Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6-60 mo: an analytical study [Nutritional status, dietary intake, and body composition]

Background: In clinical settings, wasting in childhood has primarily been assessed with the use of a weight-for-height z score (WHZ), and in community settings, it has been assessed via the midupper arm circumference (MUAC) with a cutoff <115 mm for severe wasting and <115–125 mm for moderate wasting. Our recent experience indicates that many wasted children were not identified when these cutoffs for MUAC were used.

Objective: We determined the cutoffs for MUAC to detect wasting in Bangladeshi children aged 6–60 mo.

Design: A secondary analysis was carried out on data from 27,767 children aged 6–59 mo. This analysis comprised 1) 9131 children across Bangladesh and 2) 18,636 children enrolled in a surveillance study in the Dhaka Hospital of icddr,b during 1996–2014. The area under the receiver operating curve was used to indicate the most appropriate choice for cutoffs that related MUAC with WHZ.

Results: The mean ± SD age for the entire group was 21 ± 14 mo, WHZ was –1.18 ± 1.23, height-for-age z score was –1.63 ± 1.39, MUAC was 136 ± 14 mm, and 45% of subjects were girls. MUAC correlated with the WHZ (r: 0.618, P < 0.001). Age-stratified analyses revealed that, for ages 6–24 mo, MUAC cutoffs were <120 mm for a WHZ <–3 and <125 mm for a WHZ <–2 with a sensitivity of 72.9% and 63.2%, respectively, and a specificity of 84.7% and 85.3%, respectively; for ages 25–36 mo, MUAC cutoffs were <125 mm for a WHZ <–3 and <135 mm for a WHZ <–2 with a sensitivity of 55.0% and 71.7%, respectively, and a specificity of 92.8% and 78.7% respectively; and for ages 37–60 mo, MUAC cutoffs were <135 mm for a WHZ <–3 and <140 mm for a WHZ <–2 with a sensitivity of 71.4% and 70.4%, respectively, and a specificity of 84.6% and 80.3%, respectively.

Conclusion: The respective cutoffs for MUAC to better capture the vulnerability and risk of severe (WHZ <–3) and moderate (WHZ <–2) wasting would be <120 and <125 mm for ages 6–24 mo, <125 and <135 mm for ages 25–36 mo, and <135 and <140 mm for ages 37–60 mo.

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