Use of mid-upper arm circumference for determining overweight and overfatness in children and adolescents

Association of interarm blood pressure difference with selected body circumferences among Walter Sisulu University community

BACKGROUND

A high interarm blood pressure difference (IAD) has been identified as a precursor of vascular diseases. Anthropometric measures for obesity such as body circumferences including waist circumference (WC), mid-upper arm circumference (MUAC) and neck circumference (NC) have been associated with a high IAD in Western countries. However, the prevalence of IAD and its association with body circumferences in South African communities such as universities is not well established. Therefore, this study aimed at investigating the correlation of IAD with selected body circumferences among the Walter Sisulu University (WSU) community.

METHODS

A total of 230 participants, 117 males and 113 females, consisting of 185 students and 45 staff members from WSU, aged 18-27 and 18-63 years respectively, participated in this cross-sectional study. The selected body circumferences: WC, MUAC, and NC were measured using standard procedures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in both arms simultaneously using automated machines. IAD was achieved by calculating differences in SBP and DBP between the left (L) and right (R) arms, (R -L), and getting the absolute value, L-R (|L-R|).

RESULTS

14.78% of the participants had an interarm SBP difference (IASBPD) ≥ 10 mmHg, and 4.35% of participants had an interarm DBP difference (IADBPD) ≥ 10 mmHg. In a Pearson's correlation analysis, IASBPD was positively correlated with the selected body circumferences (WC, r = 0.29; P < 0.001; MUAC, r = 0.35; P < 0.001; NC, r = 0.27; P < 0.001) and mean arterial pressure (MAP) (r = 0.30; P < 0.001). In the multivariable-adjusted regression analyses, IASBPD was positively associated with MUAC (adjusted R2 = 0.128, β = 0.271 (95% CI = 0.09; 0.60), P = 0.008), and NC (adjusted R2 = 0.119, β = 0.190 (95% CI = 0.01; 0.32), P = 0.032) only, adjusted for MAP, age, gender, body mass index, smoking, and alcohol. There was no association of body circumferences with IADBPD.

CONCLUSION

A high IAD is common among students and staff members of the WSU community. Furthermore, IAD showed a positive correlation with MUAC and NC. These body circumferences can serve as indicators of high IAD, aiding in the early detection and prevention of vascular diseases.

Validation of mid-arm circumference for surveillance of obesity in African adolescent girls and adult women

This study aimed to assess the validity of mid-arm circumference (MAC), also known as mid-upper arm circumference (MUAC), for classification of high body fatness in Namibian adolescent girls and women and to test whether classification accuracy of MUAC was higher than the traditional simple proxy for high fatness, the BMI. In 206 adolescent girls aged 13-19 years and 207 adult women aged 20-40 years, we defined obesity conventionally (BMI-for-age Z score ≥ 2·00, adolescents; adults BMI ≥ 30·0 kg/m2) and also defined obesity using published MAC cut-off values. 2H oxide dilution was used to measure total body water (TBW) to define high body fat percentage (≥ 30 % in the adolescents, ≥ 38 % in the adults), and we compared the ability of BMI and MAC to classify high body fatness correctly using sensitivity, specificity and predictive values. In the adolescents, obesity prevalence was 9·2 % (19/206) using BMI-for-age and 63·2 % (131/206) using TBW; sensitivity of BMI-for-age was 14·5 % (95 % CI 9·1, 22·0 %) but was improved significantly using MAC of 22·6 cm (sensitivity 96·9 %; 95 % CI 92·1 %, 99·3 %). In the adults, obesity prevalence was 30·4 % (63/207) using BMI and 57·0 % (118/207) using TBW, and sensitivity of BMI was 52·5 % (95 % CI 43·6, 62·2 %), but using a MAC of 30·6 cm sensitivity was 72·8 % (95 % CI 66·4, 82·6 %). Surveillance of obesity in African adolescent girls and adult women is likely to be improved substantially by use of MAC as an alternative to the BMI-for-age and BMI.

