Mid upper arm circumference cutoffs for identifying underweight and severe underweight among infants less than six months: A Hospital Based Cross-Sectional study

Abstract

Background: Prevalence of undernutrition among infants <6 months are very high in India. WAZ is the most
sensitive predictor of mortality among infants <6 months as compared to other anthropometric parameters.
However, taking weight and calculating z-score in the community setting have many challenges. Taking mid
upper arm circumference (MUAC) is more feasible in a field setting. Methodology: A cross-sectional study
was conducted with 419 infants <6 months in a tertiary care hospital in India to identify appropriate MUAC
cutoffs for identifying underweight (WAZ<-2) and severe underweight (WAZ<-3) among infants <6 months
by calculating sensitivities, specificities and Youden indices. Cohen kappa coefficients were calculated to
assess agreements between MUAC and WAZ cutoffs. Results: The MUAC cut-offs for underweight and
severe underweight were calculated as 11cm (Youden Index: 0.503; sensitivity: 83.4%; specificity: 66.9%)
and 10.9cm (Youden Index: 0.504; sensitivity: 76.3%; specificity: 74.1%), respectively. Kappa coefficients to
diagnose underweight with MUAC<=11cm was highest at 0.48. Conclusions: The MUAC cut-off of 11cm
could reliably be used to screen infants <6 months with underweight and severe underweight for providing
appropriate care in the Indian settings.