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Validity of single-weight measurements to predict current malnutrition and mortality in children
J Van den Broeck1, R Eeckels, G Massa
1Bureau of the Dutch Growth Foundation, Academisch Ziekenhuis, Leiden, The Netherlands.
Insights
Underweight and wasting indicators have limited effectiveness in identifying protein-energy malnutrition in Zairian children. Improving diagnostic criteria, like using Z-score -0.75 for wasting, enhances accuracy for nutritional interventions.
Area of Science:
- Global Health
- Pediatrics
- Nutritional Science
Background:
- Protein-energy malnutrition (PEM) is a significant health concern in developing regions.
- Accurate anthropometric indicators are crucial for identifying at-risk children and guiding interventions.
Purpose of the Study:
- To assess the diagnostic validity of underweight and wasting for identifying PEM in Zairian children.
- To evaluate the prognostic validity of anthropometric indicators for mortality.
- To explore improvements in diagnostic criteria for wasting.
Main Methods:
- Cross-sectional study of 4238 rural Zairian children aged 0-5 years.
- Assessed underweight (weight-for-age < 75%) and wasting (weight-for-height < 80%) against US NCHS reference.
- Used low arm circumference and clinical muscle loss as criteria for PEM.
- Employed Receiver Operating Characteristic (ROC) analysis for diagnostic and prognostic validity.
Main Results:
- Underweight and wasting showed low sensitivity in detecting PEM, particularly during the weaning period (12-30 months).
- Adjusting the wasting cutoff to Z-score -0.75 improved diagnostic validity compared to Z-score -2 or 80% reference median.
- Arm circumference and age demonstrated better prognostic validity for 30-month mortality than weight-for-age or weight-for-height.
Conclusions:
- Standard underweight and wasting measures have limited utility for community-level PEM screening and intervention targeting.
- Optimized anthropometric cutoffs and the use of arm circumference can improve nutritional assessment accuracy.
- Nutritional interventions focused solely on identified underweight or wasted children may have a limited impact on overall PEM prevalence and associated mortality.
Abstract:
In this cross-sectional study of a random cluster sample of 4238 rural Zairian children aged 0-5 y, we assessed underweight and wasting, defined as weight-for-age < 75%, and weight-for-height < 80% of the U.S. National Center for Health Statistics reference median, respectively. We determined the diagnostic validity of underweight and wasting for protein-energy malnutrition, taking a low arm circumference and clinical signs of muscle loss as criteria. Both underweight and wasting had low sensitivity in recognizing low arm circumference, any clinical muscle loss and even severe marasmus, especially in the weaning period of 12-30 mos. Receiver operating characteristic (ROC) analysis showed that the diagnostic validity of weight-for-height can be improved by using a cutoff for wasting at Z-score -0.75 instead of Z-score -2 or 80% of reference median. ROC analysis of 30-mo mortality revealed a poor prognostic validity of weight-for-height and weight-for-age and better performances of arm circumference (cm) and of age. These data suggest that nutritional intervention programs targeted at wasted or underweight children can have only a limited effect on the prevalence of protein-energy malnutrition in the community or on the long-term mortality associated with it.