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

Research output: Contribution to journalJournal articleResearchpeer-review


  • André Briend
  • Mark Myatt
  • James A Berkley
  • Robert E Black
  • Erin Boyd
  • Michel Garenne
  • Natasha Lelijveld
  • Sheila Isanaka
  • Christine M McDonald
  • Martha Mwangwome
  • Kieran S O'Brien
  • Catherine Schwinger
  • Heather Stobaugh
  • Sunita Taneja
  • Keith P West
  • Tanya Khara

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.

Original languageEnglish
JournalPublic Health Nutrition
Issue number6
Pages (from-to)1210-1221
Number of pages12
Publication statusPublished - 2023

    Research areas

  • Faculty of Science - Wasting, Stunting, Underweight, Mid-upper arm circumference, Anthropometry, Mortality

ID: 334990317