Upper arm length along with mid-upper arm circumference to enhance wasting prevalence estimation and diagnosis: sensitivity and specificity in 6–59-months-old children

ObjectiveTo evaluate the added value of the use of upper arm length (UAL) along with mid-upper arm circumference (MUAC) to diagnose and estimate the prevalence of wasting in comparison to current WHO standard and other MUAC-based methods.DesignUAL and usual anthropometric measurements were collected during a national cross-sectional nutritional survey. Children were classified into three upper arm length groups (UALGs): UALG1, UALG2 and UALG3 according to the following UAL limits: ≤150, 151–180 and ≥181 mm, respectively. Receiver operating characteristic curves were used to determine the best MUAC cut-off for each group using weight-for-height Z-score (WHZ) as a reference standard. Wasting prevalence, sensitivity and specificity of all diagnostic methods were compared.SettingThis study was conducted in Mauritania.ParticipantsNational representative sample of children from 6 to 59 months old.ResultsIn total, 12 590 children were included in the study. Wasting prevalence was 16.1%, 5.0% and 12.5% when diagnosed by WHZ <−2, MUAC <125 mm and MUAC–UALG methods, respectively. Using the MUAC–UALG method increased the sensitivity for wasting diagnosis from 17.98% with MUAC <125 mm to 39.43% with MUAC–UALG. The specificity decreased from 97.49% with MUAC <125 mm to 92.71% with MUAC–UALG. With MUAC–height Z score and MUAC <138 mm, sensitivity was 26.04% and 69.76% and specificity were 97.40% and 75.64% respectively.ConclusionThis alternative method using MUAC tape to measure UAL increases the wasting diagnosis accuracy and allows for a better estimation of wasting prevalence. This method could be used as a potential alternative method for quick surveys in emergency settings such as Corona virus disease 2019 context.

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Upper arm length along with mid-upper arm circumference to enhance wasting prevalence estimation and diagnosis : sensitivity and specificity in 6 to 59 month-old children.

10.1101/2020.05.12.20089433 ◽

2020 ◽

Author(s):

Mouhamed Barro ◽

Mohamed Daouda Baro ◽

Djibril Cisse ◽

Noel Zagre ◽

Thierno Ba ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Virus Disease ◽

Diagnostic Methods ◽

Added Value ◽

Z Score ◽

Upper Arm ◽

Alternative Method ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

Upper Arm Length

Objective: To evaluate the added value of the use of upper arm length (UAL) along with MUAC (mid-upper arm circumference) to diagnose and estimate the prevalence of wasting in comparison to current WHO standard and others MUAC based methods. Design: We included UAL to usual anthropometric measurements during a Mauritanian national 6-59-month-old cross-sectional nutritional survey. Children were classified into 3 groups UALG1, UALG2 and UALG3 according to the following UAL limits: ≤ 150 mm, 151-180, and > 180mm respectively. We used a Receiver Operating Characteristic curve to determine the best MUAC cut-off for each group with weight-for-height Z score as a reference standard. We compared the wasting prevalence, sensitivity, and specificity, of all diagnostic methods. Findings: In total, 12 619 children were included in the study. Wasting prevalence was 16.1%, 5.0% and 12.5% when diagnosed by WHZ < -2, MUAC < 125 mm and MUAC-UALG methods respectively. Using the MUAC-UALG method increased the sensitivity for wasting diagnosis from 17.98 % with MUAC < 125 mm to 39.43% with MUAC-UALG. The specificity decreased from 97.49% with MUAC < 125 to 92.71% with MUAC-UALG. With MUAC-height Z score and MUAC < 138 mm, sensitivity was 26.04% and 69.76%and specificity were 97.40%and 75.64% respectively. Conclusion: This alternative method using MUAC measuring tape to measure UAL increases the wasting diagnosis accuracy and allows for a better estimation of wasting prevalence. This method could be used as a potential alternative method for quick surveys in emergency settings such as Corona virus disease 2019 context.

