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Body composition, energy expenditure and physical activity

Mid-upper-arm-circumference and mid-upper-arm circumference z-score: the best predictor of mortality?

European Journal of Clinical Nutrition volume 66, pages 998–1003 (2012)Cite this article

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Abstract

Background/Objective:

Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify children with high short-term mortality risk in Guinea-Bissau.

Subjects/Methods:

The Bandim Health Project visits children 3-monthly until 3 years of age. MUAC is measured and deaths are registered. We studied a high-mortality cohort of children born in 1995–96 and a lower mortality cohort of children born in 2005–06. The prognostic ability of MUAC and MUAC z-score to predict mortality within 1 and 3 months after the MUAC assessment were compared by area under the receiver operating characteristic curve, sensitivity and positive predictive value.

Results:

Compared with MUAC z-score, MUAC identified as malnourished more girls than boys (prevalence ratio (PR)=1.74 (1.52;2.01)) and more children aged 6–11 months than children aged 12–35 months (1.59 (1.38;1.82)). There was no difference in the prognostic ability of MUAC and MUAC z-score to predict mortality for children aged 6–35 months. The prognostic ability was higher when mortality was lower. MUAC performed well in the youngest infants.

Conclusion:

In the age group 6–35 months, MUAC and MUAC z-score had the same prognostic ability to predict short-term mortality. As MUAC is easier to use in field settings, there is no need to use MUAC z-score to identify children with a high-mortality risk.

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Acknowledgements

The study received funding from The Danish Medical Research Council and Augustinus Fonden. JR received a Danida Travel Grant. PA holds a research professorship grant from the Novo Nordisk Foundation. CB is funded through an ERC Starting Grant (ERC-2009-StG-243149). The sponsors had no role in the study design, data collection, data analysis, data interpretation, or the writing of the report.

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Authors and Affiliations

  1. Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau

    J Rasmussen, A Andersen, A B Fisker, A Rodrigues, C S Benn & P Aaby

  2. Bandim Health Project, Statens Serum Institut, Ørestads Boulevard 5 Copenhagen S, Denmark,

    H Ravn, C S Benn & P Aaby

  3. Faculty of Health Science, University of Southern Denmark, Winsløwparken 19, 3 Odense C, Denmark,

    J Rasmussen & M Sodemann

Authors
  1. J Rasmussen
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  2. A Andersen
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  3. A B Fisker
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  4. H Ravn
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  5. M Sodemann
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  6. A Rodrigues
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  7. C S Benn
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  8. P Aaby
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Correspondence to J Rasmussen.

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The authors declare no conflict of interest.

Additional information

Contributors: PA and AR supervised the data collection. CBS, PA and ABF designed the study. AA, JR and HR did the statistical analysis, and JR wrote the first draft of the paper. All authors contributed to and approved the final version of the paper.

Supplementary Information accompanies the paper on European Journal of Clinical Nutrition website

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Rasmussen, J., Andersen, A., Fisker, A. et al. Mid-upper-arm-circumference and mid-upper-arm circumference z-score: the best predictor of mortality?. Eur J Clin Nutr 66, 998–1003 (2012). https://doi.org/10.1038/ejcn.2012.95

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