Anthropometric deficits and the associated risk of death by age and sex in children aged 6–59 months: A meta‐analysis

Abstract

Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6-59 months by age and sex. We categorised children into younger (6-23 months) and older (24-59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-incomecountries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < −2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001).For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children underfive in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits.

Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis

“…The 2020 Global Nutrition Report also showed that boys under‐5 years of age had a higher prevalence of stunted and wasted compared to girls (Micha et al, 2020 ). However, contrary to our results, in a recent study, the risk of death was found to be similar in boys and girls (Thurstans et al, 2023 ). One possible explanation could be that their analysis was limited to children aged 6–59 months, while ours to infants aged <6 months.…”

Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis

“…Two recent metaanalyses provide support to the nutritional disadvantages in boys, one conducted in 84 countries among older children aged 6-59 months (Khara et al, 2018), and another conducted in 74 studies among children aged 0-59 months (Thurstans et al, 2020). However, contrary to our results, the risk of death was found to be similar in boys and girls (Thurstans et al, 2023). The 2020 Global Nutrition Report also showed that boys under-five years of age had a higher prevalence of stunted and wasted compared to girls (Micha et al, 2020).…”

How age and sex affect treatment outcomes for children with severe malnutrition: A multi‐country secondary data analysis

“…We did not observe any differences in age or sex in relation to mortality. While this sample likely lacked sufficient power for this outcome, the finding is consistent with our recent meta‐analysis (S. Thurstans et al, 2022 ), showing no difference in the risk of mortality associated with wasting between boys and girls and between children under 2 years versus those 2–5 years. This highlights the importance of access to treatment for all children under 5 years, regardless of age and sex.…”

“…Wasting has also been shown to peak in younger children between 0 and 3 months (Benjamin‐Chung et al, 2020; Mertens et al, 2023). Despite higher levels of wasting among children under 2 years compared with children aged 2–4 years (14% and 9%, respectively) (Karlsson et al, 2022), we recently demonstrated equivalent levels of associated mortality risk for younger (6–23 months) and older (24–59 months) wasted children and equivalent levels of mortality risk between wasted girls and boys (S. Thurstans et al, 2022).…”