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Mid upper arm circumference as an alternative measure to assess the nutritional status of adolescents: a study in India based on NFHS-4 data

Journal of Biosocial Science ◽

10.1017/s0021932021000298 ◽

2021 ◽

pp. 1-12

Author(s):

Aparna Roy ◽

T. V. Sekher

Keyword(s):

Nutritional Status ◽

Sensitivity And Specificity ◽

Measurement Data ◽

Anthropometric Measurement ◽

Alternative Measure ◽

Upper Arm ◽

Male Adolescents ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

The Relationship

Abstract Use of body mass index (BMI) to assess the nutritional status of adolescents requires many resources, especially for country-level assessment. This study aimed to determine the relationship between BMI and mid upper arm circumference (MUAC) among adolescent males and females in India and to examine whether MUAC effectively represents the nutritional status of adolescents. The study utilized anthropometric measurement data collected by India’s National Family Health Survey-4 (2015–16). The weighted sample for analysis included 91,315 female and 14,893 male adolescents. The BMI and MUAC measurements showed a positive correlation in both female and male adolescents. Using BMI-for-age Z-score classifications, 12.7% of the adolescents were undernourished. Using MUAC (in cm) as per NACS (Nutrition Assessment, Counselling, and Support) guidelines and Mramba et al. (2017) classified 22.9% and 3.7% of the adolescents as undernourished respectively. Finally, using the MUAC-for-age Z-score classification, 98.4% of adolescents were determined to be normal and 1.7% undernourished. Sensitivity and specificity tests of the MUAC cut-offs, in comparison with BMI cut-offs, showed that all three MUAC cut-off classifications had high specificity (NACS cut-off: 81.3%; Mramba et al. cut-off (cm): 97.7%; Mramba et al. cut-off (Z-score): 99.1%). The NACS cut-off had moderately high sensitivity (52.2%) but the Mramba et al. cut-offs had low sensitivity (13.3% for the centimetre cut-off and 6.6% for the Z-score cut-off). Sensitivity and specificity tests proved the relationship between BMI and MUAC, and that MUAC represents adolescent nutritional status with considerable efficiency. With further research, it may be established that MUAC is a better and promising measure of adolescent nutrition, having the advantage of needing fewer resources for data collection. The MUAC has the potential to offer a simple and low-resource alternative to BMI to assess nutritional status among adolescents in poor countries.

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Comparison of Clinical Characteristics and Treatment Outcomes of Children Selected for Treatment of Severe Acute Malnutrition Using Mid Upper Arm Circumference and/or Weight-for-Height Z-Score

PLoS ONE ◽

10.1371/journal.pone.0137606 ◽

2015 ◽

Vol 10 (9) ◽

pp. e0137606 ◽

Cited By ~ 18

Author(s):

Sheila Isanaka ◽

Benjamin Guesdon ◽

Amy S. Labar ◽

Kerstin Hanson ◽

Celine Langendorf ◽

...

Keyword(s):

Treatment Outcomes ◽

Clinical Characteristics ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Z Score ◽

Upper Arm ◽

Arm Circumference ◽

Mid Upper Arm Circumference

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Diagnostic Concordance between Random Upper Arm Circumference and Mid Upper Arm Circumference Measurements among Children Aged 6–59 Months in South Ethiopia: A Community-Based Cross-Sectional Study

Journal of Nutrition and Metabolism ◽

10.1155/2021/6654817 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Juhar Admama Bamud ◽

Afework Mulugeta Bezabih ◽

Fentaw Wassie Feleke ◽

Getahun Fentaw Mulaw

Keyword(s):

Sensitivity And Specificity ◽

Cross Sectional Study ◽

Receiver Operating Curve ◽

Sectional Study ◽

Upper Arm ◽

Cross Sectional ◽

Arm Circumference ◽

Diagnostic Concordance ◽

Mid Upper Arm Circumference ◽

Kappa Agreement

Random upper arm circumference (RUAC) is frequently used for malnutrition screening among children aged 6–59 months. However, inadequate evidence exists regarding its agreement with mid upper arm circumference (MUAC). This study examined diagnostic concordance between RUAC and standard MUAC measurements and tested RUAC’s ability for screening malnutrition among children aged 6–59 months. A cross-sectional study was conducted from April 30 to May 30/2015 in Ethiopia. Data were taken from a sample of 819 children aged 6–59 months with a simple random sampling technique. The data were analyzed using SPSS version 22 software. The kappa agreement level, sensitivity, and specificity were calculated. The receiver operating curve was prepared to determine the optimal cutoff RUAC for the sensitivity and specificity. With National Center for Health Statistics (NCHS) cutoff (12 cm), the performance of RUAC measurements in terms of sensitivity was low (44%). The kappa agreement level between the two measurements was 0.551 ( p value < 0.001). With the new WHO cutoff (12.5 cm), however, RUAC was improved in validity (sensitivity 81%), specificity 96.9%, and kappa agreement level (K = 0.807; p < 0.001 ).

