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Nutritional status of children: validity of mid-upper arm circumference for screening undernutrition
R Kumar1, A K Aggarwal, S D Iyengar
1Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh.
Insights
Nearly half of preschool children in Ambala, Haryana, are undernourished. Mid-upper arm circumference (MAC) measurements suggest higher optimal cut-off points for diagnosing malnutrition in this population compared to standard values.
Area of Science:
- Pediatric Nutrition
- Public Health
- Anthropometry
Background:
- Childhood malnutrition remains a significant global health issue, particularly in developing regions.
- Accurate and accessible screening tools are crucial for early detection and intervention.
- Mid-upper arm circumference (MAC) is a commonly used anthropometric indicator for assessing nutritional status.
Purpose of the Study:
- To evaluate the nutritional status of preschool children in District Ambala, Haryana.
- To determine the validity and optimal cut-off points of MAC for diagnosing malnutrition (underweight, stunting, wasting) in this specific population.
- To compare the effectiveness of MAC with established NCHS standards.
Main Methods:
- A cross-sectional household survey was conducted in 47 villages.
- Data on age, weight, height, and MAC were collected from 3747 children under six years old.
- Prevalence rates of underweight, stunting, and wasting were calculated, and the sensitivity and specificity of MAC were assessed for children aged 1-4 years.
Main Results:
- High prevalence of undernutrition: 48.8% stunted, 49.6% underweight, and 9.1% wasted.
- Severe forms of malnutrition were also prevalent (18.1% severe stunting, 11.5% severe underweight).
- Optimal MAC cut-off points for detecting wasting, underweight, and stunting in this setting were found to be higher than conventional values.
Conclusions:
- Undernutrition is highly prevalent among preschool children in the study area, with a significant increase after 12 months of age.
- Girls exhibited higher rates of stunting and underweight compared to boys.
- The study recommends adjusted MAC cut-off points for more accurate malnutrition diagnosis in this population.
Objectives:
To determine the nutritional status and validity of mid upper arm circumference (MAC) in diagnosing malnutrition among preschool children.
Design:
Cross-sectional household survey.
Setting:
47 villages in District Ambala, Haryana.
Subjects:
3747 children aged less than six years.
Methodology:
Trained field workers recorded age, weight, length/ height and MAC of children. Prevalence of underweight, stunting, and wasting were calculated in reference to National Centre for Health Statistics (NCHS) standards. Sensitivity and specificity of MAC for detecting underweight, wasting and stunting among children aged 1 to 4 years were determined.
Results:
At the cut-off level of < -2.00 SD of Z-scores, 48.8% children were stunted, 49.6% were underweight and 9.1% were wasted whereas 47.6% children had neither wasting nor stunting. Prevalence of severe stunting, underweight, and wasting (Z-score < -3 SD) was 18.1%, 11.5% and 0.6%, respectively. Undernutrition showed a significant rise after 12 months of age (p < 0.0001). Stunting and underweight were significantly more among girls compared to boys (p < 0.01) but wasting was not significantly different in them. Compared to the conventional MAC cut off levels of < 13.5 cm and < 12.5 cm, sensitivity and specificity in our setting were optimum at < 13.5 cm for detection of wasting and < 14.0 cm for diagnosis of underweight and stunting, and < 13.0 cm for detection of severe wasting and < 13.5 cm for diagnosis of severe underweight and severe stunting.
Conclusions:
Almost every second child was undernourished. Optimum cut off level of MAC in our setting were higher than the conventional cut off points for detection of undernutrition among children.