在尼日尔6至24个月儿童的基于社区的横断面样本中，上臂中部周长用于诊断急性营养不良的效能。

Performance of mid-upper arm circumference to diagnose acute malnutrition in a cross-sectional community-based sample of children aged 6-24 months in Niger.

作者信息

Marshall Sarah K, Monárrez-Espino Joel, Eriksson Anneli

机构信息

Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.

Coordination for Health Research. Christus LatAm Hub - Center for Excellence and Innovation, 66260 Monterrey, Nuevo León, Mexico.

出版信息

Nutr Res Pract. 2019 Jun;13(3):247-255. doi: 10.4162/nrp.2019.13.3.247. Epub 2019 May 31.

BACKGROUND/OBJECTIVES: Accurate, early identification of acutely malnourished children has the potential to reduce related child morbidity and mortality. The current World Health Organisation (WHO) guidelines classify non-oedematous acute malnutrition among children under five using Mid-Upper Arm Circumference (MUAC) or Weight-for-Height Z-score (WHZ). However, there is ongoing debate regarding the use of current MUAC cut-offs. This study investigates the diagnostic performance of MUAC to identify children aged 6-24 months with global (GAM) or severe acute malnutrition (SAM).

SUBJECTS/METHODS: Cross-sectional, secondary data from a community sample of children aged 6-24 months in Niger were used for this study. Children with complete weight, height and MUAC data and without clinical oedema were included. Using WHO guidelines for GAM (WHZ < -2, MUAC < 12.5 cm) and SAM (WHZ < -3, MUAC < 11.5 cm), the sensitivity (Se), specificity (Sp), predictive values, Youden Index and Receiver Operating Characteristic (ROC) curves were calculated for MUAC when compared with the WHZ reference criterion.

RESULTS

Of 1161 children, 23.3% were diagnosed with GAM using WHZ, and 4.4% with SAM. Using current WHO cut-offs, the Se of MUAC to identify GAM was greater than for SAM (79 vs. 57%), yet the Sp was lower (84 vs. 97%). From inspection of the ROC curve and Youden Index, Se and Sp were maximised for MUAC < 12.5 cm to identify GAM (Se 79%, Sp 84%), and MUAC < 12.0 cm to identify SAM (Se 88%, Sp 81%).

CONCLUSIONS

The current MUAC cut-off to identify GAM should continue to be used, but when screening for SAM, a higher cut-off could improve case identification. Community screening for SAM could use MUAC < 12.0 cm followed by appropriate treatment based on either MUAC < 11.5 cm or WHZ < -3, as in current practice. While the practicalities of implementation must be considered, the higher SAM MUAC cut-off would maximise early case-finding of high-risk acutely malnourished children.

背景/目的：准确、早期识别急性营养不良儿童有降低相关儿童发病率和死亡率的潜力。世界卫生组织（WHO）现行指南使用中上臂围（MUAC）或身高别体重Z评分（WHZ）对五岁以下儿童的非水肿型急性营养不良进行分类。然而，关于当前MUAC临界值的使用仍存在争议。本研究调查了MUAC用于识别6至24个月大的患有全球急性营养不良（GAM）或重度急性营养不良（SAM）儿童的诊断性能。

对象/方法：本研究使用了来自尼日尔6至24个月大儿童社区样本的横断面二手数据。纳入体重、身高和MUAC数据完整且无临床水肿的儿童。根据WHO关于GAM（WHZ < -2，MUAC < 12.5 cm）和SAM（WHZ < -3，MUAC < 11.5 cm）的指南，将MUAC与WHZ参考标准进行比较时，计算其灵敏度（Se）、特异度（Sp）、预测值、约登指数和受试者工作特征（ROC）曲线。

结果

在1161名儿童中，使用WHZ诊断为GAM的占23.3%，诊断为SAM的占4.4%。使用WHO现行临界值，MUAC识别GAM的Se高于识别SAM的Se（79%对57%），但其Sp较低（84%对97%）。通过检查ROC曲线和约登指数，MUAC < 12.5 cm用于识别GAM时Se和Sp最大化（Se 79%，Sp 84%），MUAC < 12.0 cm用于识别SAM时Se和Sp最大化（Se 88%，Sp 81%）。

结论

应继续使用当前识别GAM的MUAC临界值，但在筛查SAM时，较高的临界值可能会改善病例识别。社区筛查SAM可使用MUAC < 12.0 cm，然后根据当前做法，基于MUAC < 11.5 cm或WHZ < -3进行适当治疗。虽然必须考虑实施的实际情况，但较高的SAM MUAC临界值将最大限度地早期发现高危急性营养不良儿童。