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Mid-upper arm circumference measurement for severe malnutrition screening in underfives

Paediatrica Indonesiana ◽

10.14238/pi60.1.2020.42-52 ◽

2020 ◽

Vol 60 (1) ◽

pp. 42-52

Author(s):

Stephanie Adelia ◽

Johannes Capistrano Susanto

Keyword(s):

Screening Method ◽

Cross Sectional Study ◽

Severe Malnutrition ◽

Z Score ◽

Upper Arm ◽

Cross Sectional ◽

Kappa Test ◽

Arm Circumference ◽

Significant Difference ◽

Mid Upper Arm Circumference

Background Severe malnutrition in Indonesia remains abundant. Severe malnutrition has been assessed by several methods, including mid–upper arm circumference (MUAC) and weight-for-height z-score (WHZ). As a screening method, MUAC is expected to be useful for identifying malnutrition in communities. Objective To determine whether MUAC measurements can be used for screening severe malnutrition at the community level in Indonesia. Method A cross-sectional study was conducted in 853 children aged 6 – 59 months who came to an integrated health service post (Posyandu) in Semarang, Central Java. Anthropometric measurements were performed by cadres and researchers and included MUAC and WHZ. Statistical analysis was done by McNemar test; results with P values >0.05 indicated no significant difference. Sensitivity and specificity were determined by 2 x 2 tables. The MUAC cut-off values were determined by receiver-operating characteristic (ROC) curve. Results Eight hundred fifty-three out of 1,115 children met the inclusion criteria, consisting of 419 (49.1%) boys, with most over the age of 2 years (57.2%). Kappa test revealed good inter-rater reliability in measurements between the cadre and researchers (Kappa=0.726). There were significant differences between MUAC (by cadres) and below red line status as well as WHZ, between MUAC (by researchers) and WHZ, as well as MUAC (by cadre and researchers) with WHZ and height-for-age z-score/HAZ . Sensitivity, specificity, PPV, and NPV of MUAC (by cadre) were 12.5%, 99.9%, 75%, and 97.5%, respectively, while those by the researchers were 16.7%, 99.6%, 57%, and 97.6%, respectively. In this study, MUAC of 14 cm was the best cut-off for severe malnutrition. Conclusion The MUAC measurement of 14 cm can be used for screening severe malnutrition in underfives at community.

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Assessing effectiveness of a novel mid-upper arm circumference Z-score tape in a community setting in Guatemala

Archives of Public Health ◽

10.1186/s13690-019-0370-0 ◽

2019 ◽

Vol 77 (1) ◽

Cited By ~ 2

Author(s):

Mikaela A. Miller ◽

Kristen Mallory ◽

Manolo Escobedo ◽

Ana Cecilia Tarot ◽

Susan Abdel-Rahman

Keyword(s):

Community Health ◽

Community Setting ◽

Rehabilitation Program ◽

Nutritional Risk ◽

Anthropometric Measurement ◽

Z Score ◽

Upper Arm ◽

Community Health Volunteers ◽

Arm Circumference ◽

Mid Upper Arm Circumference

Abstract Background Mid-Upper Arm Circumference (MUAC) is an independent anthropometric measurement used to identify malnutrition in children. While much research has been dedicated to applying fixed estimates of MUAC to identify cases of malnutrition in children under 5 years of age, far less has been done with age-specific MUAC Z-score values across the continuum of age from birth through adolescence. Methods The present study examined the effectiveness of a novel MUAC Z-score tape, in the hands of community health volunteers, to identify children over the age of 5 who would benefit from nutritional rehabilitation. In January of 2019, 112 community health volunteers working within Children International in Guatemala were trained to use the MUAC Z-score tape and asked to collect measurements on children or youth in their communities. Results Of the 818 MUAC Z-score tape measurements obtained by volunteers, 88.26% (722/818) were concordant with nutritional risk status as predicted by BMI Z-score, and 90.95% (744/818) were concordant with MUAC Z-score tape measurements made by field medical staff. MUAC Z-scores identified 87.10% (27/31) of the severely or moderately undernourished children as determined by the BMI Z-score who would be candidates for the nutrition rehabilitation program (Z-score ≤ − 2) along with an additional six children that would not have been classified as such with BMI Z-score. A qualitative survey distributed to the volunteers showed moderate rates of understanding of nutritional risk using the tape, and 62.50% reported the tape was easy to use. Conclusions These quantitative and qualitative findings suggest that with more in-depth training and education the MUAC Z-score tape is a viable, low-cost, low-burden alternative for community-level nutritional status assessment among the population served by Children International in Guatemala.

