VALIDITY OF SINGLE-WEIGHT MEASUREMENTS TO PREDICT CURRENT MALNUTRITION AND MORTALITY IN CHILDREN

In this cross-sectional study of a random cluster sample of 4238 rural Zairian children aged 0-5 y, we assessed underweight and wasting, def ined as weight-for-age < 75%, and weight-for-height < 80% of the U.S. National Center for Health Statistics reference median, respectively. We determined the diagnostic validity of underweight and wasting for p rotein-energy malnutrition, taking a low arm circumference and clinica l signs of muscle loss as criteria. Both underweight and wasting had l ow sensitivity in recognizing low arm circumference, any clinical musc le loss and even severe marasmus, especially in the weaning period of 12-30 mos. Receiver operating characteristic (ROC) analysis showed tha t the diagnostic validity of weight-for-height can be improved by usin g a cutoff for wasting at Z-score -0.75 instead of Z-score -2 or 80% o f reference median. ROC analysis of 30-mo mortality revealed a poor pr ognostic validity of weight-for-height and weight-for-age and better p erformances of arm circumference (cm) and of age. These data suggest t hat nutritional intervention programs targeted at wasted or underweigh t children can have only a limited effect on the prevalence of protein -energy malnutrition in the community or on the long-term mortality as sociated with it.