Mid-upper Arm Circumference Measurements Research Articles

Measurement of mid-upper arm circumference to screen for childhood malnutrition: General applicability and use in special populations.

Since the development of consensus-recommended indicators for pediatric malnutrition in 2014, screening and diagnosis of pediatric malnutrition have improved, but the indicators are not always used; malnutrition continues to be underdiagnosed in some community and healthcare settings. In particular, mid-upper arm circumference (MUAC) is underused as a screening indicator for pediatric malnutrition, despite its unique advantages and usefulness in several clinical situations. In December 2022, a scientific roundtable was held to bring together several experts in pediatric malnutrition. One of the goals of the scientific roundtable was to discuss the clinical use of anthropometric measures as screening tools for pediatric malnutrition status, with a focus on the use of MUAC. This article arose from that event and is intended as an educational tool to aid clinicians in implementing MUAC measurements. In addition to describing the use of MUAC as a screening tool, the article discusses several clinical situations in which MUAC is especially useful. Additionally, the article reviews practical aspects of measuring and interpreting MUAC values, provides links to additional educational resources, and briefly reviews areas in which further research is needed regarding the use of MUAC for screening of nutrition status in children.

Effect of nutrition education on the nutritional status of pregnant women in Robe and Goba Towns, Southeast Ethiopia, using a cluster randomized controlled trial

Maternal malnutrition is pervasive throughout the world, notably in sub-Saharan Africa (SSA), including Ethiopia. This study aimed to assess the effect of nutrition education on the nutritional status of pregnant women in urban settings in Southeast Ethiopia. A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control). We used a multistage cluster sampling technique followed by systematic sampling to select the pregnant women. Pregnant women who participated in the intervention arm received six nutrition education sessions. Women in the control group received standard care. A nonstretchable mid-upper arm circumference (MUAC) tape was used to measure the MUAC. A linear mixed effects model (LMM) was used to evaluate the effect of the intervention on MUAC, accounting for the clustering. The net mean ± standard error of MUAC between the intervention and control groups was 0.59 ± 0.05 (P < 0.0001). The multivariable LMM indicated that having received nutrition education interventions (β = 0.85, 95% CI 0.60, 1.12, P < 0.0001) improved the MUAC measurement of pregnant women. Thus, nutrition education during pregnancy will combat undernutrition among pregnant women.Trial Registration: Clinicaltrials.gov (PACTR202201731802989), retrospectively registered on 24/01/2022.

Global Leadership Initiative on Malnutrition criteria using calf and upper arm circumference as phenotypic criteria for assessing muscle mass demonstrate satisfactory validity for diagnosing malnutrition in hospitalized patients: A prospective cohort study.

Hospitalized individuals present high rates of malnutrition and loss of muscle mass (MM). Imaging techniques for assessing MM are expensive and scarcely available in hospital practice. The Global Leadership Initiative on Malnutrition (GLIM) proposed a framework for malnutrition diagnosis that includes simple measurements to assess MM, such as calf circumference (CC) and mid-upper arm circumference (MUAC). This study aimed to analyze the validity of the GLIM criteria with CC and MUAC for malnutrition diagnosis, using Subjective Global Assessment (SGA) as the reference standard, in inpatients. A prospective cohort study was conducted on 453 inpatient adults in a university hospital. The presence of malnutrition was assessed within 48 h of hospital admission using SGA and GLIM criteria using CC and MUAC as phenotypic criteria for malnutrition diagnosis. Accuracy, agreement tests, and logistic regression analysis adjusted for confounders were performed to test the validity of the GLIM criteria for malnutrition diagnosis. The patients were aged 59 (46-68) years, 51.4% were male, and 67.8% had elective surgery. Compared with SGA, the GLIM criteria using the two MM assessment measures showed good accuracy (area under the curve > 0.80) and substantial agreement (κ > 0.60) for diagnosing malnutrition. The highest sensitivity was obtained with GLIMCC (89%), whereas GLIMMUAC showed high specificity (>90%). Also, malnutrition identified by GLIMCC and GLIMMUAC was significantly associated with prolonged hospitalization and in-hospital death. In the absence of imaging techniques to assess MM, the use of CC and MUAC measurements from the GLIM criteria demonstrated satisfactory validity for diagnosing malnutrition in hospitalized patients.

