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

Abstract

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.

Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment

“…Weight, height, and head circumference were measured using standard protocols, and z-scores determined using the World Health Organization (WHO) child growth standards and DS-specific growth charts. Children with z-scores below − 2 were considered undernourished (i.e., those who were underweight and stunted) and microcephalic [ 65 – 67 ].…”

Early Tube Feeding Improves Nutritional Outcomes in Children with Neurological Disabilities: A Retrospective Cohort Study

“…The nutritional assessment of ND children is primarily based on low weight and/or low triceps skinfold thickness according to the ESPGHAN guidelines [ 7 ], which are time-consuming and require trained staff in this group of children. In children older than 2 years with cerebral palsy, obtaining weight by direct measurement becomes more difficult due to lack of balance and the motor compromise preventing them to stay still on a regular scale, particularly in low- and middle-income countries with limited access to wheelchair adapted scales or even regular scales [ 17 , 18 ]. MUAC, a segmental measure indirectly assessing growth and changes in caloric and protein intake, uses the fat, bone, and muscle areas of the arm as an indirect measure to evaluate body weight [ 18 , 19 ].…”