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Detecting malnutrition at age 6-12 months: international comparisons of arm circumference v. standard anthropometry
R Pust1, P Johnson, J Lautenschlager
1Department of Family and Community Medicine, University of Arizona, Tucson 85724.
Insights
A simple arm circumference (AC) screening tool shows promise for early detection of protein-energy malnutrition (PEM) in infants aged 6-12 months. This method is effective in identifying infants at risk, even when standard weight-for-age measurements are less reliable.
Area of Science:
- Pediatrics
- Global Health
- Nutritional Science
Background:
- Growth faltering, often indicating protein-energy malnutrition (PEM), typically emerges between 6 and 12 months of age.
- Current screening methods for PEM, like arm circumference (AC), are primarily used for older children (12-60 months) when AC is age-independent.
Purpose of the Study:
- To evaluate the effectiveness of arm circumference (AC) as a screening tool for protein-energy malnutrition (PEM) in infants aged 6-12 months.
- To determine an appropriate AC cut-off value for identifying infants at risk of PEM in this age group.
Main Methods:
- A study involving 378 infants aged 6-12 months was conducted across Pakistan, Nepal, Sierra Leone, and Papua New Guinea.
- Arm circumference (AC) measurements were taken and compared with weight-for-age (WA) and weight-for-length indicators.
- The age-independence of AC in this age group was analyzed by plotting AC against age.
Main Results:
- A cut-off of 12.5 cm for AC demonstrated 76% sensitivity and 90% specificity in identifying infants with less than 80% weight-for-age (WA).
- 33% of infants had AC < 12.5 cm, and 35% had WA < 80%, indicating a significant prevalence of potential malnutrition.
- AC showed an age-independent 'plateau' between 6-12 months in the studied population, mirroring the weight-for-age (WA) plateau common in developing nations.
Conclusions:
- An AC cut-off of 12.5 cm appears to be a simple and valid screening method for early PEM detection in infants aged 6-12 months.
- This screening approach is particularly relevant given the age-independent nature of AC in this age bracket, aligning with typical growth patterns in developing countries.
- Further confirmatory studies in diverse regions are recommended to validate these findings.
Abstract:
Growth faltering, which may herald protein-energy malnutrition (PEM) usually begins between ages 6 and 12 months. However, arm circumference (AC or MUAC) has mainly been used to screen for PEM between 12 and 60 months of age, when AC is age-independent. This study of 378 infants aged 6-12 months in Pakistan, Nepal, Sierra Leone, and Papua New Guinea showed that a cut-off 12.5 cm AC selects infants < 80 per cent weight-for-age (WA) with 76 per cent sensitivity and 90 per cent specificity. Of the 378 infants studied 131 (35 per cent) had WA < 80 per cent and 126 (33 per cent) had AC < 12.5 cm. Weight-for-length agreed less well with AC. The inter-regional prevalence range of AC < 12.5 cm was 29-40 per cent, while the WA < 80 per cent range was 27-45 per cent. When AC is plotted against age, a flat 'plateau' (slope = 0.04) shows age-independence between 6 and 12 months in these 378; this contrasts to the 10 per cent AC increase in European reference populations. Because this AC plateau parallels the WA plateau seen between 6 and 12 months of age in most developing nations, AC < 12.5 cm may provide a simple and valid screening test for early PEM in this crucial age bracket. Conformatory studies elsewhere are indicated.