Mid-Upper Arm Circumference Is a Strong Predictor of Mortality Among Ugandan Adults With HIV-Associated Cryptococcal Meningitis: A Prospective Cohort Study.

Mortality among adults diagnosed with HIV-associated cryptococcal meningitis remains high (24%-40%). We hypothesized that nutritional state, as measured by mid-upper arm circumference (MUAC), is a potentially modifiable risk factor for mortality. Ugandan adults hospitalized with HIV-associated cryptococcal meningitis had MUAC measurements performed at baseline. We compared MUAC measurements with baseline clinical and demographic variables and investigated associations with survival using Cox regression. Of 433 participants enrolled, 41% were female, the median CD4 T-cell count (interquartile range [IQR]) was 15 (6-41) cells/μL, and 37% were antiretroviral therapy naïve. The median MUAC (IQR) was 24 (22-26) cm, the median weight (IQR) was 53 (50-60) kg, and MUAC correlated with weight (Pearson r = 0.6; P < .001). Overall, 46% (200/433) died during the 18-week follow-up. Participants in the lowest MUAC quartile (≤22 cm) had the highest mortality: 39% (46/118) at 2 weeks and 62% (73/118) at 18 weeks. A baseline MUAC ≤22 cm was associated with an 82% increased risk of 18-week mortality as compared with participants with an MUAC >22 cm (unadjusted hazard ratio, 1.82; 95% CI, 1.36-2.42; P < .001). Following adjustment for antiretroviral therapy status, CD4 count, hemoglobin, amphotericin dose, and tuberculosis status, the adjusted hazard ratio was 1.84 (95% CI, 1.27-2.65; P < .001). As a continuous variable, 18-week mortality was reduced by 10% for every 1-cm increase in MUAC. CSF Th17 immune responses were positively associated with MUAC quartile. MUAC measurement is a simple bedside tool that can identify adults with HIV-associated cryptococcal meningitis at high risk for mortality for whom an enhanced bundle of care, including nutritional supplementation, should be further investigated.

Diagnostic Accuracy of Mid-Upper Arm Circumference for the Detection of Acute Malnutrition Among Children Aged 6-60 Months: A Diagnostic Accuracy Study.

Timely and accurate screening of malnutrition at the community level is essential to identifying malnourished children. The World Health Organization (WHO) guidelines classify non-oedematous acute malnutrition among children using mid-upper arm circumference (MUAC) or weight-for-height Z-score (WHZ). Study Design: A cross-sectional study. This study was conducted among children aged 6‒60 months. After necessary exclusions, 433 participants were selected using a multi-stage simple random sampling method. Using WHO guidelines for global acute malnutrition (GAM) [WHZ<-2, MUAC<12.5 cm], the sensitivity (Se), specificity (Sp), predictive values, likelihood ratios, Youden index, and receiver operating characteristic (ROC) curve were calculated for MUAC using WHZ as the criterion. Out of 433 participants, 30% were diagnosed with GAM using WHZ, while 17.6% were found malnourished using MUAC measurements. As per WHO cut-offs, the Se, Sp, positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of MUAC were 48%, 96%, 83%, 81%, 0.44, 12, and 0.54, respectively. The ROC curve displayed an area under the curve of 0.86 (95% confidence interval=0.83, 0.90) for MUAC<12.5 cm. Bivariate Pearson correlation also demonstrated a positive linear relationship (R2=0.302) between the WHZ and MUAC variables. Based on the findings, 48% of the children were correctly identified by the MUAC with an 83% probability of GAM (PPV=0.83). Moreover, there was 96% Sp in non-malnourished children, with only 4% false positives. Therefore, personnel at the grassroots level can use MUAC for timely and accurate screening of children in Anganwadi centers (AWCs) due to its ease of use and simplicity.

