DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20184283

Derivation of MUAC cut-off to identify undernourished 1-6 months old infants

Ramamani D., Suganya E.

Abstract


Background: Under nutrition is the major public health problem in our country. There are numerous anthropometric methods, one of which is mid upper arm circumference (MUAC). MUAC cut-off classify the nutritional status of the children aged between 6-60 months. However, there is no specific cut-off for MUAC to identify the undernourished infants aged between 1-6 months. With the above background study was planned with the following objectives. Objectives of this study were to classify the nutritional status of 1-6 months aged infants using WLZ classification and to derive a cut off value for Mid upper arm circumference, to define under nutrition/wasting among 1-6 months aged infants

Methods: The cross-sectional study was carried out among 706 infants aged between 1-6 months. Nutritional status was assessed using WLZ. Various MUAC was tested against WLZ of <-2, in order to identify the cut-off below which, the infant will be considered undernourished.

Results: Mean age of the participants was 96±55 days. Mean weight, length and mid upper arm circumference was 4.75±1.02 kg, 58.51±4.47 cm and 12.15±3.01cm respectively. MUAC cut-off <13.5 cm has yielded highest youden index, accuracy and sensitivity of 0.36, 0.79,99% respectively. The total area under ROC curve is 0.707 [95% CI: 0.66, 0.74; p<0.0001], having a good diagnostic accuracy and it is statistically significant.

Conclusions: A MUAC cut-off value below 13.5 cm, among 1-6 months aged infants will be considered to be undernourished.


Keywords


Accuracy, MUAC cut-off, ROC curve, Youden’s index

Full Text:

PDF

References


UNICEF. Neonatal mortality. 2018. Available at https://data.unicef.org/topic/child-survival/neonatal-mortality/

WHO. Global Health Observatory (GHO) data. Neonatal mortality. Available at http://www.who.int/gho/child_health/mortality/neonatal_infant_text/en/

National Institution for Transforming India. Infant Mortality Rate (IMR) (per 1000 live births). NITI Aayog. Available at http://niti.gov.in/content/infant-mortality-rate-imr-1000-live-births

Park K. Park’s Textbook of Preventive and Social Medicine. Banarsidas Bhanot Publishers; 2015;23.

Duren DL, Sherwood RJ, Czerwinski SA. Body composition methods: comparisons and interpretation. J Diabetes Sci Tech. 2008;2(6):1139-46.

Mwangome MK, Berkley JA. The reliability of weight-for-length/height Z scores in children. Maternal Child Nutr. 2014;10(4):474-80.

WHO. Global Database on Child Growth and Malnutrition. Available at http://www.who.int/nutgrowthdb/about/introduction/en/index5.html

Namakin K, Sharifzadeh GR, Zardast M, Khoshmohabbat Z, Saboori M. Comparison of the WHO child growth standards with the NCHS for estimation of malnutrition in Birjand-Iran. Int J Preventive Med. 2014;5(5):653-7.

Craig E, Bland R, Ndirangu J, Reilly JJ. Use of mid-upper arm circumference for determining overweight and overfatness in children and adolescents. Arch Dis Childhood. 2014;99(8):763-6.

Simundić AM. Measures of diagnostic accuracy: basic definitions. EJIFCC. 2009;19(4):203-11.

Pradhan S, Prasuna J. A cross-sectional study of the association of postnatal growth and psychosocial development of the infants in an urban slum of Delhi. Indian Journal of Community Medicine 2007;32:46-8.

Obuchowski NA, Lieber ML, Wians FH. ROC curves in clinical chemistry: uses, misuses, and possible solutions. Clin Chem. 2004;50(7):1118-25.

Hakeem R, Shaikh AH, Asar F. Assessment of linear growth of affluent urban Pakistani adolescents according to CDC 2000 references. Ann Hum Biol. 2004;31:282-91.

Beaton G, Kelly J, Kenvey R. Appropriate use of anthropometric indices in children. ACC/SCN State of art series on nutrition policy discussion paper not United Nation Administrative Communiqué on Coordination/Subcommittee on Nutrition. 1990. Available at https://www.unscn.org/web/archives_resources/files/Policy_paper_No_7.pdf

Chand S, Shah D. Mid upper arm circumference for detection of severe acute malnutrition in infants aged between one and six months. Indian Pediatr. 2015;52:528-9.

Kerac M, Blencowe H, Grijalva-Eternod C. Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards: a secondary data analysis. Arch Dis Childhood. 2011;96(11):1008-13.

Shekhar S, Shah D. Validation of mid upper arm circumference cut offs to diagnose severe wasting in Indian children. Indian Pediatr. 2012;49:496-7.