The development of reference values for the brachial perimeter and body height in comparison with other indicators used for screening of the nutritional status

Abstract

Mid-upper-arm circumference (MUAC) based on a single cut-off value for all children under 5 years of age has been used for many years as an alternative nutritional status index for children during famines or refugee crises, and as an additional screening tool in nonemergencies. However, it has recently been questioned whether MUAC is age- and sex-independent. After reviewing the scientific evidence underlying the use and interpretation of MUAC, a WHO Expert Committee recommended a new MUAC-for-age reference for under-5-year-olds. In some settings, however, it is difficult to assess a child's age and in such circumstances MUAC-for height may be a good alternative. The height-based QUAC stick offers a simple means of adjusting MUAC cut-offs according to height, and the MUAC-for-height reference and construction and use of the QUAC stick are described in this article. Also described is the use of the receiver operating characteristic (ROC) curve method to evaluate the performance of MUAC, MUAC-for-age, and MUAC-for-height in screening malnourished children.