Association of maternal nutritional status and small for gestational age neonates in peri-urban communities of Karachi, Pakistan: findings from the PRISMA study

BackgroundEarly pregnancy nutritional status can be associated with adverse birth outcomes such as small-for-gestational age (SGA) and low birth weight (LBW). BMI (Body Mass Index) and MUAC (Mid-upper arm circumference) are easy to use assessments and are indicative of the pre-pregnancy nutritional status if obtained in the first trimester. This study primarily assesses the association of maternal nutritional status using BMI and MUAC with SGA in a community-based cohort of Pakistani women. It also aims to determine the predictive ability of MUAC and BMI in predicting SGA. Secondarily, we assessed the association between maternal nutrition and large for gestational age (LGA) and LBW.MethodsThis study is a secondary analysis of an ongoing pregnancy cohort “Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA)“in Ibrahim Hyderi and Rehri Goth, Karachi. PRISMA participants who were enrolled between January 2021 to August 2022 were included given they had a gestational age < 14 weeks confirmed via ultrasound, MUAC and BMI measurements were available and birth weight was captured within 72 hours. Multivariable logistic regression was used to determine an association between maternal nutritional status and SGA. The PRISMA study was approved by the Aga Khan University Ethics Review Committee (2021–5920-15,518).ResultsOf 926 women included in the analysis, 26.6% (n = 247) had a low MUAC (< 23 cm) while 18.4% (n = 171) were underweight (BMI < 18.5 kg/m2). Nearly one third of low MUAC and underweight women delivered SGA infants (34.4 and 35.1% respectively). Underweight women and women with low MUAC had a statistically significant association with SGA (Underweight: OR 1.49, 95% CI 1.1,2.4; Low MUAC-OR 1.64, 95% CI 1.2,2.3) as well as LBW (Underweight: OR-1.63, 95% CI 1.1,2.4; Low MUAC-OR-1.63, 95% CI 1.2,2.3). ROC curves showed that MUAC and BMI had modest predictability for SGA (AUC < 0.7).ConclusionMaternal nutritional status as indicated by BMI and MUAC are strongly associated with adverse pregnancy outcomes including SGA, LGA and LBW. Although MUAC and BMI are widely used to determine maternal nutritional status, they have poor predictive ability for newborn size. Further research is needed to identify other tools or a combination of tools to better predict adverse birth outcomes in resource-limited settings and plan interventions.

The Predictive and Prognostic Value of Percentage Change in Calf Circumference in Infants and Children During the First Week of Admission in the Pediatric Intensive Care Unit: A Prospective Cohort Study.

Calf circumference (CC) is an easy measure of muscle loss; yet, there are limited studies in children. We aimed to assess the viability of the first-week percent change in CC as a prognostic nutritional marker. Two MUAC (mid-upper arm circumference), CC, and weight measurements were carried out: one on the first day of admission and another on the seventh day. The differences and correlations between their percent changes were examined. The possible association between CC percent change and prolonged length of hospital stay (PLOS) and in-hospital mortality was assessed. Seventy participants were enrolled with a median age of 19.5 months. The median (interquartile range [IQR]) of CC percent change was 0.54 (5.5) with significant correlations between it and each of MUAC and weight percent change (ρ = 0.928, P = .001), (ρ = 0.902, P = .001), respectively. Calf circumference percent changes were significantly more negative in children with PLOS; (P = .004). These changes seem to be viable measures of nutritional status.

Completion of a Nutrition-Focused Physical Exam with hospitalized adults and pediatric patients: Secondary analysis of a prospective cohort study.

