Second degree of under nutrition means -

<p> Malnutrition: Defined as a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. It comprises: Undernutrition, Overnitrition, Imbalance and Specific deficiency. Main victims are children under 15 years. Children under 5 years are hit the hardest. Malnutrition in India is mainly attributed to kwashiorkar, marasmus, xerophthalmia, nutritional anemia and endemic goitre. Iron deficiency anemia is the most widespread micronutrient deficiency affecting all age groups in India. The effects are direct and indirect. Direct effects are occurence of frank and subclinical nutrition deficiency diseases such as kwashiorkar, marasmus, vitamin and mineral deficiency. Indirect effects are a high morbidity and moality among young children retarded physical and mental growth. Malnutrition predisposes to infection and infection to malnutrition. Waterlow&;s classification of PEM: It defines two groups- 1. Malnutrition with a retarded growth, in which a drop in height/age ratio points to a chronic condition - shoness/stunting. It is an index of duration of malnutrition 2. Malnutrition with a low weight fir a normal height, in ehich the weight for height ratio is indicative of acute condition of rapid weight loss/ wasting . It is an index of severity of malnutrition. Classification of grades of PEM is given by ICMR. IAP Classification of malnutrition: Based on % of ideal weight expected for the age. 1. Normal : >80% 2. Grade 1 PEM: 71-80% 3. Grade 2 PEM:61-70% 4. Grade 3 PEM:51-60% 5. Grade 4 PEM:<50% {Reference: Park&;s textbook of community medicine 23 rd edition, pg no. 640}