Chapter IV

Endocrine, nutritional and metabolic diseases

(E00-E90)

Malnutrition

(E40-E46)

**Note:**

The degree of malnutrition is usually measured in terms of weight, expressed in standard deviations from the mean of the relevant reference population. When one or more previous measurements are available, lack of weight gain in children, or evidence of weight loss in children or adults, is usually indicative of malnutrition. When only one measurement is available, the diagnosis is based on probabilities and is not definitive without other clinical or laboratory tests. In the exceptional circumstances that no measurement of weight is available, reliance should be placed on clinical evidence.

If an observed weight is below the mean value of the reference population, there is a high probability of severe malnutrition if there is an observed value situated 3 or more standard deviations below the mean value of the reference population; a high probability of moderate malnutrition for an observed value located between 2 and less than 3 standard deviations below this mean; and a high probability of mild malnutrition for an observed value located between 1 and less than 2 standard deviations below this mean.

*Excludes:** intestinal malabsorption (K90.-)

* nutritional anaemias (D50-D53)

* sequelae of protein-energy malnutrition (E64.0)

* slim disease (B22.2)

* starvation (T73.0)

E40 | KwashiorkorLatin: Morbus kwashiorkor | |||||||

Severe malnutrition with nutritional oedema with dyspigmentation of skin and hair. | ||||||||

Excludes: | marasmic kwashiorkor (E42) |

E41 | Nutritional marasmusLatin: Marasmus malnutritionalis | |||||||

Severe malnutrition with marasmus | ||||||||

Excludes: | marasmic kwashiorkor (E42) |

E42 | Marasmic kwashiorkorLatin: Kwashiorkor marasmaticus | |||||||

Severe protein-energy malnutrition [as in E43]: · intermediate form · with signs of both kwashiorkor and marasmus |

E43 | Unspecified severe protein-energy malnutritionLatin: Malnutritio proteinoenergetica gravis, non specificata | |||||||

Severe loss of weight [wasting] in children or adults, or lack of weight gain in children leading to an observed weight that is at least 3 standard deviations below the mean value for the reference population (or a similar loss expressed through other statistical approaches). When only one measurement is available, there is a high probability of severe wasting when the observed weight is 3 or more standard deviations below the mean of the reference population. | ||||||||

Starvation oedema |

E44 | Protein-energy malnutrition of moderate and mild degreeLatin: Malnutritio proteinoenergetica mitis et moderate gravis | |||||||

E44.0 | Moderate protein-energy malnutritionLatin: Malnutritio moderata | |||||||

Weight loss in children or adults, or lack of weight gain in children leading to an observed weight that is 2 or more but less than 3 standard deviations below the mean value for the reference population (or a similar loss expressed through other statistical approaches). When only one measurement is available, there is a high probability of moderate protein-energy malnutrition when the observed weight is 2 or more but less than 3 standard deviations below the mean of the reference population. | ||||||||

E44.1 | Mild protein-energy malnutritionLatin: Malnutritio proteinoenergetica mitis | |||||||

Weight loss in children or adults, or lack of weight gain in children leading to an observed weight that is 1 or more but less than 2 standard deviations below the mean value for the reference population (or a similar loss expresssed through other statistical approaches). When only one measurement is available, there is a high probability of mild protein-energy malnutrition when the observed weight is 1 or more but less than 2 standard deviations below the mean of the reference population. |

E45 | Retarded development following protein-energy malnutritionLatin: Retardatio propter malnutritionem proteinoenergeticam | |||||||

Nutritional: · short stature · stunting Physical retardation due to malnutrition |

E46 | Unspecified protein-energy malnutritionLatin: Malnutritio proteinoenergeticam, non specificata | |||||||

Malnutrition NOS Protein-energy imbalance NOS |