Nutrition-Focused Physical Exam (NFPE) feasibility is not well-studied. We describe registered dietitian nutritionist (RDN)-reported NFPE completion for hospitalized adult and pediatric patients overall and by assessment parameters. Trained RDNs systematically conducted NFPEs for hospitalized adult and pediatric patients during the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators to diagnose Malnutrition multisite cohort study (ClinicalTrials.gov: NCT03928548). RDNs reported their ability to evaluate assessment sites for subcutaneous fat and muscle loss, fluid accumulation, and micronutrient status and to complete handgrip strength (adults and children ≥6 years) and mid-upper arm circumference measurements (children). RDNs noted if they could complete the full NFPE; if not, they noted challenges. We descriptively summarized results and used multilevel logistic regression models to examine relationships between patient characteristics and NFPE completion. RDNs from 39 adult and 29 pediatric US hospitals conducted NFPEs for 327 adults and 214 children aged 1 month to 17.9 years. RDNs reported completing the examination for 44% (n = 145) of adults and 15% (n = 33) of children. They successfully evaluated 25 of 27 and 19 of 26 unique NFPE components in >80% of adults and children, respectively. Common reasons the full NFPE was not completed were limited mobility in adults and patient refusal in children. RDNs had lower odds of completing NFPEs in adults with lower vs higher education levels or higher vs lower nutrition complexity and in younger vs older children. RDNs evaluated NFPE components for a high proportion (>80%) of hospitalized patients.

Caregiver use of MUAC tapes in South Sudan: a three-group prospective comparison.

Nutrition program modifications occurred globally in response to the COVID-19 pandemic. Within community management of acute malnutrition (CMAM), community screenings for acute malnutrition were replaced by caregivers monitoring child mid-upper arm circumference (MUAC), but questions remain about different MUAC tapes' performance and acceptability for caregiver use. The study was conducted in Central Equatoria and Warrap States, South Sudan, between March 2022 and January 2023. A three-group prospective non-randomized design was used to compare the performance of three MUAC tapes (UNICEF 2009, UNICEF 2020, and GOAL MAMI) used by caregivers. The primary outcome was the false negative rate (i.e., the proportion of children not identified as wasted by the caregiver but classified as wasted by enumerators). Caregivers with children aged 5-53 months were assigned to and trained on the use of 1 of the 3 tapes and followed for 8 months, including three monitoring visits and baseline/endline surveys. Of the 2,893 enrolled children, 2,401 (83.0%) completed baseline, endline, and two or more monitoring visits. Only 3.7% of children were identified as wasted by caregivers and 3.8% by study team measurement. Cumulative measurement agreement between caregivers and enumerators was similar by tape. False negative and false positive rates were both <0.5% overall and similar among the tapes. There were differences in training needs and durability between the tapes, but all three were acceptable and performed equally well. Caregiver measurement of child MUAC is feasible in South Sudan. The three MUAC tapes were acceptable, and caregivers could measure accurately with minimal support. All tapes performed similarly and are appropriate for use in Family MUAC programs in South Sudan. There were indications that the UNICEF 2020 tape may be less durable; the GOAL MAMI tape has the added benefit of being suitable for assessments of infants <6 months of age.

The Role of Continuity of Care (CoC) in Supporting Pregnant Women at Risk of Chronic Energy Deficiency (CED) in Improving Nutritional Status: A Case Report

Background: Nutritional issues in pregnant women occur during the 1,000 Days of Life (HPK) period. If nutritional problems during pregnancy are not addressed, they can disrupt fetal development. The government has undertaken efforts such as providing supplementary feeding (PMT). This PMT activity should also be accompanied by nutritional education to promote behavioral change. Midwives are among the healthcare professionals who can provide comprehensive support. This support is aimed at optimizing continuous midwifery care, with the expectation of reducing the impact of Chronic Energy Deficiency (CED) on both pregnant women and their fetuses. Methods: This case report is compiled using a descriptive method with a case study approach. The researcher supported Continuity of Care (CoC) to one patient in the working area of the Surabaya Community Health Center, from the pregnancy period through to the postpartum period and the newborn phase. Case Presentation: A 20-year-old pregnant woman was identified as at risk for Chronic Energy Deficiency (CED) due to a measurement of Mid-Upper Arm Circumference (MUAC) &lt; 23.5 cm. The woman received continuous support, including monitoring her intake of prenatal vitamins, Antenatal Care (ANC) support, counseling, and nutritional education. By the end of the pregnancy, there was an increase in her MUAC, and she was no longer at risk of CED. Conclusion: With support in the form of monitoring and holistic, comprehensive, and collaborative midwifery care from the beginning of pregnancy, optimal care targets can be achieved. The role of support throughout the pregnancy and postpartum period has been carried out effectively, resulting in the mother being free from the risk of Chronic Energy Deficiency (CED) and the baby not experiencing Low Birth Weight (LBW).

