Malnutrition Matters

Malnutrition in Hospitals and Community

Malnutrition is a complex & multidimensional problem with determinants beyond the health sector. Hence there is a need to bring together experts from various sectors like public health, biotechnology, food science and nutrition etc, on a single platform, to fight against malnutrition and to facilitate exchange of knowledge and research updates. This will catalyze promotion of inter-sectoral coordination, so as to arrive at comprehensive and sustainable strategies to address the problem of malnutrition. Despite constant interventions from both public and private sector to control malnutrition at community level, evidence points that there exists various challenges and bottlenecks, to decrease its prevalence and severity. It is the need of the hour to arrive at scientific and sustainable solutions to address the same.

IAPEN follows Dutch Approch for Fighting Malnutrition

Taken from Link (http://www.fightmalnutrition.eu/fight-malnutrition/the-dutch-approach/)

The Dutch approach in 10 steps

  1. Raise a multidisciplinary steering group, which represents all disciplines involved in screening and treatment of malnutrition and which has authority
  2. Create awareness for the problem of disease related malnutrition by collecting prevalence data 
  3. Quick and easy screening tools, connected to a treatment plan
  4. Screening as a mandatory quality indicator
  5. Evidence based, validated tools and cost-effectiveness research
  6. Ministry of Health as a key stakeholder to strengthen the message
  7. Implementation projects in all health care settings:
    • Start pilot projects to implement screening and treatment of malnutrition in.
    • Evaluate and adjust where necessary
    • Use the field to develop tools and a toolkit
    • Disseminate the project over more institutions and organizations.
    • Make sure projects team are multidisciplinary and have authority
    • A website to communicatie between participating teams and organizations with
  8. Toolkits with tools, ready-to-use presentations and best practices, downloadable, free accessible to everyone
  9. Multidisciplinary project teams in all institutions
  10. Training programs and workshops

nterested people can join IAPEN by sending their biodata to info@iapen.co.in.

IAPEN Toolkits

IAPEN has developed two toolkits for monitoring malnutrition in hospital and in community.

IAPEN toolkit for community

The guidelines or IAPEN pocket toolkit is based on the approximate assessment of the weight, height and body mass index of the children, adults or elders without using weighing machines or tapes. The idea is to measure the approximate body mass index with the help of Mid Arm Circumference Measurement based on the World Health Organization Guidelines.

India has approximately 1 million Anganwadi Centers, supplying weighing machines or supplying height measuring tapes and training the uneducated anganwadi workers for measurement and monitoring of child growth etc. is becoming very difficult for ICDS or any organization in that field. 

IAPEN pocket toolkit is easy to carry, economical to distribute and easy to use by any individual for rapid detection of malnutrition or underweight. The toolkit is a black and white paper containing black lines adjusted according to the world health organization guidelines. A training can be given to the uneducated anganwadi workers or ASHA workers or doctors or health inspectors, mothers etc. about this toolkit in less than 5 minutes. 

Download Toolkit

How to use the toolkit?

1. Download the toolkit, take printout, cut the paper.
2. Measure the mid arm circumference as shown in the paper according to the age or according to the given clip arts or diagrams.
3. Black color means the child/the adult is in malnutrition state and should meet the doctor.
4. White color means safe.

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Training to uneducated anganwadi center workers is also easy as there are only two colors without any readings. If the toolkit is interesting, please include the toolkit in the training programs of NIPCCD or ICDS or tell about this toolkit to health inspectors. The toolkit is free to distribute without any modification of the contents or diagrams.

IAPEN toolkit for patients


IAPEN has developed an android based APP called SGA - IAPEN. Download it and use it in your daily routine.

The app can be downloaded using google playstore. App Name: SGA - IAPEN.

App Download LinkSGA IAPEN

Subjective Global Assessment (SGA) is a tool used by health care providers to assess nutritional status and aid in the prediction of nutrition-associated clinical outcomes, such as postoperative infections and/or mortality. 

