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ObjectiveTo compare the responsiveness of different anthropometric indicators for measuring nutritional stress among children in developing countries.DesignGrowth was studied within 6-month intervals in a rural Senegalese community during one dry and two rainy (hungry) seasons. Responsiveness was defined as the change divided by the standard deviation of each anthropometric indicator. Contrast was defined as the difference in responsiveness between dry and rainy seasons.SettingThe study was conducted in Niakhar, a rural area of Senegal under demographic surveillance, with contrasted food and morbidity situations between rainy and dry seasons.SubjectsSome 5000 children under 5 years of age were monitored at 6-month intervals in 1983–1984. The present analysis was carried out on a sub-sample of children aged 6–23 months with complete measures, totalling 2803 children-intervals.ResultsIn both univariate and multivariate analysis, mid-upper arm circumference was found to be more responsive to nutritional stress than the commonly used weight-for-height Z-score (contrast = −0·64 for mid-upper arm circumference v. −0·53 for weight-for-height Z-score). Other discriminant indicators were: muscle circumference, weight-for-height, BMI and triceps skinfold. Height, head circumference and subscapular skinfold had no discriminating power for measuring the net effect of nutritional stress during the rainy season.ConclusionsThe use of mid-upper arm circumference for assessing nutritional stress in community surveys should be considered and preferred to other nutritional indicators. Strict standardization procedures for measuring mid-upper arm circumference are required for optimal use.

The objective of this study was to evaluate the ability of the body mass index (BMI, kg/m2) to reflect low percent body fat (%BF) in a population with a rather mild but widespread prevalence of low BMI. A sample of 586 women was studied in the Plateau Koukouya, a rural area of the Republic of Congo, Central Africa. Percent BF was estimated from bio-electrical impedance (BIA). BIA parameters were assumed to reflect lean body mass. The correlation between %BF and BMI was high (r = 0.84; P is less than 0.001). Low %BF or low BIA parameters were defined as the first quartile of value of BMI is less than 18.5, an accepted international cutoff for thinness, in relation to %BF was 58.5%, 93.6%, 75.4%, and 87.1%, respectively. A continuous sensitivity/specificity analysis (receiver operator characteristic (ROC) curves) for characterizing low %BF or low BIA parameters was done for a large range of BMI values. ROC curve analysis for %BF suggested that an acceptable trade-off between sensitivity (89.8%) and specificity (77.9%) occurred at a BMI of 19.7 kg/m2. However, the positive predictive value was low (57.6%). For the prediction of low BIA parameters, results were similar, showing moderate sensitivity and high specificity for BMI is less than 18.5, a cutoff point of BMI = 19.6, and low positive predictive values (less than 48%). The data suggest that BMI was not a good predictor of low %BF. This is consistent with the assumption of a decrease in both fat and fat free body mass in cases of low BMI. (Résumé d'auteur)

Cette étude est le résultat d'une collaboration intensive de quatre années entre démographes et nutritionnistes de l'IRD (ex-ORSTOM) et de l'ORANA (Dakar) dans le cadre d'un grand programme de recherche sur les déterminants de la santé dans les pays du Sud. L'étude porte sur la relation statistique entre l'état nutritionnel des enfants d'âge préscolaire, mesuré par les indices anthropométriques, et la survie de l'enfant au cours des 6 mois suivant la mesure, dans une zone rurale d'Afrique de l'Ouest (Niakhar, Sénégal). Divers indices anthropométriques sont utilisés, et tous apparaissent fortement corrélés avec la survie de l'enfant. L'étude a permis de quantifier le rôle que la malnutrition joue dans la mortalité des jeunes enfants : environ 60 % des décès d'enfants de 1 à 60 mois sont attribuables au mauvais état nutritionnel. Cette étude voulait aussi fournir un outil pratique de dépistage de la malnutrition sur le terrain. C'est le tour de bras, mesuré simplement à l'aide d'une bandelette graduée, qui semble le plus simple à mesurer en pratique. L'étude présente aussi de nombreux résultats sur la démographie de la zone d'étude, sur l'alimentation du jeune enfant, et des résultats détaillés sur l'évaluation de l'état nutritionnel. (Résumé d'auteur)

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.

The usefulness of nutritional indices and classifications in predicting the death of children under 5 years old was evaluated by comparing measurements of 34 children with diarrhoea who died in a Dhaka hospital with those of 318 patients who were discharged in a satisfactory condition. In a logistic regression analysis mid-upper arm circumference was found to be as effective as other nutritional indices in predicting death. Combinations of different indices did not improve the prediction. Arm circumference might be preferable to more complex criteria for predicting the death of malnourished children.