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Updated: Dec 25, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Outcomes of Hospitalized Infants Aged One to Six Months in Relation to Different Anthropometric Indices - An
Praveen Kumar1, Yazhmozhi Meiyappan2, Eleanor Rogers3
1Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi, India. pkpaed@gmail.com.
Insights
Weight-for-age Z score (WAZ) below -3 is the most sensitive indicator for predicting in-patient mortality in infants aged one to six months. This finding helps identify at-risk infants for timely intervention and improved outcomes.
Area of Science:
- Pediatrics
- Public Health
- Nutritional Science
Background:
- Malnutrition in infants under six months is a growing concern.
- Existing World Health Organization (WHO) criteria for malnutrition require further evaluation regarding their ability to predict in-patient mortality.
- Accurate prediction of mortality risk is crucial for timely intervention in vulnerable infant populations.
Purpose of the Study:
- To evaluate the predictive accuracy of various anthropometric criteria and their combinations for in-patient mortality in infants.
- To identify which diagnostic criteria most effectively predict mortality risk in hospitalized infants.
- To inform clinical practice for identifying high-risk infants upon admission.
Main Methods:
- An observational study analyzed data from 1813 infants (1-6 months) admitted to Kalawati Saran Children's Hospital, New Delhi.
- Receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of weight-for-age Z score (WAZ), weight-for-length Z score (WLZ), and mid-upper arm circumference (MUAC).
- The study evaluated individual and combined anthropometric indexes for their ability to predict in-patient mortality.
Main Results:
- A total of 107 (5.9%) infants died during hospitalization.
- Severe underweight (WAZ < -3) affected 39.9% of admissions.
- WAZ < -3 demonstrated the highest sensitivity (74.8%) and specificity (62.3%) in predicting mortality, with an AUC of 0.69.
Conclusions:
- Weight-for-age Z score (WAZ) < -3 is the most sensitive predictor of in-patient mortality among infants aged one to six months.
- This criterion should be utilized for identifying at-risk infants upon admission to inpatient care.
- Infants identified with WAZ < -3 require thorough evaluation and prompt treatment during their hospital stay.
Objectives:
Malnutrition in infants less than six months is increasingly recognized. However, the WHO criteria for identifying malnutrition have not been fully evaluated against the risk of in-patient mortality. The observational study was conducted to evaluate the predictability of in-patient mortality of different anthropometric criteria and combination of criteria in order to understand which diagnostic criteria or combination of criteria most accurately predict in-patient mortality.
Methods:
Data from a cohort of infants aged one to six months, admitted to Kalawati Saran Children's Hospital, New Delhi between February and December 2018 was analyzed. The discriminatory ability of different anthropometric indexes [weight-for-age Z score (WAZ), weight-for-length Z score (WLZ) and mid-upper arm circumference (MUAC)] and their combinations to predict in-patient mortality was assessed using Receiver operating characteristic (ROC) curves.
Results:
A total of 1813 infants aged one to six months were admitted during the 11 mo period, of which 107 (5.9%) died in the hospital. Of all admissions, 39.9%, 26% and 23.4% were severely underweight, severely wasted and severely stunted, respectively. WAZ < -3 was the most sensitive predictor of mortality [sensitivity: 74.8%; specificity: 62.3%; area under the curve (AUC): 0.69, 95% CI: 0.64-0.74].
Conclusions:
WAZ < -3 was the most sensitive predictor out of all individual and combined parameters/indexes in identifying infants less than six months at high risk of mortality which suggests that, it should be used to identify at-risk infants between one to six months on admission to in-patient care. Children identified as falling into this category should be properly evaluated and treated during their in-patient stay.
