Nutritional status and mortality: a prospective validation of the QUAC stick

In December 1970, 8,292 rural Bengali children the ages of 1 and 9 had their height and arm circumference measured. Eighteen months later the fate of 98.8% of these children was ascertained. Overall, 2.3% of the children had died. Those the 9th and between the 10th and 50th percentiles of arm circumference for height were at 3.4 1.5 times greater risk of dying, respectively, than those above the 5oth percentiles. A gradient was present at every age, although it was greatest for the bulnerable 1- to 4-year age group, for whom the relative risks were 4.5, 1.6, and 1.0, respectively. The discriminant efficiency of these categories was greatest immediately following measurement and decreased with time. During the first postmeasurement month the risk of dying the poorest nutritional category was 19.8 times that of the best, and for the first 3 months, 12.2 times. By the last 3 months of followup it was only twice that of the best. Females in all three categories fared slightly worse than males, being at 1.1 times the risk of dying. This same vulnerable group of 1. to 4-year olds could be identified without knowing their age. Limiting the analysis to children whose heights were between 65 and 89 cm resulted in relative risks, for the three categories, of 4.1, 1.6, and 1.0, respectively. These arm circumference to height categories and the QUAC stick survey technique for which they were devised appear to be valid tools for identifying nutritionally disadvantaged individuals and populations at high risk of death.

Mortality committee as an educational and administrative tool

The establishment of a mortality committee as an educational exercise in a general hospital in rural Kenya was found to have widespread implications. Its findings led to an expansion of the community health services based on the hospital. Within the hospital it resulted in extensive alterations in routine procedures, plant, equipment, and a redeployment of staff.

Autopsy data and their total evaluation

The role of the autopsy is discussed in the study of the etiology of the current major causes of death (cardiovascular and neoplastic diseases) in developed countries. Evidence is accumulating for the importance of environmental factors in the etiology of these diseases. The study of regional differences in occurrence is described as a method of identifying specific factors. Maps are shown of mortality rates for all causes of death in Ontario counties for males aged 65-74 and 95+ during 1964-68. Some of the difficulties in obtaining data in this form, and in their analysis, are indicated. Regional mortality patterns can be interpreted by the use of associations with available regional socioeconomic measures, or by the use of regional data on trace-metal levels in autopsy samples of human lung, rib, vertebra, kidney and liver. The methodology and the difficulties involved in the determination of trace-metal levels in these tissues are discussed, as is the possible relevance of these levels to the study of degenerative diseases. All these considerations emphasize the valuable contributions of autopsy studies.

Immune function and survival in a long-lived mouse strain subjected to undernutrition

Functional immune changes were monitored in populations of the long-lived C57BL/6J strain of mice which were subjected to dietary restriction from time of weaning or subjected to such restriction both before and after weaning, along with the appropriate control populations. Responses to T and B cell mitogens (PHA, Con-A, pokeweed, bacterial lipopolysaccharide, and PPD), to injected sheep red blood cells, and measurement of skin allograft rejection rates were followed. Early in life, restricted mice appear immunosuppressed, as judged by all these parameters. Skin allograft rejection remained suppressed until relatively late in life. Other responses tended to reverse from the earlier pattern; by mid-life restricted mice responded better than controls. Dietary restriction profoundly affects the immune system. Mice on such regimes display anatomic and certain immune functional changes which suggest that the immune system may mature less rapidly and stay "younger" longer than in the controls. Furthermore, dietary restriction results in prolongation of life span.