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Utility of mid-upper arm circumference in pediatric malnutrition: An Australasian Society of Parenteral and Enteral
Caitlin Miles1,2, Julia Fox1,3, Kimberly Davis4
1Australasian Society of Parenteral and Enteral Nutrition, Mornington, Victoria, Australia.
Insights
Mid-upper arm circumference (MUAC) offers a cost-effective method for assessing pediatric malnutrition. This consensus review clarifies its clinical use, advantages, and limitations for screening and diagnosis.
Area of Science:
- Pediatric Nutrition
- Anthropometry
- Clinical Assessment
Background:
- Mid-upper arm circumference (MUAC) is widely used for childhood undernutrition screening in resource-limited settings.
- Evidence on MUAC's diagnostic utility in clinical settings is conflicting, lacking consensus.
- The Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) initiated a review to establish consensus on MUAC's pediatric clinical use.
Purpose of the Study:
- To develop evidence-based consensus statements on the application of MUAC in pediatric clinical settings.
- To address the lack of consensus regarding MUAC's diagnostic role beyond traditional screening contexts.
- To provide guidance for clinicians on using MUAC for pediatric malnutrition assessment.
Main Methods:
- A multidisciplinary expert group utilized the Delphi method to appraise evidence and formulate consensus statements.
- Anonymous electronic surveys with a 5-point Likert scale were employed for rating agreement.
- Consensus was defined as ≥80% agreement ('agree' or 'strongly agree') on statements.
Main Results:
- Three rounds of Delphi surveys were necessary to achieve consensus.
- A total of 18 consensus statements, with supporting rationale, were developed.
- Statements covered key areas: assessment and diagnosis, screening and monitoring, and clinical settings.
Conclusions:
- An evidence-based, region-specific consensus on MUAC use is valuable for pediatric malnutrition management.
- MUAC is a simple, non-invasive, and cost-effective tool, potentially advantageous over traditional methods in certain clinical scenarios.
- This paper empirically summarizes MUAC's advantages and limitations for screening, assessment, diagnosis, and monitoring in pediatrics.
Background:
Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting.
Methods:
An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree."
Results:
Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'.
Conclusion:
An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.
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