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Updated: Apr 16, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Mid upper-arm circumference is an effective tool to identify infants and young children with severe acute
Victor M Aguayo1, Satinder Aneja2, Nina Badgaiyan1
11United Nations Children's Fund (UNICEF),Regional Office for South Asia,PO Box 5815,Lekhnath Marg,Kathmandu,Nepal.
Insights
Mid-upper arm circumference (MUAC) cut-offs are appropriate for identifying severe acute malnutrition in Indian children, especially those aged 6-23 months. This measure effectively identifies children at high risk of complications and death.
Area of Science:
- Pediatric Nutrition
- Global Health
- Malnutrition Diagnostics
Background:
- Severe acute malnutrition (SAM) poses a significant threat to child survival globally.
- Accurate identification of SAM is crucial for timely intervention and improved outcomes.
- Current diagnostic criteria, including mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ), are continuously evaluated for their effectiveness.
Purpose of the Study:
- To evaluate the appropriateness of existing mid-upper arm circumference (MUAC) cut-offs for identifying severe acute malnutrition (SAM) in children within India.
- To compare the efficacy of MUAC<115 mm against WHZ<-3 in identifying children at risk of medical complications and mortality.
Main Methods:
- Analysis of data from 6307 children admitted to nutrition rehabilitation centers in India between 2009-2011.
- Inclusion criteria: children aged 6-59 months with bilateral pitting oedema, WHZ<-3, or MUAC<115 mm.
- Therapeutic care was administered according to WHO and Indian Academy of Pediatrics guidelines.
Main Results:
- Children aged 6-23 months constituted approximately 80% of admissions.
- MUAC<115 mm demonstrated comparable effectiveness to WHZ<-3 in identifying children with medical complications (32.2% vs 31.6%).
- Higher mortality rates were observed in children with MUAC<115 mm (0.61%) compared to WHZ<-3 (0.58%), with 91% of deaths in oedema-free children having MUAC<115 mm.
Conclusions:
- MUAC<115 mm is an appropriate criterion for identifying children with severe acute malnutrition at elevated risk of complications and death in similar populations.
- This finding is particularly relevant for children aged 6-23 months, highlighting MUAC's utility in early detection.
- The study supports the use of MUAC as a key indicator for severe acute malnutrition management in Indian children.
Objective:
To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India.
Design:
The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009-2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics.
Setting:
States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India.
Subjects:
Children aged 6-59 months with bilateral pitting oedema or weight-for-height Z-score (WHZ)<-3 or MUAC<115 mm at admission.
Results:
Children aged 6-23 months represented ~80 % of the admissions. Among them, the proportion with WHZ<-3 was similar to that with MUAC<115 mm (85·7 % v. 81·8 %); the proportion with MUAC<115 mm whose WHZ was <-3 was 82·6 %; and the proportion with WHZ<-3 whose MUAC<115 mm was 78·8 %. MUAC<115 mm was as effective as WHZ<-3 in identifying 6-59-month-old children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC<115 mm were higher than in children with WHZ<-3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedema-free children were deaths of children with MUAC<115 mm.
Conclusions:
In populations similar to those included in our analysis, MUAC<115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6-23 months old.
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