The degree of malnutrition is calculated based on a childs body size compared to the median weight for their age. The risk of death increases with increasing degrees of malnutrition.An adaptation of Gomezs original classification is still used today. While it provides a way to compare malnutrition within and between populations, this classification system has been criticized for being "arbitrary" and for not considering overweight as a form of malnutrition. Also, height alone may not be the best indicator of malnutrition; children who are born prematurely may be considered short for their age even if they have good nutrition. Definition by Waterlow
In the 1970s, John Conrad Waterlow established a new classification system for malnutrition. Instead of using just weight for age measurements, Waterlows system combines weight-for-height (indicating acute episodes of malnutrition) with height-for-age to show the stunting that results from chronic malnutrition. One advantage of the Waterlow classification is that weight for height can be calculated even if a childs age is unknown. The World Health Organization frequently uses these classifications of malnutrition, with some modifications. Effects
Malnutrition weakens every part of the immune system. Protein and energy malnutrition increases susceptibility to infection; so do deficiencies of specific micronutrients (including iron, zinc, and vitamins). In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem. Malnutrition plays a major role in the onset of active tuberculosis. It also raises the risk of HIV transmission from mother to child, and increases replication of the virus.
The permissive effect of cortisol on insulin action in liver glycogenesis is observed in hepatocyte culture in the laboratory, although the mechanism for this is unknown. Bone and collagen
Cortisol reduces bone formation, favoring long-term development of osteoporosis (progressive bone disease). The mechanism behind this is two-fold: cortisol stimulates the production of RANKL by osteoblasts which stimulates, through binding to RANK receptors, the activity of osteoclasts – cells responsible for calcium resorption from bone – and also inhibits the production of osteoprotegerin (OPG) which acts as a decoy receptor and captures some RANKL before it can activate the osteoclasts through RANK. In other words, when RANKL binds to OPG, no response occurs as opposed to the binding to RANK which leads to the activation of osteoclasts. It transports potassium out of cells in exchange for an equal number of sodium ions (see above). This can trigger the hyperkalemia of metabolic shock from surgery. Cortisol also reduces calcium absorption in the intestine. Cortisol down-regulates the synthesis of collagen. Amino acid
Cortisol raises the free amino acids in the serum by inhibiting collagen formation, decreasing amino acid uptake by muscle, and inhibiting protein synthesis. Cortisol (as opticortinol) may inversely inhibit IgA precursor cells in the intestines of calves. Cortisol also inhibits IgA in serum, as it does IgM; however, it is not shown to inhibit IgE. Electrolyte balance
Cortisol decreases glomerular filtration rate, and renal plasma flow from the kidneys thus increasing phosphate excretion, as well as increasing sodium and water retention and potassium excretion by acting on mineralocorticoid receptors.