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The importance of age in evaluating anthropometric indices for predicting mortality
1Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Insights
In preschool children, stunting poses a higher mortality risk for younger individuals, while wasting becomes a greater risk factor for older children over an 18-month period.
Area of Science:
- Pediatric Nutrition
- Global Health
- Child Mortality Studies
Background:
- Childhood malnutrition, specifically stunting (low height for age) and wasting (low weight for height), are significant global health concerns.
- Understanding the differential mortality risks associated with these nutritional indicators is crucial for targeted interventions.
Purpose of the Study:
- To compare the abilities of relative weight for height and height for age to identify children at the greatest risk of mortality.
- To investigate how age modifies the relationship between stunting, wasting, and mortality risk in preschool-aged children.
Main Methods:
- Longitudinal study involving approximately 4,000 preschool-aged children in West Java (1977-1978).
- Anthropometric measurements (weight and height) were collected at baseline.
- Mortality data were ascertained at three-month intervals over an 18-month follow-up period.
- Statistical analysis compared the predictive power of stunting and wasting for mortality across different age groups.
Main Results:
- Younger children (≤2 years) with stunting (height for age <95% of reference median) exhibited a significantly greater risk of dying.
- The elevated mortality risk associated with stunting decreased with increasing age, becoming non-significant for children aged 3-5 years.
- Mild wasting (weight for height 80-90% of reference median) showed a declining mortality risk with age.
- Conversely, moderate to severe wasting (weight for height <80% of reference median) was associated with an increased mortality risk in older children.
Conclusions:
- Stunting is a more critical indicator of mortality risk in younger preschool children.
- Wasting, particularly moderate to severe wasting, emerges as a more significant predictor of mortality risk in older preschool children over an 18-month period.
- Age-specific assessment of nutritional status is essential for accurately predicting child mortality risk.
Abstract:
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 (less than or equal to two years) with low height for age (less than 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 (less than 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.