Skip to main content


Log in

Outcomes of Hospitalized Infants Aged One to Six Months in Relation to Different Anthropometric Indices – An Observational Cohort Study

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript



Malnutrition in infants less than six months is increasingly recognized. However, the WHO criteria for identifying malnutrition have not been fully evaluated against the risk of in-patient mortality. The observational study was conducted to evaluate the predictability of in-patient mortality of different anthropometric criteria and combination of criteria in order to understand which diagnostic criteria or combination of criteria most accurately predict in-patient mortality.


Data from a cohort of infants aged one to six months, admitted to Kalawati Saran Children’s Hospital, New Delhi between February and December 2018 was analyzed. The discriminatory ability of different anthropometric indexes [weight-for-age Z score (WAZ), weight-for-length Z score (WLZ) and mid-upper arm circumference (MUAC)] and their combinations to predict in-patient mortality was assessed using Receiver operating characteristic (ROC) curves.


A total of 1813 infants aged one to six months were admitted during the 11 mo period, of which 107 (5.9%) died in the hospital. Of all admissions, 39.9%, 26% and 23.4% were severely underweight, severely wasted and severely stunted, respectively. WAZ < -3 was the most sensitive predictor of mortality [sensitivity: 74.8%; specificity: 62.3%; area under the curve (AUC): 0.69, 95% CI: 0.64–0.74].


WAZ < -3 was the most sensitive predictor out of all individual and combined parameters/indexes in identifying infants less than six months at high risk of mortality which suggests that, it should be used to identify at-risk infants between one to six months on admission to in-patient care. Children identified as falling into this category should be properly evaluated and treated during their in-patient stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. World Health Organization. Identification of Severe Acute Malnutrition in Infants Under 6 months of Age. Available at: Accessed 24 Dec 2018.

  2. Global Estimate as per the 2018 Joint Malnutrition Estimates from WHO/UNICEF/WB Group. Available at: Accessed 30 Jan 2019.

  3. Kerac M, Mwangome M, McGrath M, Haider R, Berkley JA. Management of acute malnutrition in infants aged under 6 months (MAMI): current issues and future directions in policy and research. Food Nutr Bull. 2015;36:S30–4.

    Article  Google Scholar 

  4. Ministry of Health and Family Welfare. National Health Family Survey 4 (2015–2016). Available at: Accessed 3 Dec 2018.

  5. Smart JL. Vulnerability of developing brain to undernutrition. Ups J Med Sci Suppl. 1990;48:21–41.

    PubMed  CAS  Google Scholar 

  6. Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. J Am Med Assoc. 2001;285:413–20.

    Article  CAS  Google Scholar 

  7. Elizabeth L, Kathryn P, Dewey G. Nutrition and brain development in early life. Nutr Rev. 2014;72:267–84.

    Article  Google Scholar 

  8. Sankar MJ, Neogi SB, Sharma J, et al. State of newborn health in India. J Perinatol. 2016;36:S3–8.

    Article  CAS  Google Scholar 

  9. Godinho MA, Murthy S, Lakiang T, Puranik A, Nair SN. Mapping neonatal mortality in India: a closer look. Indian J Commun Med. 2017;42:234–7.

  10. Meyberg R, Boos R, Babajan A, Ertan AK, Schmidt W. Intrauterine growth retardation--perinatal mortality and postnatal morbidity in a perinatal center. Neonatology. 2000;204:218–23.

    CAS  Google Scholar 

  11. WHO Severe Acute Malnutrition Guidelines. Available at: Accessed 25 Sept 2018.

  12. World Health Organization. Updates on the Management of Severe Acute Malnutrition in Infants and Children. Guideline. 2013 Available at: Accessed 25 Sept 2018.

  13. Ministry of Health and Family Welfare, Government of India. Facilitator Guide for Facility Based Management of Severe Acute Malnutrition. 2013. Available at: Accessed 20 Sept 2018.

  14. Receiver Operating Characteristics. Available at: Accessed 5 Jan 2019.

  15. Mwangome M, Ngari M, Fegan G, et al. Diagnostic criteria for severe acute malnutrition among infants aged under 6 months. Am J Clin Nutr. 2017;105:1415–23.

    PubMed  PubMed Central  CAS  Google Scholar 

  16. Mwangome M, Ngari M, Bwahere P, et al. Anthropometry at birth and at age of routine vaccination to predict mortality in the first year of life: a birth cohort study in Bukina Faso. PLoS One. 2019;14:e0213523.

    Article  CAS  Google Scholar 

  17. Mwangome MK, Fegan G, Fulford T, Prentice AM, Berkley JA. Mid upper arm circumference at age of routine infant vaccination to identify infants at elevated risk of death: a retrospective cohort study in the Gambia. Bull World Health Organ. 2012;90:887–94.

    Article  Google Scholar 

  18. Vesel L, Bahl R, Martines J, Penny M, Bhandari N, Kirkwood BR. Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality. Bull World Heath Organ. 2010;88:39–48.

    Article  Google Scholar 

Download references


Prachi Rajput and Deepika Choudhary for help in data collection.

Author information

Authors and Affiliations



PK, YM, SB conceptualized the study. YM led data collection. RS did the statistical analysis. ER, RS and PK wrote the first draft. AD, SB, VK, and ADW provided critical inputs in finalizing the manuscript. All authors read and approved the final draft. PK will be the guarantor of the study.

Corresponding author

Correspondence to Praveen Kumar.

Ethics declarations

Conflict of Interest


Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, P., Meiyappan, Y., Rogers, E. et al. Outcomes of Hospitalized Infants Aged One to Six Months in Relation to Different Anthropometric Indices – An Observational Cohort Study. Indian J Pediatr 87, 699–705 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: