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MUAC cut off points for school aged children

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fe

nutritionist

Normal user

25 May 2015, 06:43

Dear All,

I would like to ask, where I can find literature for MUAC cut off points for school aged children (6 years old up to 15 years). I am looking for MUAC cut off point for severe, moderately malnourished and normal for school aged children.

Martha

Frequent user

28 May 2015, 17:03

Dear Fe,

Unfortunately, I am not sure there are any mainly because there is no data to inform its interpretation in this age group. Surveys and other data sources do not collect MUAC measures at this age hence no way to estimate cut-offs. This I would say is a gapping opportunity for research and would encourage you to start collecting MUAC data for this age and start comparing its performance against routinely used anthropometric criteria like BMI or WFH even on simple estimates like prevalence, reliability, accuracy and validity. This will begin to give us a glimpse on the usability of MUAC in this age group. Later longitudinal studies can be designed to collect data on predictive values and risk analysis.

Mark Myatt

Consultant Epideomiologist

Frequent user

29 May 2015, 07:19

MUAC cut-offs in children below 5 years are decided by mortality risk. Mortality in older children is very much lower than in under five years children. This means that the older age-group has received little attention and that a large cohort sample size (very expensive) is required to estimate mortality at different cut-points. This means that we are limited to anthropometry. You could use MUAC/A z-scores or MUAC/H z-scores (from an international reference or from a local survey). My preference would be for MUAC/H as (a) age may be subject to considerable error, and (b) A QUAC stick could be used.

I hope this is of some use.

Pascale Delchevalerie

Nutrition Advisor MSF Belgium

Normal user

29 May 2015, 11:13

dear Fe,
We were confronted to the same problem in emergency in low resource setting (South Sudan), so we tried to define tentative cut-offs (for SAM) with a sort of simplified quack stick, based on the data from the article of the Bulletin of the World Health Organization, 1997, 75 (4): 333-341 ("The development of a MUAC-for-height reference, including a comparison to other nutritional status screening indicators", Z. Mei,1 L.M. Grummer-Strawn,1 M. de Onis,2 & R. Yip3).

Unfortunately, I couldn't document it because finally, the field didn't manage to collect properly the data. I just tried it myself, doing the screening in the OPD during one day, before to introduce it, to check how children identified by these cut-offs were looking clinically and most of them were visibly wasted.

I'm hoping to test it again when another emergency with over 5 malnutrition arise.
I can share my document with you.

I hope this can help you

Pascale

André BRIEND

Frequent user

29 May 2015, 13:11

Dear Fe,

As mentioned already by Mark, the mortality based approach used to determine MUAC cut-off in under-5 children cannot be used for older children. Follow-up of untreated malnourished children, as was done 30 y. ago for the under-5, is no more possible now that we have an effective home based approach to treat them. And the low mortality observed in this age group would in any case make these studies very difficult.

The idea of assessing which combination of MUAC and height fits best with the clinical diagnosis of malnutrition done by an expert clinician, as suggested by Pascale, is a good one. A similar approach was proposed almost 30 y ago to see which anthropometric indices fitted best with the clinical diagnosis of marasmus inunder-5.

See: http://www.ncbi.nlm.nih.gov/pubmed/3101482

This could be adapted to older children. Maybe a more modern method of analysis, leaving MUAC and height combine each other in an optimal way to fit with clinical wasting as was done for weight and height by Prudhon et al to assess the risk of death (http://www.ncbi.nlm.nih.gov/pubmed/8678042) would be better than using a QUAC stick index derived from standards. (by the way, no K for QUAC).

Studies examining the link between different anthropometric indices and other unfavourable outcome, apart from mortality, as suggested by Martha when she mentions risk assessment, would be most welcome, but much more complex to carry out.

In any case, this is an area deserving investigation

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