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Relationship between weight and MUAC

This question was posted the Management of wasting/acute malnutrition forum area and has 5 replies.

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Issa

IRC

Normal user

4 Feb 2021, 10:57

Hello everyone, I would like to know in the context of the management of acute malnutrition, is there a document explaining the link between weight gain and MUAC changes?

Paul

Action Against Hunger - UK

Technical expert

4 Feb 2021, 14:06

Hi Issa,

Try this:

Relationship between mid upper arm circumference and weight changes in children aged 6–59 months https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685635/

Paul

Dr Marko Kerac

LSHTM

Normal user

4 Feb 2021, 14:30

Dear Issa,

Very good question. Also see:

1) Acute malnutrition recovery energy requirements based on mid-upper arm circumference: Secondary analysis of feeding program data from 5 countries

https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0230452

2) Monitoring and discharging children being treated for severe acute malnutrition using mid-upper arm circumference: secondary data analysis from rural Gambia

https://academic.oup.com/inthealth/article/9/4/226/3926137?login=true

Hope that helps - good luck with your work

Anonymous 22505

Nutrition Specialist

Normal user

4 Feb 2021, 14:43

Thanks Paul for sharing the link. Yes is very possible to have postive correlation between the two in terms of MUAC and weight gain. My follow up question is, which one  reach the recovery treshold quickly (MUAC/WFH)? Does this correlation uniform accross the age groups and gender? 

Dr. Kamal Raj

Normal user

5 Feb 2021, 09:36

Dear Issa - thought the below link might help you. Best.

https://archpublichealth.biomedcentral.com/track/pdf/10.1186/s136…

Paul

Action Against Hunger - UK

Technical expert

5 Feb 2021, 17:17

Hi Anonymous,

The discharge criterion should be the same as the admission criterion. A child should not be admitted on one criterion and discharged on another. 

The average LOS in outpatient care for a child with uncomplicated SAM will likely be similar for MUAC and WHZ (approximately 6-8 weeks) depending on the cut offs for admission and discharge used and rate of weight gain.

The absolute differences in measurements between sexes in children of the same age (for MUAC) or same height (for WHZ) is very little (1 - 2mm for MUAC) or (+/- 100g for WHZ) so I wouldnt expect to see much of a difference in LOS based on sex alone. With the absolute cut-offs we use, the bigger effect on length of stay (LOS) is likely to be due to the degree of malnutrition on admission, the presence of other illnesses or dehydration, and compliance with attendance and treatment protocols (and thus rate of weight or MUAC gain). 

For example, a child with a MUAC of > 110mm and no illnesses on admission, with full protocol compliance, may acheive a MUAC > 125mm within about 4-6 weeks (average MUAC gain is around 2mm per week). The same child with a MUAC of less than 100mm may take approximately 10-12 weeks. For a child with oedema the LOS will depend on the severity of the oedema on admission along with the other factors described above. 

Short children (< 65cm tall) tend to experience longer stays than taller children, see:

https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-016-0136-x

There may also be some variation in LOS depending on the specific criterion for discharge recommended in national guidelines. For example, some national guidelines may recommend WHZ > -2z or > 1.5z or > -1z for discharge; the LOS will increase accordingly.

More recently simplified treatment protocols using adjusted doses of RUTF depending on absolute MUAC during recovery may also affect the LOS by virtue of a change in the rate of MUAC / weight gain. (please see the links to articles in the previous reply from Marko).

I hope this helps,

Paul 

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