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The development of a MUAC-for-height reference, including a comparison to other nutritional status screening
Z Mei1, L M Grummer-Strawn, M de Onis
1Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
Insights
Mid-upper-arm circumference (MUAC) screening for children under 5 is evolving. New MUAC-for-age references are recommended, with MUAC-for-height as a viable alternative when age is unknown.
Area of Science:
- Pediatric Nutrition
- Anthropometry
- Public Health
Background:
- Mid-upper-arm circumference (MUAC) is a widely used index for assessing nutritional status in children under 5, particularly during emergencies.
- Traditional single MUAC cut-offs are being re-evaluated for age and sex independence.
- A WHO Expert Committee recommended updated MUAC-for-age references.
Purpose of the Study:
- To introduce and describe the MUAC-for-height reference and the QUAC stick.
- To evaluate the performance of different MUAC-based screening methods for childhood malnutrition.
- To provide an alternative anthropometric tool for situations where age assessment is challenging.
Main Methods:
- Review of scientific evidence on MUAC interpretation.
- Development and description of the MUAC-for-height reference and QUAC stick.
- Application of receiver operating characteristic (ROC) curve analysis to assess screening performance.
Main Results:
- The study describes the MUAC-for-height reference and the practical application of the QUAC stick.
- ROC curve analysis was used to compare the effectiveness of MUAC, MUAC-for-age, and MUAC-for-height in identifying malnourished children.
- MUAC-for-height is presented as a valuable alternative in settings with unreliable age data.
Conclusions:
- MUAC-for-height offers a practical and effective method for nutritional screening when age is difficult to determine.
- The QUAC stick facilitates the use of MUAC-for-height in diverse field settings.
- Updated MUAC references and alternative measurements are crucial for accurate malnutrition assessment in young children.
Abstract:
Mid-upper-arm circumference (MUAC) based on a single cut-off value for all the children less than 5 years of age has been used for many years as an alternative nutritional status index for children during famines or refugee crises, and as an additional screening tool in nonemergencies. However, it has recently been questioned whether MUAC is age- and sex-independent. After reviewing the scientific evidence underlying the use and interpretation of MUAC, a WHO Expert Committee recommended a new MUAC-for-age reference for under-5-year-olds. In some settings, however, it is difficult to assess a child's age and in such circumstances MUAC-for-height may be a good alternative. The height-based QUAC stick is a simple means of adjusting MUAC cut-offs according to height, and the MUAC-for-height reference and the construction and use of the QUAC stick are described in this article. Described also is the use of the receiver operating characteristic (ROC) curve method to evaluate the performance of MUAC, MUAC-for-age, and MUAC-for-height in screening malnourished children.