Prevalence of undernutrition and its associated factors among pregnant women in north Shewa, Ethiopia: A multi-center cross-sectional study.

Maternal undernutrition remains a public health issue, particularly in low-income countries such as Ethiopia, which increases the possibility of a cycle of malnutrition in future generations. This study assessed the prevalence of undernutrition and its associated factors among pregnant women in Minjar Shenkora district north Shewa, Ethiopia. The study used a multicenter cross-sectional study design. The study was conducted from June to August 2021 with 334 pregnant women selected using systematic random sampling techniques. A semi-structured questionnaire was used to collect the sociodemographic, obstetric, and dietary data. The nutritional status of the pregnant women was assessed using mid-upper arm circumference measurements. Multivariate logistic regression was used to identify independent variables associated with maternal undernutrition, with an adjusted odds ratio (AOR) of p < 0.05 indicating statistical significance. The prevalence of undernutrition was 22.2%. Low monthly household average income (AOR = 3.69, 95% CI: 1.62-8.40), women's education limitation (AOR = 1.24, 95% CI: 0.28-5.46), poor nutritional attitude (AOR = 2.54, 95% CI: 1.21-5.32), and inadequate dietary diversity score (AOR = 4.42, 95% CI: 1.53-12.8) were significantly associated with undernutrition. Maternal undernutrition prevalence was very high based on the WHO standards, and low monthly household average income, women's education level, poor nutritional attitude, and inadequate dietary diversity scores were associated with undernutrition. Therefore, policies and programs aimed at reducing maternal undernutrition are needed. Socioeconomic strengthening and nutritional counseling during pregnancy are also recommended for improved nutritional status.

Association between nutritional risk status and both diaphragmatic dysfunction and diaphragm atrophy in medical ıntensive care unit patients.

Aim: critical illness often leads to malnutrition and diaphragmatic dysfunction (DD), common in intensive care units (ICU). Ultrasonography (US) is a potent tool for detecting DD. This study examines the connection between malnutrition risk and DD in ICU patients using ultrasonographic diaphragm measurements in medical ICU patients. Methods: we assessed nutritional risk using risk screening tools and mid-upper arm circumference measurements (MUAC). Diaphragm atrophy (DA) and DD were evaluated by measuring diaphragmatic excursion (DE), thickness, and thickening fraction (TF) by US. We then compared these diaphragmatic measurements in patients based on their nutritional risk scores. Results: of the fifty patients studied, 54 % to 78 % were at risk of malnutrition, 28 % exhibited diaphragm atrophy (DA), and 24 % showed DD upon ICU admission. Malnutrition risk diagnosed by all nutritional risk screening tools was significantly more frequent in patients with DD, while diagnosed by MUAC was considerably higher in patients with DA. A total of 16 patients (32 %) died during their ICU stay, with DD, DA, and malnutrition risks (as identified by the mNUTRIC Score) being more prevalent among non-survivors (p < 0.05). Malnutrition risk (as determined by the mNUTRIC Score) was an independent risk factor for DD [OR (95 % CI): 6.6 (1.3-34), p = 0.03]. Conclusion: malnutrition risk may be significantly associated with DD and DA in medical ICU patients upon ICU admission.

