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Updated: Jan 7, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Optimizing Mid-Upper Arm Circumference (MUAC) Thresholds for Screening Wasting and Severe Wasting in Children Aged
Rajesh Kumar Sinha1, Praveen Kumar2, Anju Seth2
1Department of Finance, Jaipuria Institute of Management, Jaipur, Rajasthan, India. cmarajesh@gmail.com.
Insights
New mid-upper arm circumference (MUAC) thresholds can effectively screen for child wasting and severe wasting in India. These MUAC cut-offs offer a practical alternative to weight-for-height Z-scores (WHZ) in resource-limited settings.
Area of Science:
- Pediatric Nutrition
- Anthropometry
- Public Health
Background:
- Childhood malnutrition, including wasting and severe wasting, remains a significant public health concern in India.
- Accurate screening methods are crucial for timely intervention and effective management of malnutrition.
- Mid-upper arm circumference (MUAC) is a simple anthropometric measurement that can be used for nutritional assessment.
Purpose of the Study:
- To determine optimal mid-upper arm circumference (MUAC) thresholds for identifying wasting and severe wasting in Indian children.
- To evaluate the agreement between MUAC and weight-for-height Z-scores (WHZ) for nutritional screening.
- To provide evidence-based MUAC cut-offs for use in resource-limited settings.
Main Methods:
- Cross-sectional community-based studies were conducted in five districts across four Indian states.
- Anthropometric measurements, including MUAC and WHZ, were collected from 2,335 children aged 6-59 months.
- Receiver Operating Characteristic (ROC) curve analyses were performed to identify optimal MUAC thresholds.
Main Results:
- Prevalence of wasting and severe wasting was 30.9% and 5.5%, respectively.
- A strong correlation (0.72) was observed between MUAC and WHZ, but agreement for current thresholds was poor (Cohen's Kappa < 0.4).
- Optimal MUAC cut-offs were identified: <12.8 cm for severe wasting and <13.8 cm for wasting in children aged 6-59 months.
Conclusions:
- MUAC is a reliable indicator for assessing WHZ in children aged 6-59 months in India.
- Recommended MUAC cut-offs of <14.0 cm for wasting and <13.0 cm for severe wasting can be utilized for initial screening in under-resourced areas.
- MUAC screening can facilitate further assessment using WHZ, improving malnutrition detection and management.
Objectives:
To identify suitable mid-upper arm circumference (MUAC) thresholds for screening wasting and severe wasting among children in India.
Methods:
Community-based cross-sectional studies were conducted in five districts from four Indian states- Jharkhand, Odisha, Uttar Pradesh, and Madhya Pradesh. Anthropometric measurements of 2,335 children aged 6-59 mo were taken.
Results:
Wasting [Weight-for-height Z-score (WHZ) <-2] and severe wasting (WHZ <-3) prevalence were found to be 30.9% and 5.5%, respectively. A strong correlation [0.72 (95% CI: 0.69, 0.74; P < 0.001)] between MUAC and WHZ was observed. However, Cohen's Kappa coefficients of 0.28 (P < 0.001) and 0.36 (P < 0.001) suggested a lack of strong agreement between the current WHZ and MUAC thresholds for detecting wasting and severe wasting. ROC analyses for identifying severe wasting indicated that MUAC of 12.8 cm was appropriate for children aged 6-59 mo (sensitivity: 0.80, specificity: 0.87, AUC: 0.91; 95% CI: 0.89, 0.93). For children 6-23 mo and 24-59 mo, MUAC of 12.7 cm and 13.3 cm respectively were suitable. For identifying wasting, the appropriate MUAC cut-offs were 13.8 cm for children 6-59 mo (sensitivity: 0.82, specificity: 0.69, AUC: 0.84; 95% CI: 0.82, 0.86), 13.1 cm for children 6-23 mo, and 13.8 cm for children 24-59 mo.
Conclusions:
MUAC is a reliable indicator of WHZ for children 6-59 mo in India. In under-resourced areas where measuring WHZ may be challenging, MUAC cut-offs of < 14.0 cm for wasting and < 13.0 cm for severe wasting can be used for initial screening. Further assessment using WHZ can follow MUAC screening.
