The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries
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McDonald, C. M.
Fawzi, W. W.
Caulfield, L. E.
Black, R. E.
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CitationMcDonald, Christine M, Ibironke Olofin, Seth Flaxman, Wafaie W Fawzi, Donna Spiegelman, Laura E Caulfield, Robert E Black, Majid Ezzati, and Goodarz Danaei. 2013. “The Effect of Multiple Anthropometric Deficits on Child Mortality: Meta-Analysis of Individual Data in 10 Prospective Studies from Developing Countries.” The American Journal of Clinical Nutrition 97 (4): 896–901. https://doi.org/10.3945/ajcn.112.047639.
AbstractBackground: Child stunting, wasting, and underweight have been individually associated with increased mortality. However, there has not been an analysis of the mortality risk associated with multiple anthropometric deficits. Objective: The objective was to quantify the association between combinations of stunting, wasting, and underweight and mortality among children <5 y of age. Design: We analyzed data from 10 cohort studies or randomized trials in low- and middle-income countries in Africa, Asia, and Latin America with 53,767 participants and 1306 deaths. Height-for-age, weight-for-height, and weight-for-age were calculated by using the 2006 WHO growth standards, and children were classified into 7 mutually exclusive combinations: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight (deficit defined as < -2 z scores). We calculated study-specific mortality HRs using Cox proportional hazards models and used a random-effects model to pool BRs across studies. Results: The risk of all-cause mortality was elevated among children with 1, 2, and 3 anthropometric deficits. In comparison with children with no deficits, the mortality Irks were 3.4 (95% CI: 2.6, 4.3) among children who were stunted and underweight but not wasted; 4.7 (95% CI: 3.1, 7.1) in those who were wasted and underweight but not stunted; and 12.3 (95% CI: 7.7, 19.6) in those who were stunted, wasted, and underweight. Conclusion: Children with multiple deficits are at a heightened risk of mortality and may benefit most from nutrition and other child survival interventions. Am J Clin Nutr 2013;97:896-901.
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