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close this bookNew and Noteworthy in Nutrition (World Bank, 150 pages)
close this folderNo. 24, October 13, 1994
View the document(introductory text...)
View the documentA new look at mortality
View the documentMore on nutrition and productivity - and the 1995 WDR
View the documentThe population link
View the documentOn food and agriculture
View the documentInsights in infant feeding
View the documentOperations
View the documentMonitoring growth monitoring
View the documentNutrition needs in resettlement projects
View the documentTips for task managers
View the documentWorth noting

A new look at mortality

1. Dead Wrong. The bottom line of one of the most talked about papers in nutrition circles in recent years is that malnutrition has a far more powerful impact on child deaths than is typically recognized. Conventional methods of classifying cause of death suggest that roughly 70 percent of child deaths worldwide are due to diarrhea, acute respiratory infection, malaria and immunizable diseases. Wrong, some now say. Or, at least, misleading. The new paper by David Pelletier and colleagues from Cornell (presented at the 1994 annual federation meetings for experimental biology) applies a freshly-developed epidemiological method to estimate the percentage of child deaths caused by "the potentiating effects of malnutrition in infectious disease." With nationally representative data on weight-for-age of 6-to-59 month olds for 53 developing countries (an earlier paper by the authors, published last year in The American Journal of Public Health, had looked at six countries), the model indicates that a full 56 percent of child deaths are due to malnutrition's potentiating effects. Particularly noteworthy is the finding that 83 percent of these deaths are due to mild-to-moderate, not to severe, malnutrition. These yet-to-be published results (the methodology itself is discussed in the October issue of the Journal of Nutrition) hold obvious implications for the design of child survival strategies.

2. Fatal Subtraction. Similarly, Robert Fogel notes in his Nobel Prize Lecture, published in the June American Economic Review, that chronic malnutrition was a far more important cause of the high mortality rates in the past than was previously recognized. He also demonstrates the benefits that result from improving nutrition. For instance, gains in height and body mass index (BMI), his research shows, explain about 90 percent of the large decline in French mortality rates between 1785 and l870.