Assessment of Nutritional Status of Under Five Years Children in Kolati Bhumlu of Kavrepalanchok District

Background: The nutritional status of children is one of the major indicators of child survival and a proxy indicator for the general health of the population. Malnutrition is a significant public health issue in the majority of developing nations and is particularly prevalent among children under five years of age. Mortality and morbidity among children under-five years of age are influence by nutritional status. The context of Nepal, more than one-third (36%) of children under-five years of age stunted or too short for their age. 10% of children wasted (too thin for height), a sign of acute malnutrition. 27% of children underweight or too thin for their age. These children had greater risk of severe acute malnutrition and death. Objective: Study’s objective was to assess the nutritional status of under-five year’s children and factors associated with malnutrition. Method: A descriptive cross-sectional study conducted in Kolati Bhumlu of Kavrepalanchok district of Nepal. A total of 115 under-five year’schildren and their mothers were included in study. Statistical Package for the Social Sciences (SPSS) version16 was used to analyze the data. Result: The prevalence of underweight was found to be 28.7% according to the classification of malnutrition based on Z- score .Similarly, the prevalence of wasting was found to be 18.3% and the prevalence of stunting was found to be 29.6%. According to Gomez’s malnutrition classification (NCHS/WHO as standard) for Weight for age (underweight) 3.5% children were severely malnourished. According to Water-low’s classification, regarding the height for age (stunting) 9.6% children were severely malnourished. Regarding MUAC measurement 7.8% children had severe malnutrition. The Gender of the child was associated with stunting. Conclusion: In the study population, the high prevalence of malnutrition especially stunting among under-five years children. Taking weight, height, age, and mid- upper arm circumference (MUAC) measurements of malnourished children more than three-fifths of them were below -2SD and nearly one-fourths were below -3SD which needs intervention.

Rotavirus and bacterial diarrhoea among children in Ile-Ife, Nigeria: Burden, risk factors and seasonality.

Diarrhoea is a leading cause of death among under-five children globally, with sub-Saharan Africa alone accounting for 1/3 episodes yearly. Viruses, bacteria and parasites may cause diarrhoea. Rotavirus is the most common viral aetiology of diarrhoea in children less than five years globally. In Nigeria, there is scarce data on the prevalence/importance, burden, clinical/risk factors and seasonality of rotavirus and bacteria and this study aims to determine the role of rotavirus and bacteria on diarrhoea cases in children less than five years in Ile-Ife, Nigeria. Socio-demographic data, environmental/risk factors and diarrhoiec stool samples were collected from children less than five years presenting with acute diarrhoea. Rotavirus was identified using ELISA. Bacteria pathogens were detected using cultural technique and typed using PCR. Diarrhoeagenic E. coli (DEC) isolates were subjected to antimicrobial susceptibility testing. Pathogen positive and negative samples were compared in terms of gender, age-group, seasonal distribution, and clinical/risk factors using chi-square with two-tailed significance. SPSS version 20.0.1 for Windows was used for statistical analysis. At least one pathogen was detected from 63 (60.6%) children having gastroenteritis while 28 (44.4%) had multiple infections. Rotavirus was the most detected pathogen. Prevalence of rotavirus mono-infection was 22%, multiple infection with bacteria was 45%. Mono-infection prevalence of DEC, Shigella spp., and Salmonella spp. were 5.8% (6/104), 5.8% (6/104), and 2.9% (3/104) and co-infection with RVA were 23.1% (24/104), 21.2% (22/104) and 10.6% (11/104) respectively. All rotaviral infections were observed in the dry season. The pathotypes of DEC detected were STEC and EAEC. Parent earnings and mid-upper arm circumference measurement have statistical correlation with diarrhoea (p = 0.034; 0.035 respectively). In this study, rotavirus was more prevalent than bacteria and occurred only in the dry season. Among bacteria aetiologies, DEC was the most common detected. Differences in seasonal peaks of rotavirus and DEC could be employed in diarrhoea management in Nigeria and other tropical countries to ensure optimal limited resources usage in preventing diarrhoea transmission and reducing indiscriminate use of antibiotics.

