The importance of age in evaluating anthropometric indices for predicting mortality

Weights and heights were obtained on approximately 4,000 preschool-aged children in six rural villages of West Java between 1977 and 1978. Deaths occurring in the ensuing 18 months were ascertained at three-month intervals. The abilities of relative weight for height and height for age to discriminate children at greatest risk of dying were compared. Younger children (≤two years) with low height for age (<95% of the reference median) were at greater risk of dying than children of the same age who were not stunted. This risk declined with increasing age, and among children aged 3-5 years, those who were stunted were at no greater risk than those of normal height for age. The mortality risk associated with mild wasting (80-90% of the reference median) also declined with increasing age. However, the risk of dying among moderately to severely wasted (<80% of the reference median) children increased with increasing age. These results suggest that stunting, rather than wasting, puts younger children at greater risk of death, but among older children, wasting carries a greater relative mortality risk over an 18-month period.