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Updated: Aug 12, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Prognostic value of different anthropometric indices over different measurement intervals to predict mortality in
André Briend1,2, Mark Myatt3,4, James A Berkley5,6
1Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, DK-1958, Frederiksberg, Denmark.
Insights
Frequent anthropometric measurements, including mid-upper arm circumference (MUAC), improve identifying malnourished children at high risk of death. Shorter follow-up periods enhance prediction accuracy for mortality risk in children.
Area of Science:
- Pediatric Nutrition
- Global Health
- Biostatistics
Background:
- Child malnutrition remains a significant global health challenge, contributing to high mortality rates.
- Accurate and timely identification of at-risk children is crucial for effective intervention.
- Anthropometric measurements are widely used indicators of nutritional status in children.
Purpose of the Study:
- To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height Z-score (WHZ), and weight-for-age Z-score (WAZ) for predicting child mortality.
- To evaluate the predictive accuracy of these indices over different follow-up periods (1, 3, and 6 months).
Main Methods:
- Pooled analysis of twelve prospective community-based studies from Africa and Asia.
- Inclusion of children aged 6-59 months.
- Comparison of sensitivity and false-positive ratios for MUAC, WHZ, and WAZ in predicting death within 1, 3, and 6 months.
Main Results:
- Receiver operating characteristic curves indicated higher accuracy for shorter follow-up durations across all anthropometric indices.
- 1-month follow-up showed significantly higher sensitivity for death prediction compared to 6-month follow-up for MUAC, WHZ, and WAZ.
- Weight-for-age Z-score (WAZ) < -3 identified more children who died but also resulted in a higher false-positive ratio compared to MUAC < 115 mm.
Conclusions:
- Regular anthropometric measurements enhance the identification of malnourished children at high risk of mortality with minimal increase in false positives.
- While combining indices increases sensitivity, it may also elevate false-positive rates.
- Shorter follow-up periods improve the predictive value of anthropometric indices for mortality in children.
Objective:
To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height Z-score (WHZ) and weight-for-age Z-score (WAZ) for predicting death over periods of 1, 3 and 6 months follow-up in children.
Design:
Pooled analysis of twelve prospective studies examining survival after anthropometric assessment. Sensitivity and false-positive ratios to predict death within 1, 3 and 6 months were compared for three individual anthropometric indices and their combinations.
Setting:
Community-based, prospective studies from twelve countries in Africa and Asia.
Participants:
Children aged 6-59 months living in the study areas.
Results:
For all anthropometric indices, the receiver operating characteristic curves were higher for shorter than for longer durations of follow-up. Sensitivity was higher for death with 1-month follow-up compared with 6 months by 49 % (95 % CI (30, 69)) for MUAC < 115 mm (P < 0·001), 48 % (95 % CI (9·4, 87)) for WHZ < -3 (P < 0·01) and 28 % (95 % CI (7·6, 42)) for WAZ < -3 (P < 0·005). This was accompanied by an increase in false positives of only 3 % or less. For all durations of follow-up, WAZ < -3 identified more children who died and were not identified by WHZ < -3 or by MUAC < 115 mm, 120 mm or 125 mm, but the use of WAZ < -3 led to an increased false-positive ratio up to 16·4 % (95 % CI (12·0, 20·9)) compared with 3·5 % (95 % CI (0·4, 6·5)) for MUAC < 115 mm alone.
Conclusions:
Frequent anthropometric measurements significantly improve the identification of malnourished children with a high risk of death without markedly increasing false positives. Combining two indices increases sensitivity but also increases false positives among children meeting case definitions.
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