Mid-upper-arm-circumference and mid-upper-arm circumference z-score: the best predictor of mortality?

Abstract

BACKGROUND/OBJECTIVE: Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify children with high short-term mortality risk in Guinea-Bissau. SUBJECTS/METHODS: The Bandim Health Project visits children 3-monthly until 3 years of age. MUAC is measured and deaths are registered. We studied a high-mortality cohort of children born in 1995-96 and a lower mortality cohort of children born in 2005-06. The prognostic ability of MUAC and MUAC z-score to predict mortality within 1 and 3 months after the MUAC assessment were compared by area under the receiver operating characteristic curve, sensitivity and positive predictive value. RESULTS: Compared with MUAC z-score, MUAC identified as malnourished more girls than boys (prevalence ratio (PR) ¼ 1.74 (1.52;2.01)) and more children aged 6-11 months than children aged 12-35 months (1.59 (1.38;1.82)). There was no difference in the prognostic ability of MUAC and MUAC z-score to predict mortality for children aged 6-35 months. The prognostic ability was higher when mortality was lower. MUAC performed well in the youngest infants. CONCLUSION: In the age group 6-35 months, MUAC and MUAC z-score had the same prognostic ability to predict short-term mortality. As MUAC is easier to use in field settings, there is no need to use MUAC z-score to identify children with a high-mortality risk.European Journal of Clinical Nutrition (2012) 66, 998-1003; doi:10.1038/ejcn.2012.95; published online 18 July 2012 Keywords: anthropometry; child mortality; child nutrition disorders/mortality; predictive value of tests INTRODUCTION Nutritional status in children has often been assessed by z-scores for weight-for-height, weight-for-age and height-for-age. These methods require exact information about age, and scales and measuring boards, which may be difficult to use in fields settings. Mid-upper-arm circumference (MUAC) is a cheap and simple way to access nutritional status, and a recent study showed that it performed as well as weight-for-height in predicting mortality. 1 As MUAC has been regarded independent of age and sex among 1-4 year-old children, 2 fixed common cutoff values has been used to detect malnutrition in this age group. 3 This assumption was later questioned, which led to the development of sex-specific MUAC-for-age z-scores. 4 In 2006-07 WHO introduced a new set of child growth standards based on The WHO Multicentre Growth Reference Study, including a MUAC-for-age z-score for children older than 3 months of age. 5,6 To our knowledge there has been no evaluation of the association between the new MUAC z-scores and mortality.In this study, we aimed to evaluate whether MUAC or MUAC z-score had the best ability to identify children at high risk of subsequent death. Taking advantage of a long-lasting health and demographic surveillance system in...

The effect of early measles vaccination at 4.5 months of age on growth at 9 and 24 months of age in a randomized trial in Guinea-Bissau

“…MUAC is a valid measure of nutritional status and a good predictor of mortality [16, 19]. The finding that early MV had a positive effect on MUAC among girls at 24 months corresponds with previous studies from the same trial concluding that the effects of early MV were strongest among girls.…”

“…MUAC was not converted to Z-score as the recommendation for MUAC cutoffs is not valid for children under 6 months of age [14, 15]. Furthermore, we have found that MUAC is as good a predictor of mortality as MUAC z-score [16]. …”

Comparison of Mid-Upper Arm Circumference and Weight-for-Height to Diagnose Severe Acute Malnutrition: A Study in Southern Ethiopia

“…Others also reported similar findings [15,16]. As the growth reference values and MUAC are lower in girls [30,35], a single cut-off to define acute malnutrition may result in over diagnosis of the condition in girls compared with indicators that are standardized for age and sex [15,36]. While our results show the prevalence of wasting in boys to be higher than girls when WHZ was used, there was no sex-difference when MUAC was used.…”

Mid-upper arm circumference at age of routine infant vaccination to identify infants at elevated risk of death: a retrospective cohort study in the Gambia

“…[17][18][19][20] Within this age group, adjusting MUAC by calculating the Z score or adjusting for height does not improve MUAC's predictive value. 21 MUAC can be measured easily, quickly and affordably. Values below the cut-offs of 125 mm and 115 mm are used to define moderate and severe acute malnutrition, respectively.…”