Differences in wasting assessment through Middle‐Upper Arm Circumference (MUAC) adjusted by sex, age and geographic origin for children aged 6–59 months: New reference based on anthropometric surveys from 22 low‐and‐middle‐income countries

Abstract

Objectives The Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal cut‐off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut‐off point. In addition, the creation of MUAC growth charts is presented for reference use. Materials and Methods This study was carried out with a database developed by Action Against Hunger, composed, after the data pre‐processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k‐means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method. Results Our research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k‐means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group. Conclusions All statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.

Composite indexes of anthropometric failure in children under 5 years of age in Argentina: Comparative analysis among regions: 2019–2020

“…The population differences were practically nil and therefore these values could be applied universally (WHO, 2006b). Subsequent studies, in which the authors of the present study participated and which have been published in this same journal (Lescure et al, 2023;Martín-Turrero et al, 2022) have shown that growth patterns of healthy children may vary among populations of different origins, so that the WHO standards may moderately overestimate or underestimate the rates of child malnutrition in some populations.…”

Disparities with global standards about growth references of mid‐upper arm circumference‐for‐age for Pakistani children aged 6–60 months

“…The WHO 2007 growth standards for children between the ages of 6 and 60 months were widely recognised as useful tools for nutritional assessment when it pertains to assistance from humanitarian organisations. However, certain systematic reviews [9][10][11][12][13][14] and a further study 9 identified significant variations between national or regional references that were generated while using the same inclusion criteria as well as the WHO S3).…”

“…It should be noted that if paediatricians and researchers use the WHO 2007 standards to estimate the nutritional status of Pakistani children, they may incorrectly diagnose the health status of Pakistani children. The WHO 2007 standards might lack precision for South Asian countries like Pakistan, attributable to genetic and environmental distinctions between these countries and the WHO reference standards 9 …”

“…In many studies, 7–11 the median references for the Asian population fell below the WHO growth standards, whereas those for European studies surpassed them. A number of international studies 4,6–14 concluded that regional‐specific growth references are the best way to monitor the nutritional status of children globally. Additional scientific diagnostic standards for MUAC‐for‐age are necessary to assess the nutritional status of children in countries like Pakistan where such references are lacking.…”

“…In many studies, [7][8][9][10][11] the median references for the Asian population fell below the WHO growth standards, whereas those for European studies surpassed them. A number of international studies 4,6-14 concluded that regional-specific growth references are the best way to monitor the nutritional status of children globally.…”