title: The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries.
abstract: BACKGROUND
  Child stunting, wasting, and underweight have been individually associated with increased mortality. However, there has not been an analysis of the mortality risk associated with multiple anthropometric deficits.
  
  
  OBJECTIVE
  The objective was to quantify the association between combinations of stunting, wasting, and underweight and mortality among children <5 y of age.
  
  
  METHODS
  We analyzed data from 10 cohort studies or randomized trials in low- and middle-income countries in Africa, Asia, and Latin America with 53,767 participants and 1306 deaths. Height-for-age, weight-for-height, and weight-for-age were calculated by using the 2006 WHO growth standards, and children were classified into 7 mutually exclusive combinations: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight (deficit defined as < -2 z scores). We calculated study-specific mortality HRs using Cox proportional hazards models and used a random-effects model to pool HRs across studies.
  
  
  RESULTS
  The risk of all-cause mortality was elevated among children with 1, 2, and 3 anthropometric deficits. In comparison with children with no deficits, the mortality HRs were 3.4 (95% CI: 2.6, 4.3) among children who were stunted and underweight but not wasted; 4.7 (95% CI: 3.1, 7.1) in those who were wasted and underweight but not stunted; and 12.3 (95% CI: 7.7, 19.6) in those who were stunted, wasted, and underweight.
  
  
  CONCLUSIONS
  Children with multiple deficits are at a heightened risk of mortality and may benefit most from nutrition and other child survival interventions.
authors: Departments of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
authors: Christine M
authors: CM
authors: McDonald
authors: Ibironke
authors: I
authors: Olofin
authors: Seth
authors: S
authors: Flaxman
authors: Wafaie W
authors: WW
authors: Fawzi
authors: Donna
authors: D
authors: Spiegelman
authors: Laura E
authors: LE
authors: Caulfield
authors: Robert E
authors: RE
authors: Black
authors: Majid
authors: M
authors: Ezzati
authors: Goodarz
authors: G
authors: Danaei
mesh_terms: D000349:Africa; D000886:Anthropometry; D001208:Asia; D015992:Body Mass Index; D049628:Body Size; D002423:Cause of Death; D002648:Child; D046688:Child Mortality; D003906:Developing Countries; D006130:Growth Disorders / Q000150:complications / Q000401:mortality*; D006801:Humans; D007843:Latin America; D044342:Malnutrition / Q000150:complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013851:Thinness / Q000150:complications / Q000401:mortality*; D019282:Wasting Syndrome / Q000150:complications / Q000401:mortality*