Concordance Between Indices of Malnutrition: Mid-Upper Arm Circumference V/S Weight for the Height Z Score in
Prinka Bai1, Heena Rais1, Bina Fawad2
1Pediatric Medicine, Ziauddin University, Karachi, PAK.
Insights
Mid-upper arm circumference (MUAC) and weight-for-height z-score (WHZ) show varied effectiveness for acute malnutrition in Pakistani children. MUAC sensitivity peaked at 12-24 months, while specificity was highest from 6-12 months.
Area of Science:
- Pediatrics
- Nutritional Science
- Public Health
Background:
- Acute malnutrition remains a critical health issue in children under five.
- Mid-upper arm circumference (MUAC) and weight-for-height z-score (WHZ) are key indicators for assessing malnutrition.
- Optimal screening tools require validation across diverse age groups and populations.
Purpose of the Study:
- To compare the World Health Organization (WHO) cut-off for MUAC against WHZ in Pakistani children aged 6–59 months with acute malnutrition.
- To evaluate the diagnostic performance of MUAC across different age strata.
Main Methods:
- A cross-sectional study was conducted with 450 children aged 6–59 months diagnosed with acute malnutrition (WHZ ≤ -2SD or ≤ -3SD).
- Children with conditions affecting growth (chronic illness, congenital defects, immune deficiencies) were excluded.
- MUAC and WHZ measurements were compared, analyzing sensitivity and specificity at different age groups.
Main Results:
- Significant mean differences in weight, height, and MUAC were observed among participants.
- MUAC demonstrated its highest sensitivity for detecting malnutrition in the 12–24-month age group (<11.5 cm).
- MUAC exhibited its highest specificity in the 6–12-month age group, with performance varying across other age brackets.
Conclusions:
- The effectiveness of MUAC cut-offs for acute malnutrition varies by age in children.
- MUAC shows the best specificity in infants (6–12 months) and the best sensitivity in toddlers (12–24 months).
- Age-specific considerations are crucial when utilizing MUAC for malnutrition screening in pediatric populations.
Abstract:
Objective To compare the WHO cut-off of the mid-upper arm circumference (MUAC) with the weight for height z-score (WHZ) in different age groups of children (6 months to 59 months of age) with acute malnutrition in Pakistan. Methodology A cross-sectional study was carried out in the pediatric unit of Ziauddin Medical University and Hospital on malnourished children from six to 59 months of age to compare two different indices of malnutrition, MUAC and WHZ. A total of 450 children with WHZ of <-2SD and <-3SD were included in the study after excluding children with failure to thrive due to chronic illness, congenital defects, and immune deficiencies/malabsorption. Results The study revealed a significant mean difference in weight, height, and MUAC among the participants (0.030, 0.053, and 0.02). The sensitivity of MUAC at <11.5 cm was highest in the 12-24-month age group with a decline at 24-48 months while specificity was highest at six to 12 months of age, which shows a mixed response. Conclusion The result revealed variation in the cut-off value of MUAC in different age groups; the best specificity of MUAC was found at six to 12 months of age and the best sensitivity at 12-24 months of age.
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