Examining Mid‐Upper Arm Circumference Malnutrition<i>z</i>‐Score Thresholds

Stephens, K.; Orlick, Meike C.; Beattie, S.; Snell, Audrey; Munsterman, Kim; Oladitan, Leah; Abdel‐Rahman, Susan M.

doi:10.1002/ncp.10324

Cited by 12 publications

(6 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…MAC and BMI, though cannot differentiate between fat and muscle mass, have been useful anthropometry parameters for PEW assessment in children with CKD. [ 3 15 16 17 ] Though MAC has been noted to be useful for assessment of undernutrition and frailty in these children,[ 3 18 ] it is a surrogate parameter that reflects subcutaneous fat tissue, bone, and muscle and may not be an ideal tool to specifically detect MW. The role of MAMA in determining MW or PEW has not been studied in children.…”

Section: Discussionmentioning

confidence: 99%

Nutrition-focused physical examination for detecting protein energy wasting in children with chronic kidney disease

Iyengar,

Collins,

Ashok

et al. 2023

Indian J Nephrol

View full text Add to dashboard Cite

Introduction: There is a need to explore less laborious point-of-care assessment tools to diagnose protein energy wasting (PEW) in children with chronic kidney disease (CKD). This cross-sectional study was undertaken to assess the profile of specific nutrition-focused physical examination (NFPE) and mid-arm muscle area (MAMA) in children with CKD and determine their role in the diagnosis of PEW. Methods: PEW criterion was applied to all eligible children and MAMA was derived from mid-arm circumference and triceps skin fold thickness. NFPE signs examined were muscle wasting (MW) and subcutaneous fat loss (FL). Results: One hundred and twenty-six children with CKD (86 in CKD stages 2–4 and 40 on dialysis) were studied. PEW was prevalent in 41.8% children with CKD2-4 and in 72.5% on dialysis. In children with CKD 2–4, low MAMA, MW, and FL were significantly associated with PEW with an odd’s ratio of 5.3 (1.55,18.30), 10.6 (3.8,29.8), and 10.5 (3.7,29.2) respectively (P = <0.001). Similarly, in children on dialysis, low MAMA, MW, and FL were more likely to be associated with PEW with an odd’s ratio of 17 (2.2,127.7); P = 0.017, 16.6 (3,90.8); P = 0.001 and 19 (2.1,170.3); and P = 0.009, respectively. MW demonstrated high sensitivity and specificity [80.6 and 72%, respectively, with a positive predictive value (PPV) of 67.4%] to diagnose PEW in the CKD 2-4 group and in those on dialysis [86.2 and 72.1%, respectively, with PPV of 89.3%]. Conclusion: Clinical signs based on NFPE are useful in detecting PEW in children with CKD2-4 and in those on dialysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Nutrition-focused physical examination for detecting protein energy wasting in children with chronic kidney disease

Iyengar,

Collins,

Ashok

et al. 2023

Indian J Nephrol

View full text Add to dashboard Cite

show abstract

“…We think it important to overcome these barriers and obtain all necessary anthropometric measurements. For example, severe acute malnutrition includes in its definition a MUAC less than or equal to 115 mm (20); in the NutriPIC study, of 15 patients less than 24 months old who had a MUAC z score of less than -2, there were 7 with measurement less than or equal to 115 mm. In Guinea-Bissau (1995 vs 2006), MUAC appeared to be associated with nutritional changes in muscle and fat mass, rather than BMI (21).…”

