Definition of chronic energy deficiency in adults. Report of a working party of the International Dietary Energy Consultative Group.

New criteria are proposed for classifying chronic energy deficiency in adults and a progressively more precise approach to identifying affected individuals involves measuring body weight and height, then energy intake and finally the basal metabolic rate (BMR).

Abstract

New criteria are proposed for classifying chronic energy deficiency (CED) in adults. A progressively more precise approach to identifying affected individuals involves measuring body weight and height, then energy intake (or expenditure) and finally the basal metabolic rate (BMR). Three cut-off points for body mass index (BMI) were identified: 18.5, 17.0 and 16.0. A BMI above 18.5 is classified as normal and below 16.0 as grade III CED. A diagnosis of grades I and II CED depends on finding the combination of a BMI of 16.0-16.9 or 17.0-18.4 with a ratio of energy turnover to predicted BMR of less than 1.4. Measuring the individual BMR avoids misclassification and confirms the diagnosis. In groups of African adults 38-63 per cent of each group had a BMI below 18.5 and the majority require studies of their energy turnover before specifying their degree of CED; 3 per cent of Ethiopian women and 24 per cent of a selected male African group had grade III CED. These guidelines can be used when assessing the input of aid programmes and for clinical and other studies.