title: Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles.
abstract: BACKGROUND
  Previous analyses derived the relative risk (RR) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight.
  
  
  OBJECTIVE
  The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight.
  
  
  METHODS
  Data were obtained from investigators of 10 cohort studies with both weight-for-age category (<-3 SDs, -3 to <-2 SDs, -2 to <-1 SD, and >-1 SD) and cause of death information. All 10 studies contributed information on weight-for-age and risk of diarrhea, pneumonia, and all-cause mortality; however, only 6 studies contributed information on deaths because of measles, and only 3 studies contributed information on deaths because of malaria or fever. With use of weighted random effects models, we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition. Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys. With use of the RR and prevalence information, we then calculated the fraction of deaths by cause attributable to undernutrition.
  
  
  RESULTS
  The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality. Overall, 52.5% of all deaths in young children were attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea.
  
  
  CONCLUSIONS
  A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.
authors.affiliation: Department of International Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA. lcaufie@jhsph.edu
authors.forename: Laura E
authors.initials: LE
authors.lastname: Caulfield
authors.forename: Mercedes
authors.initials: M
authors.lastname: de Onis
authors.forename: Monika
authors.initials: M
authors.lastname: Blössner
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D001835:Body Weight; D002423:Cause of Death; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000401:mortality*; D008457:Measles / Q000453:epidemiology / Q000401:mortality*; D015201:Meta-Analysis as Topic; D009749:Nutrition Surveys; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors