Khan Ahad Mahmud, Sharmin Robaiyat, Ahasan Md Faizul
Public Health, Projahnmo Research Foundation, Dhaka, BGD.
Usher Institute, The University of Edinburgh, Edinburgh, GBR.
Cureus. 2022 Dec 30;14(12):e33137. doi: 10.7759/cureus.33137. eCollection 2022 Dec.
Background The weight-for-height z-score (WHZ) is considered the gold standard for detecting acute malnutrition in children. However, an accurate assessment of WHZ can often be challenging, especially in community settings. Mid-upper arm circumference (MUAC) is a simple and easy-to-perform method to identify children with acute malnutrition. The objective of the study was to evaluate the accuracy of MUAC in detecting acute malnutrition compared to WHZ among children aged 6-59 months in Bangladesh. Methods We used anthropometric data for 239 children aged 6-59 months from a cross-sectional study conducted in 2013 in an urban slum in Dhaka, Bangladesh. The sensitivity and specificity of MUAC to detect acute malnutrition were calculated, considering WHZ as the gold standard. Results The mean age of the children was 29.4 ± 12.7 months, with a male-to-female ratio of 1:1.2. The prevalence of acute malnutrition was 17.1% and 22.5% based on WHZ and MUAC, respectively. The total area under the receiver operating characteristic curve was 0.816. For detecting acute malnutrition, the sensitivity of MUAC was 61.0% and the specificity was 85.4% for the World Health Organization (WHO) recommended cutoff of <125 mm. Using the Youden index, the best MUAC cutoff point to detect acute malnutrition was <128 mm with a sensitivity of 75.6% and a specificity of 74.7%. Conclusions Our study demonstrated a low sensitivity of MUAC to identify acute malnutrition at the WHO cutoff of <125 mm. The cutoff could be increased to <128 mm to capture more children with acute malnutrition.
身高别体重Z评分（WHZ）被视为检测儿童急性营养不良的金标准。然而，准确评估WHZ往往具有挑战性，尤其是在社区环境中。上臂中部周长（MUAC）是一种识别急性营养不良儿童的简单易行的方法。本研究的目的是评估在孟加拉国6至59个月大的儿童中，与WHZ相比，MUAC检测急性营养不良的准确性。方法：我们使用了2013年在孟加拉国达卡一个城市贫民窟进行的横断面研究中239名6至59个月大儿童的人体测量数据。以WHZ为金标准，计算MUAC检测急性营养不良的敏感性和特异性。结果：儿童的平均年龄为29.4±12.7个月，男女比例为1:1.2。基于WHZ和MUAC，急性营养不良的患病率分别为17.1%和22.5%。受试者工作特征曲线下的总面积为0.816。对于检测急性营养不良，世界卫生组织（WHO）建议的<125mm的临界值下，MUAC的敏感性为61.0%，特异性为85.4%。使用约登指数，检测急性营养不良的最佳MUAC临界值为<128mm，敏感性为75.6%，特异性为74.7%。结论：我们的研究表明，在WHO<125mm的临界值下，MUAC识别急性营养不良的敏感性较低。临界值可提高到<128mm，以发现更多急性营养不良的儿童。