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Use of Mid-Upper Arm Circumference (MUAC) to Predict Malnutrition among Sri Lankan Schoolchildren

Nutrients ◽

10.3390/nu12010168 ◽

2020 ◽

Vol 12 (1) ◽

pp. 168

Author(s):

Chisa Shinsugi ◽

Deepa Gunasekara ◽

Hidemi Takimoto

Keyword(s):

Birth Weight ◽

Rank Correlation ◽

Overweight And Obesity ◽

Public Health Issue ◽

Sri Lankan ◽

Z Score ◽

Upper Arm ◽

Double Burden ◽

Arm Circumference ◽

Mid Upper Arm Circumference

The double burden of malnutrition (under- and overnutrition) is a serious public health issue in childhood. The mid-upper arm circumference (MUAC) is a simple tool for screening nutritional status, but studies of the optimal cutoff to define malnutrition are limited. This study aimed to explore the prediction of malnutrition by MUAC in Sri Lankan schoolchildren. The participants were 538 students (202 boys, 336 girls) aged 5–10 years. Spearman’s rank correlation was calculated for MUAC and both body-mass-index-for-age z-score (BAZ) and height-for-age z-score (HAZ). Receiver operating characteristic (ROC) analysis was conducted to assess the ability of MUAC to correctly classify malnutrition, after stratifying for age and birth weight. MUAC correlated significantly with BAZ (r = 0.84) and HAZ (r = 0.35). The areas under the ROC curve for thinness, overweight, obesity, and stunting were 0.88, 0.97, 0.97, and 0.77, respectively. The optimal MUAC cutoff values for predicting thinness and stunting were 167.5 mm and 162.5 mm, respectively; the optimal cutoffs for predicting overweight and obesity were 190.5 mm and 218.0 mm, respectively. These cutoffs differed after stratification by age group and birth weight. Our results confirm MUAC to be a useful tool for monitoring growth in schoolchildren.

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Comparison of Weight-for-Height Z-score and mid-upper arm circumference to diagnose moderate and severe acute malnutrition in children aged 6-59 months

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.2.45 ◽

2019 ◽

Vol 35 (2) ◽

Author(s):

Attia Bari ◽

Mubeen Nazar ◽

Aisha Iftikhar ◽

Sana Mehreen

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Z Score ◽

Roc Curve Analysis ◽

Upper Arm ◽

Male Predominance ◽

Creative Commons ◽

Rehabilitation Programs ◽

Arm Circumference ◽

Mid Upper Arm Circumference

Objective: To compare weight for height (WHZ) and mid upper arm circumference (MUAC) to diagnose malnutrition in children aged 6–59 months and to determine the association of various risk factors with the nutritional status of the children. Methods: Descriptive study conducted at the Department of Paediatric Medicine of The Children’s Hospital Lahore from May 2017 to April 2018. A total of 257 children 6 to 59 months of age having MUAC of <125mm were included. WHZ scoring was done and compared with MUAC. Results: There was slight male predominance 135 (52.5%). Mean age of children was 13.43 + 8.81 months (95% CI: 12.34-14.51). Mean MUAC was 103±13.5 mm (95%CI: 101-105mm). Exclusive breast feeding was present in 82 (32%). Maternal illiteracy was common in SAM (p = was 0.001). More children (73.2%) were identified as SAM by MUAC of <115 mm as compared to WHZ of <-3SD (70%). The ROC curve analysis for MUAC (cut-off value:103, 95%CI; AUC: 101-107 mm) showed it as an excellent predictor (p=<0.001) for children having SAM and WHZ <-3SD, with (AUC= 0.786 [95%CI; 0.725-0.848]). Conclusion: Both MUAC and WHZ showed fair degree of agreement to diagnose moderate and severe acute malnutrition among children aged 6–59 months. At the community level of resource limited countries, MUAC can be used as an appropriate rapid diagnostic method to identify malnourished children to be managed in nutritional rehabilitation programs. How to cite this:Bari A, Nazar M, Iftikhar A, Mehreen S. Comparison of Weight-for-Height Z-score and mid-upper arm circumference to diagnose moderate and severe acute malnutrition in children aged 6-59 months. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.45 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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