Objective: This study aimed to synthesize the existing evidence on the performance of Mid-Upper Arm Circumference (MUAC) to identify children and adolescents with overweight and obesity. Design: Systematic review and meta-analysis. Setting: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL, and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared to a reference standard for diagnosing overweight and obesity in children and adolescents aged 2 to 19 years were included. Participants: A total of 54,381 children and adolescents from twenty-one studies were reviewed; 10 studies contributed to meta-analyses. Results: In Boys, MUAC showed a pooled Area Under the Curve (AUC) of 0.92 (95% CI 0.89 - 0.94), sensitivity of 84.4 (95% CI 84.6-.90.8), and a specificity of 86.0 (95% CI 79.2-90.8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0.93 (95% CI 0.90 - 0.95) sensitivity of 86.4 (95% CI 79.8- 91.0), specificity of 86.6 (95% CI 82.2-90.1) when compared against overweight and obesity defined using BMI z-scores. Conclusion: In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared to gold standard measures of adiposity. Future research should compare performance of MUAC to the “golden standard” measure of excess adiposity.
Background Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6–59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1–6 mo. Objective The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1–6 mo. Methods We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1–6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of −3 SDs from the median as per the WHO 2006 child growth standards. Receiver operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs. Results The median age, MUAC, and WLZ were 100 d (IQR: 69–145 d), 119 mm (IQR: 103–130 mm), and −1.27 (IQR: −2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n = 101 (21.6%) and n = 61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI: 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI: 76.7%, 91.4%) and a specificity of 76.0% (95% CI: 71.2%, 80.2%). Conclusions A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1–6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo.
Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6–23 months in Ethiopia. We included 2960 children aged 6–23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6–23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6–23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9–11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12–17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18–23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.
Mid-upper arm circumference (MUAC) is an age-sensitive anthropometric measurement in infants. However, exact age is difficult to know, particularly in low-income countries. We evaluated the diagnostic accuracy of an age-independent mid-upper arm circumference-to-length (MUAC/L) ratio measurement in detecting wasting among infants aged 1–6 months in Ethiopia. A facility-based diagnostic accuracy study was conducted on 467 in-patient infants aged 1–6 months from March to May 2019. The receiver operating characteristic (ROC) curve was used to evaluate the ability of MUAC/L to detect wasting. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive and negative predictive values were calculated. The magnitude of severe wasting was 21⋅6 % and moderate wasting was 13⋅0 %. The area under the ROC curve (AUC) of MUAC/L was 0⋅77 (95 % CI 0⋅73, 0⋅81) for detecting moderate wasting and 0⋅92 (95 % CI 0⋅89, 0⋅94) for detecting severe wasting. MUAC/L had a sensitivity of 91⋅1 % (95 % CI 81⋅3, 94⋅4), a specificity of 84⋅7 % (95 % CI 80⋅6, 88⋅2), a positive likelihood ratio of 5⋅82 (95 % CI 4⋅53, 7⋅48) and a negative likelihood ratio of 0⋅13 (95 % CI 0⋅07, 0⋅22) in total infants. The optimal MUAC/L cut-off was <0⋅190 for boys and <0⋅185 for girls. MUAC/L had an AUC of 0⋅77 and 0⋅92 in predicting moderate and severe wasting in infants aged 1–6 months, respectively. Using MUAC/L to treat Ethiopian infants with severe wasting and infants with similar characteristics in other countries could improve treatment coverage.
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