Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.

<h4>Background</h4>Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.<h4>Methods</h4>Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in...

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Autores principales:	Ibironke Olofin, Christine M McDonald, Majid Ezzati, Seth Flaxman, Robert E Black, Wafaie W Fawzi, Laura E Caulfield, Goodarz Danaei, Nutrition Impact Model Study (anthropometry cohort pooling)
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e12adbd24975435b8f86825991adc7c3
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spelling	oai:doaj.org-article:e12adbd24975435b8f86825991adc7c32021-11-18T07:43:55ZAssociations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.1932-620310.1371/journal.pone.0064636https://doaj.org/article/e12adbd24975435b8f86825991adc7c32013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23734210/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.<h4>Methods</h4>Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (-2≤Z<-1), moderate (-3≤Z<-2), or severe (Z<-3) anthropometric deficits with the reference category (Z≥-1).<h4>Results</h4>53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality.<h4>Conclusions</h4>All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases.Ibironke OlofinChristine M McDonaldMajid EzzatiSeth FlaxmanRobert E BlackWafaie W FawziLaura E CaulfieldGoodarz DanaeiNutrition Impact Model Study (anthropometry cohort pooling)Public Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 5, p e64636 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ibironke Olofin Christine M McDonald Majid Ezzati Seth Flaxman Robert E Black Wafaie W Fawzi Laura E Caulfield Goodarz Danaei Nutrition Impact Model Study (anthropometry cohort pooling) Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.
description	<h4>Background</h4>Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.<h4>Methods</h4>Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (-2≤Z<-1), moderate (-3≤Z<-2), or severe (Z<-3) anthropometric deficits with the reference category (Z≥-1).<h4>Results</h4>53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality.<h4>Conclusions</h4>All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases.
format	article
author	Ibironke Olofin Christine M McDonald Majid Ezzati Seth Flaxman Robert E Black Wafaie W Fawzi Laura E Caulfield Goodarz Danaei Nutrition Impact Model Study (anthropometry cohort pooling)
author_facet	Ibironke Olofin Christine M McDonald Majid Ezzati Seth Flaxman Robert E Black Wafaie W Fawzi Laura E Caulfield Goodarz Danaei Nutrition Impact Model Study (anthropometry cohort pooling)
author_sort	Ibironke Olofin
title	Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.
title_short	Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.
title_full	Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.
title_fullStr	Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.
title_full_unstemmed	Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.
title_sort	associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/e12adbd24975435b8f86825991adc7c3
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Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.

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