TY - JOUR

T1 - Prognostic value of different anthropometric indices over different measurement intervals to predict mortality in 6-59-month-old children

AU - Briend, André

AU - Myatt, Mark

AU - Berkley, James A

AU - Black, Robert E

AU - Boyd, Erin

AU - Garenne, Michel

AU - Lelijveld, Natasha

AU - Isanaka, Sheila

AU - McDonald, Christine M

AU - Mwangwome, Martha

AU - O'Brien, Kieran S

AU - Schwinger, Catherine

AU - Stobaugh, Heather

AU - Taneja, Sunita

AU - West, Keith P

AU - Khara, Tanya

N1 - CURIS 2023 NEXS 047

PY - 2023

Y1 - 2023

N2 - 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 one month follow-up compared to six 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 to 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.

AB - 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 one month follow-up compared to six 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 to 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.

KW - Faculty of Science

KW - Wasting

KW - Stunting

KW - Underweight

KW - Mid-upper arm circumference

KW - Anthropometry

KW - Mortality

U2 - 10.1017/S1368980023000149

DO - 10.1017/S1368980023000149

M3 - Journal article

C2 - 36722310

VL - 26

SP - 1210

EP - 1221

JO - Public Health Nutrition

JF - Public Health Nutrition

SN - 1368-9800

IS - 6

ER -