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aIn thousands.

Sources: http://childinfo.org/eddb/malnutrition/database1.htm (underweight), http://childinfo.org/eddb/malnutrition/database2.htm (stunting), and http://childinfo.org/eddb/malnutrition/database3.htm (wasting).

aIn thousands.

Sources: http://childinfo.org/eddb/malnutrition/database1.htm (underweight), http://childinfo.org/eddb/malnutrition/database2.htm (stunting), and http://childinfo.org/eddb/malnutrition/database3.htm (wasting).

weight and height for epidemiological assessment of undernutrition. Measures of mid-upper arm circumference, however, are useful for screening to quickly identify the severely undernourished, especially children, who are at high risk of dying and need urgent case management.

Anthropometry is also used to assess undernutri-tion in adults, usually as the body mass index (weight/ height2). A body mass index of less than 18.5 defines chronic energy deficiency, and that less than 16.0 defines severe chronic energy deficiency. A global database on maternal nutrition is not available.

Anthropometric surveys do not give information on the causes (dietary, infectious, or other) of the weight and height deficits they measure. Genetic factors are unlikely to determine child growth at a population level because growth is very similar among well-off children from different countries. Breast-feeding patterns, however, may affect growth patterns, and WHO is developing new growth references based on a longitudinal study of infants from diverse geographic sites who are exclusively or predominantly breast fed for at least 4 months with continued breast feeding throughout the first year and on a cross-sectional study of infants and young children age 18-71 months.

Approximately 55% of all child deaths in developing countries are associated with undernutrition (Figure 4), of which at least three-fourths are related to moderate or mild undernutrition rather than severe undernutrition. Some nutritional deficiencies, such as vitamin A, can result in higher mortality without a clear effect on growth. Hence, studies examining the association between undernutrition and mortality, using anthropometry as proxy for undernutrition, are likely to underestimate the strength of this relationship.

Figure 4 Association between malnutrition assessed by anthropometry and cause-specific mortality in children younger than 5years of age. (Reproduced with permission from the WHO Department of Child and Adolescent Health and Development (2002) Available at www.who.int/child-adolescent-health/ OVERVIEW/CHILD_HEALTH/map_02_world.jpg. Sources: for cause-specific mortality, EIP/WHO; for malnutrition, Pelletier DL, Frongillo EA Jr, and Habicht JP (1993) Epidemiological evidence for a potentiating effect of malnutrition on child mortality. American Journal of Public Health 83: 1130-1133.)

Figure 4 Association between malnutrition assessed by anthropometry and cause-specific mortality in children younger than 5years of age. (Reproduced with permission from the WHO Department of Child and Adolescent Health and Development (2002) Available at www.who.int/child-adolescent-health/ OVERVIEW/CHILD_HEALTH/map_02_world.jpg. Sources: for cause-specific mortality, EIP/WHO; for malnutrition, Pelletier DL, Frongillo EA Jr, and Habicht JP (1993) Epidemiological evidence for a potentiating effect of malnutrition on child mortality. American Journal of Public Health 83: 1130-1133.)

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