Nutritional status as predictors for quality of life among caregivers of children with severe cerebral palsy.

Individuals with severe cerebral palsy (CP) often experience various health issues, including feeding difficulties, which can adversely affect their nutritional status and caregivers' quality of life, e.g., more time spent for feeding rather than own selfcare. This study aimed to determine the prevalence of poor nutritional status among individuals with severe CP and explore its role as predictors for caregivers' quality of life. This cross-sectional study was conducted in a government hospital (Cheras Rehabilitation Hospital), Community-Based Rehabilitation (CBR) Program, and Spastic Centre [non-profit organization (NGO)] in Klang Valley, Malaysia. Seventy-one participants with Gross Motor Function Classification System (GMFCS) level IV and V were recruited. Sociodemographic data, health-associated data, and anthropometric data were collected. Caregivers' quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) CP module version 3.0 which included domains such as Movement and Balance, Eating Activities, and School Activities. Most participants were males (60.6%), with 61 classified as level IV in the GMFCS classification. According to the Eating and Drinking Ability Classification System (EDACS), 59 children were at level IV. In total, 40.8% were underweight according to CP growth chart and 49.3% had mid-upper arm circumference (MUAC) readings below the 5th percentile. The lowest scores in the PedsQL CP module version 3.0 were observed in the Daily Activities (5.34±10.87), and School Activities domains (8.15±18.65). Sociodemographic and anthropometric data, including body mass index (BMI)-for-age, MUAC, body fat, triceps, and subscapular skinfold measurement, were predictors for the School Activities domain [F (11, 44)=3.981, P<0.005, R2=0.499]. Poor nutritional status in individuals with severe CP has been shown to negatively impact caregivers' quality of life. Therefore, a multidisciplinary approach involving nutritional intervention is essential to improve dietary provision and the nutritional status of children with CP.

An Evaluation of Mid-upper Arm Circumference Measurement in a Neonatal Intensive Care Unit Follow-up Population

An Evaluation of Mid-upper Arm Circumference Measurement in a Neonatal Intensive Care Unit Follow-up Population

Mid-upper arm circumference (MUAC) measurement usage among children with disabilities: A systematic review.

Background: Anthropometric measurements, including mid-upper arm circumference (MUAC), are used for monitoring and evaluating children's nutritional status. Evidence is limited on optimal nutritional assessment for children with disabilities, who are at high risk for malnutrition. Aim: This study describes MUAC use among children with disabilities. Methods: Four databases (Embase, Global Health, Medline, and CINHAL) were searched from January 1990 through September 2021 using a predefined search strategy. Of the 305 publications screened, 32 papers were included. Data included children 6 months to 18 years old with disabilities. Data including general study characteristics, methods for MUAC measurement, terminology, and measurement references were extracted into Excel. Due to heterogeneity of the data, a narrative synthesis was used. Results: Studies from 24 countries indicate that MUAC is being used as part of nutritional assessment, but MUAC measurement methods, references, and cutoffs were inconsistent. Sixteen (50%) reported MUAC as a mean ± standard deviation (SD), 11 (34%) reported ranges or percentiles, 6 (19%) reported z-scores, and 4 (13%) used other methods. Fourteen (45%) studies included both MUAC and weight-for-height but nonstandard reporting limited comparability of the indicators for identifying those at risk of malnutrition. Conclusion: Although its speed, simplicity, and ease of use afford MUAC great potential for assessing children with disabilities, more research is needed to understand its appropriateness, and how it performs at identifying nutritionally high-risk children in comparison to other measures. Without validated inclusive measures to identify malnutrition and monitor growth and health, millions of children could have severe consequences for their development.

