Anthropometric criteria for best identifying children at high risk of mortality: A pooled analysis of 12 cohorts

Tanya Khara, Mark Myatt, Kate Sadler, Paluku Bahwere, James A. Berkley, Robert E. Black, Erin Boyd, Michel Garenne, Sheila Isanaka, Natasha Lelijveld, Christine McDonald, Andrew Mertens, Martha Mwangome, Kieran O'Brien, Heather Stobaugh, Sunita Taneja, Keith P. West, André Briend

Research output: Contribution to journalReview Articlepeer-review

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Objective: To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications. Design: A multiple cohort individual data meta-analysis of mortality risk (within six months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences modelled. Setting: Community-based cohort studies in 12 low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread. Participants: Children aged 6 to 59 months Results: Of the 12 anthropometric case definitions, four (weight-for-age Z-score (WAZ) <-2), (mid-upper-arm circumference (MUAC) <125 mm), (MUAC <115 mm or WAZ <-3), and (WAZ <-3) had the highest informedness in predicting mortality. A combined case definition (MUAC <115 mm or WAZ <-3) was better at predicting deaths associated with weight-for-height Z-score (WHZ) <-3 and concurrent wasting and stunting (WaSt) than the single WAZ <-3 case-definition. After assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC <115 mm or WAZ <-3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1.87 times larger than programmes admitting on MUAC <115 mm alone. Conclusions: A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.

Original languageEnglish
Number of pages17
Publication statusE-pub ahead of print - 2023
Publication typeA2 Review article in a scientific journal


  • Anthropometry
  • Child survival
  • Key words:
  • Mid-upper arm circumference
  • Mortality
  • Therapeutic feeding
  • Underweight
  • Wasting, Stunting

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Public Health, Environmental and Occupational Health


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