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Updated: Nov 30, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Diagnostic performance of midupper arm circumference for detecting severe wasting among infants aged 1-6 months in
Beshada R Jima1, Hamid Y Hassen2, Yalemwork Getnet1
1Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Insights
Midupper arm circumference (MUAC) effectively identifies severe wasting in infants aged 1-6 months. A MUAC cutoff of ≤112 mm shows good diagnostic performance for this vulnerable age group.
Area of Science:
- Pediatric Nutrition
- Global Health
- Diagnostic Accuracy Studies
Background:
- Midupper arm circumference (MUAC) is a key indicator for detecting child wasting.
- Limited data exists on MUAC's diagnostic performance in infants aged 1-6 months.
Purpose of the Study:
- To assess the diagnostic accuracy of MUAC for severe wasting in infants aged 1-6 months.
- To determine an optimal MUAC cutoff for identifying severe wasting in this age group.
Main Methods:
- Cross-sectional study of 467 hospitalized infants (1-6 months) in Ethiopia.
- Severe wasting defined by weight-for-length z-score (WLZ) < -3 SDs (WHO 2006 standards).
- Receiver operating characteristic (ROC) analysis used to evaluate MUAC's discriminatory power.
Main Results:
- Prevalence of severe wasting was 21.6% (101 infants).
- MUAC demonstrated good accuracy (Area Under ROC Curve = 0.86) in identifying severe wasting.
- Optimal MUAC cutoff of ≤112 mm achieved 85.1% sensitivity and 76.0% specificity.
Conclusions:
- A MUAC cutoff of ≤112 mm is a reliable indicator for detecting severe wasting in infants aged 1-6 months.
- Further research should explore community-level MUAC performance and mortality prediction in infants <6 months.
Background:
Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6-59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1-6 mo.
Objective:
The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1-6 mo.
Methods:
We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1-6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of -3 SDs from the median as per the WHO 2006 child growth standards. Receiver operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs.
Results:
The median age, MUAC, and WLZ were 100 d (IQR: 69-145 d), 119 mm (IQR: 103-130 mm), and -1.27 (IQR: -2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n = 101 (21.6%) and n = 61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI: 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI: 76.7%, 91.4%) and a specificity of 76.0% (95% CI: 71.2%, 80.2%).
Conclusions:
A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1-6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo.