Allan S. Detsy and his team, in 1987, published the first report of a nutritional assessment tool, entitled SGA, that uses clinical judgment to assess nutritional status in preoperative surgical patients and to predict postoperative infections; SGA had the best sensitivity and specificity for predicting infection after surgery.

The original SGA form had clinicians score 5 components of a medical history (i.e., weight change, dietary intake, gastrointestinal symptoms, functional capacity, disease and its relation to nutritional requirements) and 3 components of a brief physical examination (ie, signs of fat and muscle wasting, nutrition-associated alternations in fluid balance). The patient is then assigned a rating of Well nourished (A), moderately undernourished (B), or Severely undernourished (C) by subjective consideration of the data collected in the 8 areas, without adhering to a rigid scoring system. The SGA Toolkit developed by IAPEN also contains 7-point scale SGA.

References: 

1. Detsky, A. S., Baker, J. P., Johnston, N., Whittaker, S., Mendelson, R. A., & Jeejeebhoy, K. N. (1987). What is subjective global assessment of nutritional status?. Journal of parenteral and enteral nutrition, 11(1), 8-13.

2. Steiber, A. L., Kalantar-Zadeh, K., Secker, D., McCarthy, M., Sehgal, A., & McCann, L. (2004). Subjective Global Assessment in chronic kidney disease: a review. Journal of Renal Nutrition, 14(4), 191-200.

Partner Against Malnutrition Program


India has a long and proud history of research excellence in health, and continues to make important differences in people’s lives. One area that remains a serious problem, though, is malnutrition in care homes, children in schools and in the community and also in hospitals. For PAM, solving the problem is a very realistic goal and a welcome challenge.MSG - IAPEN

Healthcare professionals are committed to best practices and quality of care for their patients. We need their support through strategic initiatives that include training and developing, evaluating and disseminating best practices.

Who can join PAM (Partners Against Malnutrition) Program of IAPEN
1. Educational Institutions.
2. Food and Nutrition Service Organizations.
3. Industries, NGOs, old age homes, orphanages etc.
4. Hospitals and health care settings.
5. Organizations related to Physical Activity
6. Any other interested organization.

Benefits to the Educational Institutions/Industries/NGOs
1. Monitoring of malnourished, under weight or over weight population in the organization and consultancy.
2. Personalized nutrition care plan for the organizations.
3. Promotion of the malnutrition initiative taken by the organization by participating in PAM.
4. Meal plan development and monitoring for canteens or hostels.
4. Regular visits to the organization by expert doctors.
5. Sharing the list of nearby restaurants, food courts, fast food centers, bakeries, participating in PAM program to the employees of the organization.

Benefits to the restaurants
Presently, PAM fixes only few simple eligibility criteria for restaurants/sweet stalls etc. in India for participating in this program.

The simple list of criteria are,
1. Addition of color/preservatives is strictly prohibited.
2. Food should be served on the plate along with plastic covers/thin plastic foils/leaf.
3. Food should not be touched by the hand after preparation (Gloves may be recommended).
4. Food should always be covered/closed.
5. Neatness, enough ventilation and space is mandatory in kitchen.
6. Food calorie has to be calculated with the help of dietitian.

Restaurants accepting the above list of criteria's are eligible to join PAM scheme and the names will be shared to nearby organizations.

Benefits to the fitness centers
1. Advanced training to the Physiotherapists/Personal Trainer/Nutritionist.
2. Converting fitness centers to diet clinics or weight loss or weight gain clinics.

Hospitals and health care settings
1. Regular training on malnutrition, screening, detection and prevention.
2. Advanced training on enteral and parenteral nutrition to nurses and dietitians.
3. Lifelong learning in clinical nutrition.

Organizations can join this program with a prescribed fee.
Organization Membership (<50 Employees) - INR 10,000
Organization Membership (51 to 300 Employees) - INR 50,000
Organization Membership (>300 Employees) - INR 1,00,000

FOR NGO/Non Profit: Life membership

Check membership page for more details.

Download PAM Flyer
For more details, email to info@iapen.co.in.