Section: At the Bedsidementioning

confidence: 99%

Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study

Campos-Miño,

Figueiredo-Delgado,

Zárate

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objectives: To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations. Design: The Nutrition in PICU (NutriPIC) study was a combined point-prevalence study of malnutrition carried out on 1 day in 2021 (Monday 8 November) and a retrospective cohort study of adequacy of nutritional support in the week preceding. Setting: Four-one PICUs in 13 LA countries. Patients: Patients already admitted to the PICU of 1 month to 18 years old on the study day were included in the point-prevalence study. For the retrospective arm, we included patients receiving nutritional support on the study day and with a PICU length of stay (LOS) greater than or equal to 72 hours. Exclusion criteria were being a neonate, conditions that precluded accurate anthropometric measurements, and PICU LOS greater than 14 days. Interventions: None. Measurements and Main Results: Of 316 patients screened, 5 did not meet age criteria. There were 191 of 311 patients who were included in the point-prevalence study and underwent anthropometric evaluation. Underweight and length for age less than –2 z scores were present in 42 of 88 children (47.7%) and 41 of 88 children (46.6%) less than 24 months old, and 14 of 103 (13.6%) and (23/103) 22.3% of 103 children greater than or equal to 24 months, respectively. Evidence of obesity (body mass index > 2 z score) was present in 7 of 88 children (5.7%) less than 24 months old and 13 of 103 children (12.6%) greater than or equal to 24 months. In the 115 of 311 patients meeting criteria for the retrospective arm, a total of 98 patients reported complete nutritional data. The 7-day median (interquartile range) adequacy for delivered versus recommended enteral energy and protein requirement was 114% (75, 154) and 99% (60, 133), respectively. Conclusions: The NutriPIC study found that in 2021 malnutrition was highly prevalent especially in PICU admissions of less than 24 months old. Retrospectively, the 7-day median nutritional support appears to meet both energy and protein requirements.

show abstract

“…Although the anthropometric z-scores used in diagnosis and classification of malnutrition, specifically BMI, WFL and MUAC z-scores, are not exactly concordant, the thresholds proposed for classification are identical (62). Indeed, the sensitivity of proposed MUAC z-score thresholds was reported to systematically decrease with increasing severity of malnutrition, emphasizing the need for optimization to decrease the risk of misclassification and for further complementary data from longitudinal studies (62). Accordingly, while the MUAC z-score tape seems to meet the criteria of a desirable (i.e., inexpensive, noninvasive, easy to implement) pediatric malnutrition screening tool (20,63), it has yet to be evaluated in larger populations by increasing the accessibility to device not only for community health workers and volunteers but also in the hospital setting (21, 32).…”

Section: Assessment Of Muac Z-score: Traditional Vs Z-score Tapementioning

confidence: 99%

Section: Assessment Of Muac Z-score: Traditional Vs Z-score Tapementioning

confidence: 99%

The significance of MUAC z-scores in diagnosing pediatric malnutrition: A scoping review with special emphasis on neurologically disabled children

Aydın

Dalgıç²,

Kansu³

et al. 2023

Front. Pediatr.

View full text Add to dashboard Cite

This review by a panel of pediatric gastroenterology-hepatology-nutrition and pediatric neurology experts aimed to address the significance of mid-upper arm circumference (MUAC) assessment in diagnosis of pediatric malnutrition. Specifically, the potential utility of recently developed MUAC z-score tape in clinical practice for larger patient populations was addressed including the neurologically disabled children. In accordance with the evidence-based data, four statements were identified by the participating experts on the utility of MUAC z-score tape, including (1) MUAC z-scores correlate with body mass index (BMI) and weight for height/length (WFH/l) z-scores in diagnosing malnutrition; (2) MUAC z-score tape offers a higher sensitivity to diagnose the mild and moderate malnutrition and better ability to track the changes in nutritional status over time than the other single datapoint measurements; (3) Using single-step MUAC z-score tape in children with cerebral palsy (CP) seems to provide more reliable data on anthropometry; and (4) The clinical value of the tool in classifying secondary malnutrition in CP should be investigated in large-scale populations. In conclusion, enabling single-step estimation of nutritional status in a large-scale pediatric population regardless of age and within a wide range of weight, without formal training or the need for ancillary reference charts and calculators, MUAC z-tape offers a favorable tool for easier and earlier diagnosis of pediatric malnutrition. Nonetheless, further implementation of MUAC z-score screening in larger-scale and/or special populations is necessary to justify its utility in relation to other primary anthropometric indicators in diagnosis of malnutrition as well as in treatment monitoring in the community and hospital setting.

show abstract

Examining Mid‐Upper Arm Circumference Malnutritionz‐Score Thresholds

Cited by 12 publications

References 29 publications

Nutrition-focused physical examination for detecting protein energy wasting in children with chronic kidney disease

Nutrition-focused physical examination for detecting protein energy wasting in children with chronic kidney disease

Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study

The significance of MUAC z-scores in diagnosing pediatric malnutrition: A scoping review with special emphasis on neurologically disabled children

Contact Info

Product

Resources

About