Fish Consumption Improved Head Circumference and Mid-Upper Arm Circumference among Infants in Zambia: A Randomised Controlled Trial

Fish is a good source of Animal Source Proteins (ASP). Families from low-income countries with limited access to other animal source proteins can utilize it to improve the nutrition status of infants and young children. The objective of the study was to assess if fish fed during the early complementary feeding period had an effect on improved head circumference (HC) and mid-upper arm circumference (MUAC) among infants aged 6–7 months. A randomised controlled trial was conducted from April 2019 to January 2020 in the Samfya district, Luapula Province, Zambia. The infants (238) were randomised to either the fish group (intervention) or the sorghum group (control). Every week for a period of 6 months, infants received seven sachets of fish powder and sorghum powder, respectively. Compliance was also monitored during the fish powder distribution. The head circumference measurements were conducted at baseline and once each follow-up month for a period of six months while the MUAC measurements were conducted twice (at baseline and endline). Using statistical software for data science (STATA) (version 16), a linear mixed effect model was used to analyse the data. The results showed that fish improved head circumference for age z score (HCZ) by 0.53 (95% CI: 0.23–0.82), p-value &lt; 0.001, and MUAC by 0.36 (95% CI: 0.13–0.59) p-value &lt; 0.002. Therefore, fish can be used as the main source of protein in complementary foods for infants and young children in low-income communities with limited access to meat.

Assessment of thinness based on BMI and MUAC among the adult Jaunsari

Background: Researchers worldwide have tried to develop alternative measures to assess the nutritional status, especially among adults in developing countries. Body mass index (BMI) is a commonly used technique but sometimes difficult to obtain in large-scale surveys. Mid-upper arm circumference (MUAC) has been used as an alternative, but data are limited, especially in the Indian context.&#x0D; Objectives: The objective of the present study was to evaluate the BMI and MUAC of the Jaunsari tribal community of Uttarakhand and to assess whether MUAC is an acceptable proxy for BMI.&#x0D; Sample and Methods: A total of 303 (male 134, female 169) healthy adult Jaunsari individuals aged 18-60 years from Lakhamandal village of Dehradun district of Uttarakhand, India have been selected. Anthropometric measurements of height (cm), weight (kg), and MUAC (cm) were taken following the standard protocol. Globally accepted cut-off values for thinness were used (BMI&lt;18.5kg/m2 and MUAC&lt;24.0cm). Descriptive statistics, Student’s t-test and Chi-square test were performed. The statistically significant level was set at p&lt;0.05.&#x0D; Results: The Jaunsari people of Lakhamandal village of Dehradun district are very thin when following the categories developed by WHO (30.4%). Females are on average thinner than males when assessed by BMI and MUAC. Overweight was found in 12.2% of the village’s people. Individuals are two times more likely to be considered thin when classified by MUAC, than if classified by BMI.&#x0D; Conclusions: Healthy Jaunsari people are on average very thin, but there is already some evidence of overnutrition in a few cases. Thinness when assessed by MUAC is twice as prevalent, than if assessed by BMI.

Assessing Mbiotisho: A smartphone application used to collect high-frequency health and nutrition data from difficult-to-reach populations.

There is an urgent need for improved and timely health and nutrition data. We developed and tested a smartphone application that caregivers from a pastoral population used to measure, record and submit high-frequency and longitudinal health and nutrition information on themselves and their children. The data were assessed by comparing caregiver-submitted measurements of mid-upper arm circumference (MUAC) to several benchmark data sets, including data collected by community health volunteers from the participating caregivers during the project period and data generated by interpreting photographs of MUAC measurements submitted by all participants. We found that the caregivers participated frequently and consistently over the 12-month period of the project; most of them made several measurements and submissions in at least 48 of the 52 weeks of the project. The evaluation of data quality was sensitive to which data set was used as the benchmark, but the results indicate that the errors in the caregivers' submissions were similar to that of enumerators in other studies. We then compare the costs of this alternative approach to data collection through more conventional methods, concluding that conventional methods can be more cost-effective for large socioeconomic surveys that value the breadth of the survey over the frequency of data, while the alternative we tested is favoured for those with objectives that are better met by high-frequency observations of a smaller number of well-defined outcomes.