Mid-upper arm circumference as a screening tool for identifying adolescents with thinness

Abstract

Objective: To evaluate the performance of mid-upper arm circumference (MUAC) to identify thinness in the late adolescence period (aged 15–19 years) in Ethiopia. Design: We conducted a school-based cross-sectional study. The receiver operating characteristics curve was used to examine the validity of MUAC compared with BMI Z-score to identify adolescents with thinness (BMI Z-score <−2 sd). Settings: Fifteen high schools (grade 9–12) located in Addis Ababa, Ethiopia. Participants: A total of 851 adolescent (456 males and 395 females) were included in the study. Results: The prevalence of thinness and severe thinness among high-school adolescents in Addis Ababa was 9·5 % (95 % CI 7·7, 11·7 %). The overall AUC for MUAC against BMI Z-score <−2 SD was 0·91 (95 % CI 0·88, 0·93). The optimal MUAC cut-offs to identify thinness were 23·3 cm for males and 22·6 cm for females. These cut-off points give high sensitivity and specificity for both males (a sensitivity of 87·9 % and a specificity of 75·9 %) and females (a sensitivity of 100 % and a specificity 88·2 %). Conclusions: MUAC has a comparable level of accuracy with BMI Z-score to identify thinness in adolescents aged 15–19 years. Hence, MUAC could be used as an alternative tool for surveillance and screening of thinness among adolescents aged 15–19 years. The optimum cut-off proposed by this study may incorrectly include a large number of adolescents when used in a relatively well-nourished population. In this situation, it would be necessary to choose a cut-off with greater positive predictive value.

Discriminatory performance of mid-upper arm circumference for identifying thin and severely thin adolescents: a secondary data analysis using Comprehensive National Nutrition Survey

“…Study by Sethi et al proposed the cut-off of 19.4 cm (10-14 years) and 21.6 cm (15-19 years) for females, like the present study [ 9 ]. In a study by Sisay et al, the proposed cut-offs for 15-19 years adolescents were 23.2 (males) and 22.6 cm (females), slightly different from the present study, might be due to the racial differences in body built, thus, pointing towards having country-specific cut-offs for adolescents [ 10 , 19 ].…”

“…[9]. In a study by Sisay et al, the proposed cut-offs for 15-19 years adolescents were 23.2 (males) and 22.6 cm (females), slightly different from the present study, might be due to the racial differences in body built, thus, pointing towards having country-specific cut-offs for adolescents [10,19]. Further, the proportion of adolescents correctly classified using MUAC cut-offs were in general more for late adolescents compared to early adolescents, possibly due to less variation in cut-offs for late adolescents as the growth is stable, similar to the findings from a previous study [9].…”

“…Similarly, a study from India reported AUC value ranging between 0.82-0.97 for age specific MUAC cut-offs in identifying thin and severely thin female adolescents [ 9 ]. Another study from Ethiopia conducted among 15-19 years adolescents reported an AUC of 0.91 for correct identification of thinness [ 10 ]. These findings point towards considering MUAC as an alternative to BAZ in identification of thin/severely thin adolescents in resource-constrained settings.…”

“…Thus, using a cut-off of 19.4 cm for a 10-year-old female would classify a normal weight adolescent as thin. However, in certain situation where age is not known, age-group specific (10)(11)(12)(13)(14)…”

“…A study by Sethi et al from eastern part of India, had proposed the age-specific cut-offs for screening thin and severely thin females in 10-19-year age group [ 9 ]. Another study from Ethiopia had proposed cut-offs for 15-19-year age group for screening thinness [ 10 ]. However, there is limited data pertaining to the age-specific cut-offs separately for males and females using a nationally representative sample.…”