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Updated: Oct 17, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Can calf circumference be a viable option for nutritional assessment in the PICU?
Rafaela Rodrigues Vieira1, Marina Morgado Simões de Campos1, Patrícia Zamberlan1
1Instituto da Criança do Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
Insights
Calf circumference (CC) shows potential for nutritional monitoring in pediatric intensive care units (PICUs). CC decreased significantly in one week, unlike mid-upper arm circumference (MUAC), suggesting it may detect changes earlier in critically ill children.
Area of Science:
- Pediatric Intensive Care
- Nutritional Assessment
- Anthropometry
Background:
- Children in PICUs require specialized nutritional support.
- Nutritional assessments guide interventions, with body composition measures like mid-upper arm circumference (MUAC) being valuable.
- Calf circumference (CC) is used in adults but understudied in children for nutritional status.
Purpose of the Study:
- To assess the utility of calf circumference (CC) for nutritional monitoring in critically ill children.
- To compare CC measurements with mid-upper arm circumference (MUAC) and weight in pediatric intensive care unit (PICU) patients.
Main Methods:
- The study included 30 children aged 2-10 years admitted to the PICU.
- Measurements of MUAC, CC, and weight were taken within 24 hours of admission and after 7 days.
- Statistical analyses included Wilcoxon signed-rank test and Spearman's correlation to compare percentage changes and assess relationships.
Main Results:
- Calf circumference (CC) significantly decreased within the first week of PICU stay (p=0.001).
- Mid-upper arm circumference (MUAC) and weight showed no significant changes during the same period.
- Percentage changes in CC and MUAC were statistically different (p=0.0449) and positively correlated (r=0.3896).
Conclusions:
- Calf circumference (CC) appears to be a viable anthropometric measure for critically ill children in PICUs.
- CC may detect nutritional depletion earlier than MUAC in this population.
- The study highlights the need for alternative anthropometric measures in critically ill children.
Background:
Children admitted to paediatric intensive care units (PICUs) often need specialised nutritional intervention. Nutritional assessments provide specific data to support such interventions. Body composition measures, such as mid-upper arm circumference (MUAC), can complement nutritional assessment. However, MUAC has limitations. Calf circumference (CC) is an easy and common measure of muscle loss in the elderly; however, there are still very few studies on CC in children.
Aims:
To evaluate the viability of using CC for nutritional monitoring of children under intensive care, compared with MUAC and weight.
Methods:
Patients aged 2-10 years admitted to the PICU between December 2018 and August 2019 were included in the study. Two MUAC, CC, and weight measurements were performed: one in the first 24 h after PICU admission and another after 7 days. As there are no reference values for CC in children, this measure was used solely to observe the patient's individual progress. The nutritional status, both according to body mass index and MUAC, was used to characterise samples. Percentage changes in these measures were compared using the Wilcoxon signed-rank test for comparison between medians and Spearman's correlation test. Information from medical records regarding hospitalisation was also collected and analysed.
Results:
Thirty patients were included in the study. During hospitalisation week 1, CC decreased significantly (p = 0.001), whereas MUAC (p = 0.427) and weight (p = 0.315) did not change significantly. Percentage changes in CC and MUAC were statistically different (p = 0.0449), with a positive correlation between the changes in both measures (p = 0.0333; r = 0.3896); conversely, although the percentage changes in CC and weight significantly differed (p = 0.0066), no correlation was found between them (p = 0.9382; r = 0.0148). The percentage changes in MUAC and weight were not different (p = 0.1880) or correlated (p = 0.1691; r = 0.2577). No statistically significant relationship was found between percentage changes in CC and clinical outcomes (length of stay, fasting time, and mechanical ventilation time).
Conclusions:
CC appears to be a viable measure for use in PICUs. Although positively correlated with MUAC, a measure proven useful in critically ill children, CC decreased significantly in the first week of intensive care, whereas MUAC remained unchanged, indicating that CC may show signs of depletion earlier than MUAC in these patients. Our study reinforces the importance of alternative measures for anthropometric assessment of critically ill children.
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