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Mid-arm circumference for detecting malnutrition during infancy
R C Bhatia1, P A Pooni, H Singh
1Department of Pediatrics, Dyanand Medical College and Hospital, Ludhiana.
Insights
Mid-arm circumference (MAC) is a reliable indicator for detecting protein-energy malnutrition (PEM) in infants aged 6-12 months. A cut-off of 12.5 cm or less demonstrates high sensitivity and specificity for early PEM assessment.
Area of Science:
- Pediatric Nutrition
- Anthropometry
- Public Health
Background:
- Mid-arm circumference (MAC) is a recognized age-independent indicator for protein-energy malnutrition (PEM) in children aged 1-5 years.
- The utility and optimal cut-off for MAC in infants under 12 months remain inadequately studied.
- Early and accurate detection of PEM in infants is crucial for timely intervention and program targeting.
Purpose of the Study:
- To establish the age-independent nature of MAC in infants aged 6-12 months.
- To identify a reliable MAC cut-off point for detecting PEM with maximum sensitivity and specificity in this age group.
- To assess the feasibility of using existing MAC measurement tools for infant PEM screening.
Main Methods:
- A cross-sectional study involving 240 malnourished infants (weight-for-age < 80% of NCHS 50th percentile) and 240 healthy controls, aged 6-12 months.
- MAC measurements were taken and analyzed for age independence within the 6-12 month range.
- Various MAC cut-off points were evaluated to determine the optimal threshold for PEM detection based on sensitivity and specificity.
Main Results:
- Mid-arm circumference was found to be age-independent in infants aged 6-12 months, with a minimal overall increase of 5.1%.
- A MAC cut-off of ≤12.5 cm demonstrated the highest sensitivity (92.1%) and specificity (88.3%) for identifying PEM.
- Existing MAC measurement tapes often feature a ≤12.5 cm color-coded cut-off, facilitating immediate application.
Conclusions:
- Mid-arm circumference is a simple, age-independent, and informative anthropometric measure for the early assessment of protein-energy malnutrition in infants aged 6-12 months.
- A single cut-off point of ≤12.5 cm for MAC is recommended as an effective screening tool for targeting infants in nutritional programs.
- The widespread availability of MAC tapes with the recommended cut-off eliminates the need for new equipment, promoting efficient implementation of screening initiatives.
Abstract:
Mid-arm circumference (MAC) has been extensively used at 1-5 years of age as an age-independent indicator of protein-energy malnutrition (PEM). Its role below 12 months of age has not been studied adequately and a search for a clinically reliable cut-off point has not been systematically done. This study was planned to establish the age-independent character of MAC within the 6-12 month age group and identify a cut-off point demonstrating the maximum sensitivity and specificity in detection of PEM. Two hundred and forty malnourished infants [< 80% weight for age (W/A) of 50th percentile of NCHS standard] were included with even distribution into 6 subgroups; 240 healthy infants were taken as controls. MAC within the age of 6-12 months was found to be age independent with an overall increase of 5.1%. By using various cut-off points a value of < or = 12.5 cm of MAC proved to be having maximum sensitivity (92.1%) and specificity (88.3%). MAC is, therefore, a simple, age independent, informative measurement for early assessment of PEM by using single cut-off point < or = 12.5 cm, and can serve as a screening test for targeting infants for meaningful utilization of nutritional programmes. Since nearly all MAC tapes in current use already have < or = 12.5 cm colour coded cut-off, no new tapes are necessary.