Mid-upper arm circumference as a screening tool for identifying adolescents with thinness
Research snapshot1
Adolescence is a unique period of rapid growth and, when combined with household food insecurity, is also a period of an increased risk of undernutrition. Failure to achieve optimal nutrition during adolescence may lead to delayed physical growth and sexual maturation and, for adolescent girls, increases the risk of giving birth to undernourished infants. There is a need for a simple, reliable and accurate screening tool to identify undernutrition in this age group to underpin effective interventions. This cross-sectional study aimed to evaluate the performance of mid-upper-arm circumference (MUAC) as an alternative to the World Health Organization-recommended body mass index (BMI) z-score to identify thinness in the late adolescence period.
In a sample of 851 adolescents aged 15 to 19 years from 15 schools in Addis Ababa, Ethiopia, the study found that MUAC had a significant strong positive correlation with BMI z-score, r = 0.81 (95% CI 0.79, 0.84) but was poorly correlated with age, r = 0.15 (95% CI 0.08, 0.21). MUAC could identify thinness among adolescents with excellent discriminatory performance (area under the curve (AUC) 0.91). The optimum MUAC cut-off point to identify thinness was ≤23.3 cm for males (sensitivity: 87.9%; specificity: 75.9%), whereas the optimum MUAC cut-off point for females was ≤22.6 cm (sensitivity: 100%; specificity: 88.2%). Based on the proposed cut-off point for the total sample (≤23.3 cm), MUAC had a high negative predictive value (NPV) – among those adolescents who identified as non-thin by MUAC, 98.0% were non-thin by BMI Z-score – and lower positive predictive value (PPV) – among those adolescents identified as thin by MUAC, only 32.4% were thin by BMI Z-score.
This indicates that MUAC is a good indicator for ruling in and ruling out thinness among adolescents but that, due to the low PPV, a large number of adolescents would be incorrectly considered to be thin leading to unnecessary nutritional support, poor use of resources and an overburdened healthcare system. When used in a relatively well-nourished population, it would be necessary to choose a cut-off with a greater positive predictive value.
Subscribe freely to receive Field Exchange content to your mailbox or front door.
Endnotes
1 Sisay, B., Haile, D., Hassen, H., & Gebreyesus, S. (2020). Mid-upper arm circumference as a screening tool for identifying adolescents with thinness. Public Health Nutrition, 1-10. doi:10.1017/S1368980020003869
More like this
FEX: Use of anthropometry in school-aged children and adolescents
This is a summary of a Field Exchange research summary that was included in issue 66. The original article was authored by Natasha Lelijveld Natasha Lelijveld is a Senior...
FEX: MUAC vs WHZ in predicting mortality in hospitalised children under five years of age
Summary of research1 This research contributes to the evidence base regarding which anthropometric indicators identify malnourished sick children most at risk of death. Low...
FEX: Anthropometric assessment of nutritional status in school-aged children and adolescents
View this article as a pdf Lisez cet article en français ici By Natasha Lelijveld Natasha Lelijveld is a senior nutritionist at ENN. She has previously worked in...
FEX: Methods to detect cases of severely malnourished infants under six months
Summary of research1 Location: Global What we know: The World Health Organization (WHO) recommends weight-for-length z score (WLZ) as an anthropometric indicator to identify...
FEX: Finding the right MUAC cut-off to improve screening efficiency
Author Koert Ritmeijer, MSF Holland In Hlaing Thayer township, Yangon, Burma, ORWs were spending a considerable amount of time doing weight and height measurements on all...
FEX: Anthropometric indicators to identify a pregnant woman as acutely malnourished and predict adverse birth outcomes
Summary of published research1 Location: Global What we know: There is no consensus on how to identify pregnant women as acutely malnourished and when to enrol them in...
FEX: A growth reference for MUAC-for-age among school age children and adolescents and validation for mortality
Summary of research1 Location: Kenya, Uganda and Zimbabwe What we know: An internationally accepted reference for mid-upper arm circumference (MUAC) does not exist for...
FEX: WHO growth reference for children and adolescents
Summary of published research1 The need for a widely applicable growth reference for older children and adolescents has increasingly been recognised by countries attempting to...
FEX: Angular stomatitis and riboflavin status
Summary of published paper1 Severe angular stomatitis Between 1990 and 1993, fear of persecution led 83,000 ethnic Nepalese to flee from Bhutan to refugee camps in Nepal....
en-net: What is the cut off point for child bearing age women to decide acute malnutrition based on MUAC?
We are planning to do nutrition assessment among child bearing age women using MUAC only. As far I know, MUAC less than 21cm (some where may be 22cm,23cm) is used as cut off...
FEX: MUAC Versus Weight-for-Height in Assessing Severe Malnutrition
Summary of published paper1 An infant having MUAC measured during the study in Kenya Current WHO guidelines for the management of severe malnutrition in children recommend...
FEX: Can height-adjusted cut-offs improve MUAC’s utility as an assessment tool?
By Michel Van Herp, An Verwulgen, Bérengère Leurquin, and Pascale Delchevalerie Michael Ven Herp, Bérengère Leurquin, An Verwulgen & Pascale Delchevalerie Michael Ven Herp is...
FEX: Diagnostic criteria for severe acute malnutrition among infants under six months of age
Summary of research1 Location: Kenya What we know: Diagnosis of acute malnutrition in infants under six months old (U6M) is currently based on weight-for-length z score...
en-net: MUAC cutoff to screen SAM
Looking at the WHO growth standard for MUAC, one can understand the change of MUAC with age. So my concern is, is it feasible to use the same MUAC cutoff (<11.5CM) for all...
FEX: Diet and nutrition status among school-age children and adolescents in Tanzania
View this article as a pdf By Sauli John, Geofrey Mchau, Heavenlight Ayubu, Stanslaus Mafung'a, Samafilan Ainan, Wiggins Kyatikila, Elizabeth Lyimo, Frank Chacky, Fatoumata...
en-net: Anthropometry (BMI) for women 19 years old - confusion on what to use
Dear Colleagues To identify mlanutrition/thinness with BMI, etc: We know we use BMI-for-Age for girls below the age of 19 years old. We also know that we need to use...
FEX: Anthropometric cut-off points for older children and adolescents in Syria
By Paluku Bahwere View this article as a pdf Paluku Bahwere is a paediatrician with over 25 years of experience in operational research and programming in the fields of...
en-net: MUAC cut offs for 6 - 10 years
I am doing malnutrition assessment of children aged 5-10 years in Kenya. Using MUAC should we use cut off points for adults, as I have not been able to get cut off points...
FEX: MUAC and weight-for-height in identifying high risk children
Summary of research1 The World Health Organisation (WHO) and UNICEF propose to use two independent criteria for diagnosing non-oedematous severe acute malnutrition (SAM) in...
FEX: Implications of 65 cm height cut-off as age proxy in Bangladesh
Summary of published research1 Location: Bangladesh What we know: Age data for children aged 6 to 59 months is often not available in poor, migrant or conflict affected...
Reference this page
Mid-upper arm circumference as a screening tool for identifying adolescents with thinness. Field Exchange 64, January 2021. p77. www.ennonline.net/fex/64/muacadolescents
(ENN_6895)