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Fatness and muscularity as risk indicators of child mortality in rural Congo
J Van den Broeck1, R Eeckels, A Hokken-Koelega
1Dutch Growth Foundation, Sophia kinderziekenhuis, Rotterdam.
Insights
Anthropometric indicators of fatness and muscularity predict child mortality in rural Africa. Even normal-weight children with low fat or muscle mass face increased mortality risks, highlighting the need for comprehensive nutritional assessments.
Area of Science:
- Pediatric Nutrition
- Global Health
- Anthropometry
Background:
- A prospective cohort study involving 5167 children aged 0-5 years was conducted in Bwamanda, Northern Congo.
- The study utilized a random cluster sample to represent the rural population.
Purpose of the Study:
- To investigate the association between anthropometric measures of fatness and muscularity and mortality rates in young children.
- To determine if these anthropometric indicators provide better mortality prediction than traditional weight-for-age measures.
Main Methods:
- Assessed short-term (within 3 months) and long-term mortality rates.
- Calculated mortality rates from all causes and specific causes like kwashiorkor and marasmus.
- Derived fatness and muscularity indicators by adjusting arm fat and muscle areas for age, sex, weight, and height (standard deviation scores - SDS).
Main Results:
- A threshold of -0.5 SDS for fatness and muscularity scores indicated a significant increase in all-cause and malnutrition-related mortality.
- These findings persisted even in normal-weight children, indicating low fat/muscle mass as a risk factor.
- Fatness and muscularity scores demonstrated superior predictive ability for mortality compared to weight-for-age, as shown by ROC curve analysis.
Conclusions:
- Nutritional status assessment should incorporate objective evaluations of fat and muscle mass, not solely rely on weight indices.
- Identifying low fat or muscle status, even in normal-weight children, is crucial for accurate malnutrition detection and mortality risk assessment.
Objectives:
To examine the relationship of anthropometrical indicators of fatness and muscularity with mortality in children in a rural African community.
Background:
A prospective cohort study was carried out in the rural health zone of Bwamanda, Northern Congo using a random cluster sample of 5167 children, aged 0-5 years.
Main Outcome Measures:
Short- and long-term mortality rates, being deaths within 3 months and deaths in 3-month periods observed 3-30 months after enrolment. Rates of all cause mortality and of mortality from kwashiorkor or marasmus, by level of baseline fatness and muscularity. Indicators of fatness and muscularity were obtained by correcting anthropometric arm fat and arm muscle areas for age, sex, weight and height.
Results:
The relationship of both the fatness and muscularity scores with short-term mortality was marked by a clear threshold (-0.5 SDS) below which there was a significant rise in mortality from all causes as well as from kwashiorkor and marasmus. These excess mortalities were also found in normal weight children. Fatness and muscularity scores remained significant determining factors of short-term mortality in a multiple logistic regression analysis with sex, age, season and weight-for-age. A ROC curve analysis showed that fat and muscularity scores had better predictive abilities than weight-for-age. Low fat status had a bad prognosis on the long-term in underweight children.
Conclusions:
Measures of current nutritional status should not be based on weight indices alone. Objective and/or clinical evaluation of fat and muscle status (also in normal weight children) should be added in order to detect a higher proportion of malnourished children and to more accurately evaluate mortality risk.