Mid-Upper-Arm Circumference and Arm-to-Height Ratio to Identify Obesity in School-Age Children

Abstract

Background:In resource-poor settings, anthropometric parameters are evaluated as potential alternatives to the body mass index (BMI) for detecting overweight and obesity in children. To this end, the mid-upperarm circumference (MUAC) and the mid-upper-arm circumference-to-height ratio (AHtR) were evaluated as proxies to BMI in Thai school-age children.Study design: An observational, cross-sectional study was performed on school-aged children.Participants: Children in grades 1 through 6 at all public elementary schools in the Ongkharak district, Nakhon Nayok, Thailand during May and June 2013 were included. This is a rural district with low per capita income.Methods: Weight, height, and MUAC were measured in school-age children and analyzed to identify optimal cut-off values for MUAC and AHtR for detection of overweight and obesity in comparison to BMI. Receiver operating characteristic (ROC) curve analysis determined the validity of MUAC and AHtR use.Results: Data from 3,618 children, aged 6.0-12.99 years, were analyzed. MUAC correlated with age and height (P < 0.001), but especially with body weight (r = 0.888 to 0.914) and BMI (r = 0.859 to 0.908) in both genders, while AHtR correlated with body weight and BMI (P < 0.001), but not with age. Cut-off values of MUAC for obesity diagnosis ranged from 18.9 to 25.5 cm for boys and from 19.8 to 25.4 cm for girls. Accuracy was excellent for both boys (AUC = 0.952-0.991) and girls (AUC = 0.917-0.990). Cut-off of MUAC for overweight diagnosis ranged from 17.2 to 22.4 cm for boys (AUC = 0.883-0.965) and from 18.0 to 23.2 cm for girls (AUC = 0.905-0.931). AHtR cut-off values for obesity and overweight diagnosis at 0.16 and 0.145, respectively, were determined with excellent diagnostic accuracy (AUC ranged from 0.920 to 0.975). Conclusion:MUAC and AHtR were reliable tools to detect overweight and obesity in Thai school-age children. Cut-off points for MUAC were age and gender specific, while AHtR at 0.16 and 0.145 were the optimal values for both genders, independent of age. These anthropometric measurements showed excellent accuracy in predicting overweight and obesity with high specificity and sensitivity. Keywords: Anthropometry; Mid-upper-arm circumference; Arm-to-height ratio; Pediatric obesity; Overweight T he widespread prevalence of obesity in children and adolescents has become an alarming public health concern in both developed and developing countries. 1-3The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure, combined with a genetic predisposition for weight gain. 4 Even in developing countries, lack of physical activity and the nutritional transition toward high energy food/junk food have been associated with a rise in obesity prevalence. 5,6 A previous cross-sectional study of school-age children in Ongkharak, Thailand found a prevalence of 12.8% for overweight and 9.4% for obesity, a dramatic increase among Thai children. 7Comorbidities that were previously considered "adult" diseases,...

How useful are anthropometric measurements as predictive markers for elevated blood pressure in adolescents in different gender?

“…In our study, we found that MUAC and AHtR were associated with increased risk for all high blood pressure conditions except isolated EBP in boys, while only diastolic HT was associated in girls. These results are compatible with previous studies and support that MUAC and AHtR can be used to screen high blood pressure [31,32].…”

“…In addition, a number of studies have reported that SFT measurements can be used to assess the body fat ratio by quantifying subcutaneous fat tissue [27,28]. Therefore, there is a need for investigations for the value of other anthropometric measurements such as midupper arm circumference (MUAC), WC, SFT, and WHtR, which are predictors of body fat ratio and regional fat mass, on blood pressure, the risk of cardiovascular disease [29][30][31][32][33].…”

Development of a Computational Model to Predict Excess Body Fat in Adolescents through Low Cost Variables

“…Hip circumference was measured at the widest point as described by Huang et al [23]. Arm circumference was evaluated at midpoint between olecranon and acromial process on the upper left-arm with the subject in standing position [24], and the calf was measured with the participant seated, knee bent at a ninety-degree angle to the floor and this was considered the point of largest calf circumference [25].…”

Mid-upper arm circumference as a simple tool for identifying central obesity and insulin resistance in type 2 diabetes

“…choose appropriate hypoglycemic agents could lead to better control of hyperglycemia and eventually reduce the mortality in diabetes. In Rerksuppaphol S' study, MUAC was suggested to be a simple and accurate parameter to identify overweight and obesity in Thai school-age children [33]. In an observational, multinational cross-sectional study with 7337 children aged 9-11 years, MUAC was shown to be a suitable method to detect obesity in children [34].…”