The importance of age in evaluating anthropometric indices for predicting mortality

Abstract

Weights and heights were obtained on approximately 4,000 preschool-aged children in six rural villages of West Java between 1977 and 1978. Deaths occurring in the ensuing 18 months were ascertained at three-month intervals. The abilities of relative weight for height and height for age to discriminate children at greatest risk of dying were compared. Younger children (less than or equal to two years) with low height for age (less than 95% of the reference median) were at greater risk of dying than children of the same age who were not stunted. This risk declined with increasing age, and among children aged 3-5 years, those who were stunted were at no greater risk than those of normal height for age. The mortality risk associated with mild wasting (80-90% of the reference median) also declined with increasing age. However, the risk of dying among moderately to severely wasted (less than 80% of the reference median) children increased with increasing age. These results suggest that stunting, rather than wasting, puts younger children at greater risk of death, but among older children, wasting carries a greater relative mortality risk over an 18-month period.