficiency, or a genetic syndrome; suggested by short stature, rapid onset, dysmorphism, or developmental delay.

A life-threatening form of acute malnutrition defined by ANY ONE of: weight-for-height z-score < −3 SD, MUAC <11.5 cm (6-59 months), or bilateral pedal oedema; carries 20-30% case fatality rate without treatment.

Displacement of the femoral head epiphysis through the growth plate, seen in obese adolescents; presents with hip/knee pain and limp; an orthopaedic emergency requiring urgent pinning.

The tendency of South Asian (including Indian) individuals to accumulate visceral adiposity and develop insulin resistance and metabolic complications at a lower BMI compared to Caucasians; necessitates lower cut-offs for waist circumference and metabolic risk assessment.

A wall-mounted height-measuring device with a fixed vertical scale and a moveable headpiece; the preferred instrument for precise height measurement in clinical settings.

Linear stretch marks caused by rapid skin expansion; silver-white in primary obesity; violaceous/purple striae indicate elevated cortisol (Cushing syndrome) and are a red flag requiring investigation.

A low height-for-age z-score (< −2 SD), reflecting chronic inadequate nutrition and/or recurrent infections over a prolonged period, particularly in the first 1000 days.

Benign glandular proliferation of male breast tissue, identifiable by a firm, sometimes tender disc of tissue palpable beneath the nipple-areolar complex; may indicate hormonal imbalance.

A public-health micronutrient deficiency causing a spectrum from subclinical immune impairment to night blindness, Bitot's spots, xerophthalmia, and permanent blindness; prevented by routine supplementation under the NHM programme in India.

Circumference of the abdomen at the midpoint between the lowest rib and iliac crest; a surrogate for visceral adiposity; >90th percentile for age and sex defines abdominal obesity in children.

Waist circumference divided by hip circumference; a measure of central adiposity and body fat distribution; less well validated in children than the waist-to-height ratio.

Waist circumference divided by height; a value >0.5 indicates elevated cardiometabolic risk; applicable across ethnicities and age groups without requiring age/sex-specific reference tables.

Low weight-for-height z-score (< −2 SD), reflecting acute, recent nutritional deficit or illness; severe wasting is one of the diagnostic criteria for Severe Acute Malnutrition (SAM).

A dual-axis classification of nutritional status that separately grades wasting (weight-for-height) and stunting (height-for-age) as percentages of reference medians, allowing simultaneous assessment of acute and chronic malnutrition.

Prescriptive growth charts derived from a multi-country longitudinal study of children raised under optimal conditions; describe how children should grow when health and nutrition needs are met; the international reference for classifying malnutrition in children 0-5 years.

India's national NHM programme providing weekly supervised supplementation of 100 mg elemental iron + 500 μg folic acid to all adolescents through schools and Anganwadi Centres; targets the 59%+ prevalence of anaemia in Indian adolescent girls.

A standardised score expressing how many standard deviations a child's measurement (weight, height, MUAC) lies above or below the reference median for their age and sex; the WHO uses z-scores to classify wasting, stunting, and underweight.

A micronutrient deficiency associated with stunting, immune impairment, poor wound healing, diarrhoea, and acrodermatitis enteropathica; therapeutic zinc supplementation (10-20 mg/day for 10-14 days) is WHO-recommended adjunct to ORS in childhood diarrhoea.