Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles

Am J Clin Nutr. 2004 Jul;80(1):193-8. doi: 10.1093/ajcn/80.1.193.


Background: Previous analyses derived the relative risk (RR) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight.

Objectives: The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight.

Design: Data were obtained from investigators of 10 cohort studies with both weight-for-age category (<-3 SDs, -3 to <-2 SDs, -2 to <-1 SD, and >-1 SD) and cause of death information. All 10 studies contributed information on weight-for-age and risk of diarrhea, pneumonia, and all-cause mortality; however, only 6 studies contributed information on deaths because of measles, and only 3 studies contributed information on deaths because of malaria or fever. With use of weighted random effects models, we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition. Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys. With use of the RR and prevalence information, we then calculated the fraction of deaths by cause attributable to undernutrition.

Results: The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality. Overall, 52.5% of all deaths in young children were attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea.

Conclusion: A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Weight
  • Cause of Death
  • Child
  • Child Nutritional Physiological Phenomena
  • Child, Preschool
  • Cohort Studies
  • Diarrhea / epidemiology
  • Diarrhea / mortality*
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Malaria / epidemiology
  • Malaria / mortality*
  • Male
  • Malnutrition / complications
  • Malnutrition / mortality*
  • Measles / epidemiology
  • Measles / mortality*
  • Meta-Analysis as Topic
  • Nutrition Surveys
  • Pneumonia / epidemiology
  • Pneumonia / mortality*
  • Prevalence
  • Risk Factors