TY - JOUR
T1 - The effect of multiple anthropometric deficits on child mortality
T2 - Meta-analysis of individual data in 10 prospective studies from developing countries
AU - McDonald, Christine M.
AU - Olofin, Ibironke
AU - Flaxman, Seth
AU - Fawzi, Wafaie W.
AU - Spiegelman, Donna
AU - Caulfield, Laura E.
AU - Black, Robert E.
AU - Ezzati, Majid
AU - Danaei, Goodarz
PY - 2013/4/1
Y1 - 2013/4/1
N2 - Background: Child stunting, wasting, and underweight have been individually associated with increased mortality. However, there has not been an analysis of the mortality risk associated with multiple anthropometric deficits. Objective: The objective was to quantify the association between combinations of stunting, wasting, and underweight and mortality among children <5 y of age. Design: We analyzed data from 10 cohort studies or randomized trials in low- and middle-income countries in Africa, Asia, and Latin America with 53,767 participants and 1306 deaths. Height-for-age, weightfor-height, and weight-for-age were calculated by using the 2006 WHO growth standards, and children were classified into 7 mutually exclusive combinations: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight (deficit defined as < -2 z scores). We calculated study-specific mortality HRs using Cox proportional hazards models and used a random-effects model to pool HRs across studies. Results: The risk of all-cause mortality was elevated among children with 1, 2, and 3 anthropometric deficits. In comparison with children with no deficits, the mortality HRs were 3.4 (95% CI: 2.6, 4.3) among children who were stunted and underweight but not wasted; 4.7 (95% CI: 3.1, 7.1) in those who were wasted and underweight but not stunted; and 12.3 (95% CI: 7.7, 19.6) in those who were stunted, wasted, and underweight. Conclusion: Children with multiple deficits are at a heightened risk of mortality and may benefit most from nutrition and other child survival interventions.
AB - Background: Child stunting, wasting, and underweight have been individually associated with increased mortality. However, there has not been an analysis of the mortality risk associated with multiple anthropometric deficits. Objective: The objective was to quantify the association between combinations of stunting, wasting, and underweight and mortality among children <5 y of age. Design: We analyzed data from 10 cohort studies or randomized trials in low- and middle-income countries in Africa, Asia, and Latin America with 53,767 participants and 1306 deaths. Height-for-age, weightfor-height, and weight-for-age were calculated by using the 2006 WHO growth standards, and children were classified into 7 mutually exclusive combinations: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight (deficit defined as < -2 z scores). We calculated study-specific mortality HRs using Cox proportional hazards models and used a random-effects model to pool HRs across studies. Results: The risk of all-cause mortality was elevated among children with 1, 2, and 3 anthropometric deficits. In comparison with children with no deficits, the mortality HRs were 3.4 (95% CI: 2.6, 4.3) among children who were stunted and underweight but not wasted; 4.7 (95% CI: 3.1, 7.1) in those who were wasted and underweight but not stunted; and 12.3 (95% CI: 7.7, 19.6) in those who were stunted, wasted, and underweight. Conclusion: Children with multiple deficits are at a heightened risk of mortality and may benefit most from nutrition and other child survival interventions.
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U2 - 10.3945/ajcn.112.047639
DO - 10.3945/ajcn.112.047639
M3 - Article
C2 - 23426036
AN - SCOPUS:84875845803
SN - 0002-9165
VL - 97
SP - 896
EP - 901
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 4
ER -