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  • Title: Comparison of weight- and height-based indices for assessing the risk of death in severely malnourished children.
    Author: Prudhon C, Briend A, Laurier D, Golden MH, Mary JY.
    Journal: Am J Epidemiol; 1996 Jul 15; 144(2):116-23. PubMed ID: 8678042.
    Abstract:
    To compare the effectiveness of treating malnourished children in different centers, the authors believe there is a need to have a simple method of adjusting mortality rates so that differences in the nutritional status of the children are taken into account. The authors compared different anthropometric indices based on weight and height to predict the risk of death among severely malnourished children. Anthropometric data from 1,047 children who survived were compared with those of 147 children who died during treatment in therapeutic feeding centers set up in African countries in 1993. The optimal ratio of weight to height determined by logistic regression was weight (kg)/height (m)1.74 (95% confidence interval of beta estimate 1.65-1.84). The receiver operating curves (sensitivity vs. specificity) showed that the body mass index (weight (kg)/height (m)2), optimal ratio of weight to height, and weight/height index expressed as the percentage of the median of the National Center for Health Statistics' standard were equivalent and superior to the weight/height index expressed as the z score of the National Center for Health Statistics' standard to predict death. As the optimal ratio of weight to height is easier to calculate than the weight/height index expressed as the percentage of the median or z score and does not depend upon either standards or tables, the optimal ratio of weight to height could be conveniently used to adjust mortality rates for nutritional status in therapeutic feeding centers. The development of a simple anthropometric index closely related to child survival prognosis could enhance the treatment of severely malnourished children at therapeutic feeding centers in Africa. This study examined whether simple ratios of weight to powers of height could be used to adjust the observed mortality rates for differences in the anthropometric state of 1194 children 6-59 months of age admitted to 9 feeding centers in Sierra Leone, Rwanda, and Madagascar. 147 of these children died during treatment. The optimal ratio of weight to height determined by logistic regression was weight (kg)/height (m). The receiver operating curves showed that the body mass index (weight (kg)/height (m)2), optimal ratio of weight to height, and weight/height index expressed as the percentage of the median of the US National Center for Health Statistics (NCHS) standard were equivalent and superior to the weight/height index expressed as the z score of the NCHS standard to predict death. Edema was a significant risk factor for death (odds ratio, 3.8; 95% confidence interval, 2.2-6.6). The optimal ratio of weight to height can be computed on a pocket calculator and does not require reference to standards or tables, making it appropriate for conditions in the feeding centers.
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