New study determines mid-upper arm circumference levels to identify malnutrition in Indian children
A new study published in the prestigious journal ‘Nutrition’ in July this year has described Mid-Upper Arm Circumference (MUAC) values and cut-offs for thinness and overnutrition in Indian children in the 5-17 age group.
MUAC is measured by wrapping a tape around the middle of the upper arm of a child. It is an easy, accurate and low-cost method for identifying malnutrition in the early stages.
For Indian children older than five years this is the first time that the national values are published, Dr Vaman Khadilkar, one of the lead authors of the study and paediatric endocrinologist at the Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI) under the Jehangir hospital in Pune told The Indian Express.
For ease of use, rounded cut-offs for thinness were 16 cm and 18.5 cm for 5-9 years and 10-14 years respectively, in both sexes. It was 22 cm in boys and 20 cm in girls in the 15-17 age bracket. For obesity, it was 20 cm for 5-9 years and 25.5 cm for 10-14 years in both girls and boys. A rounded cut-off of 29 cm in boys and 27 cm in girls in the 15-17 age group was proposed.
The National Family Health Survey-4 reports that 28 per cent of Indian children still suffer from malnutrition. “While undernutrition is more common in rural children, obesity is seen in around 1 in 5 children in urban areas. Quick, easy-to-use methods for screening nutritional levels are thus required. Additionally, in sick children quick assessment of nutrition is essential to decide if a child needs nutritional therapy, such as in children with cancer,” lead author Dr Anuradha Khadilkar from HCJMRI said.
The study assessed nutritional levels in 6,680 healthy Indian children and was carried out by HCJMRI in Pune together with doctors/health professionals from Surya Children’s Hospital and Tata Memorial Hospital in Mumbai, Postgraduate Institute of Medical Education and Research in Chandigarh, McMaster University in Canada and Columbia University Irving Medical Center in New York, USA.
The data may also be used in children with cancer and other chronic disorders with growth failure, the researchers said.
The present study aims to “construct reference centile curves for MUAC to assess nutritional status in Indian children and adolescents. The specific objectives were to achieve the construct age- and sex-specific MUAC reference centile curves for assessment of thinness and overnutrition in 5 to 17-year-olds, define MUAC cut-offs for the assessment of thinness and overnutrition and validate the MUAC cut-offs in thin, overweight, and normal-weight children and in children with a medical condition such as cancer which is likely to lead to poor nutritional status,” Dr Khadilkar said.
While Body Mass Index (BMI) z-scores are recommended by the World Health Organization (WHO) for assessment of malnutrition in children aged 5-19, weight scales and height boards are often not available for screening at the community level in low- and middle-income countries (LMICs). In disease states such as cancer and in special circumstances, such as an amputee, it may also be difficult to use BMI.
For early identification of malnutrition, MUAC has thus been suggested, especially for children below 5 years at increased risk for mortality in situations such as a famine or refugee crisis.