Allergies, body mass, and hospitalization due to arbovirus infection: A prospective surveillance study in Machala, Ecuador

Dengue, chikungunya, and Zika are arboviruses that cause 390 million infections annually. Risk factors for hospitalization are poorly understood. Communities affected by these diseases have an escalating prevalence of allergies and obesity, which are linked to immune dysfunction. We assessed the association of allergies or body mass with hospitalization for an arbovirus infection. From 2014 to 2017, we recruited participants with a clinical diagnosis of arbovirus infection. Arbovirus infections were laboratory-confirmed and allergies were self-reported. Mid-upper arm circumference (MUAC), weight, and height were measured. We used two logistic regression models to assess the relationships between hospitalization and allergies and between hospitalization and body mass (MUAC for participants <20 years old and body mass index (BMI) for adults ≥20 years old). Models were stratified by age group and adjusted for confounders. For allergies, 41 of 265 were hospitalized. There was no association between allergies and hospitalization. For body mass, 34 of 251 were hospitalized. There was a 43% decrease in hospitalization odds for each additional centimetre MUAC among children (aOR 0.566, 95% CI 0.252-1.019) and a 12% decrease in hospitalization odds for each additional BMI unit among adults (aOR 0.877, 95% CI 0.752-0.998). Our work encourages the exploration of the underlying mechanisms.

Phase angle as a marker of outcome in hospitalized pediatric patients. A systematic review of the evidence (GRADE) with meta-analysis

Phase angle (PhA) is a valuable tool for evaluating the nutritional and inflammatory status, which can accompany acute and severe disorders. PhA is a cellular health biomarker, whose value is particularly substantial due to the negative consequences of these situations in the pediatric population. Relevant literature was collected with the aim of comprehensively analysing the evidence on the association between an altered PhA can serve as a predictive-marker for mortality and poor-outcomes in at-risk-pediatric patients. Understanding this relationship could have significant implications for identifying high-risk individuals and implementing timely interventions. A systematic review with meta-analysis was conducted in the primary electronic databases from inception until January 2023. Overall, four studies with a total of 740 patients were eligible for our analysis. Evidence demonstrates that PhA is associated with nutritional status, reflecting undernutrition and changes in body composition related to illness. This review suggests that PhA can indeed be used as an indicator of nutritional status and a tool for predicting prognosis, including mortality and poor-outcomes, in hospitalized pediatric patients. A low PhA was associated with a significant mortality risk [RR:1.51;95%CI (1.22-1.88),p = 0.0002;I2 = 0%,(p = 0.99)] and an increased complications risk [OR:8.17;95%CI (2.44-27.4),p = 0.0007;I2 = 44%,(p = 0.18)]. These findings highlight the importance of taking a comprehensive approach to clinical nutrition, integrating multiple evaluation aspects to establish an accurate diagnosis and personalized therapeutic plans. While PhA emerges as a valuable tool for assessing the risk of malnutrition and as a prognostic-indicator for poor-outcomes in pediatric patients. Further future studies are needed to focus on investigating this relationship in larger and diverse population to strengthen the evidence base.

Mid upper arm circumference as screening tool of overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia

Background

Overweight or obesity is an excessive fat accumulation that impairs the health and wellbeing of the adult population throughout the world. Recently Mid upper arm circumference (MUAC) was suggested as a screening index for overweight or obesity among adolescents, but its utilization for the assessment of overweight or obesity in the adult population is not clear yet. In addition, little is known about the screening ability of MUAC for overweight or obesity in the adult population of Ethiopia. Therefore, this study aimed to evaluate the utility of MUAC for screening overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia.

Method

A Facility -based cross-sectional study was carried out from February 21 to March 20, 2020, at Mizan Tepi University. About 585 study participants were selected by gender-based stratified sampling technique. Anthropometric data like weight, height, and MUAC were collected. Pearson's correlation between MUAC, body mass index (BMI), and age was calculated to see a relationship between them. The Receiver operating characteristics (ROC) curve was calculated to identify the screening ability of MUAC for overweight or obesity. The appropriate MUAC cutoff point for both men and women established using the Youden index. Additionally, sensitivity, specificity, positive, and negative predictive values were calculated.

Result

The prevalence of overweight and obesity among the study participants was 18.1% and 4.8%, respectively. MUAC had a strong positive correlation with BMI, r = 0.65 (95% CI; 0.56–0.69). According to ROC analysis, MUAC is an excellent screening tool for male and female employees with excellent accuracy (AUC = 0.9 with 91.4% sensitivity and 76.4% specificity) and good accuracy (AUC = 0.83 with 67.2% sensitivity and 83.5% specificity), respectively. Based on the youden index, the cutoff point of MUAC to screen overweight or obesity among male and female employees was 26.91cm.

Conclusion

Mid-upper arm circumference (MUAC) has an equal ability with BMI to screen overweight or obesity among adults. Therefore, MUAC can be utilized as an alternative index to screen overweight and obesity in resource-limited setups.

Sleep duration and eating behaviours are associated with body composition in 5-year-old children: findings from the ROLO longitudinal birth cohort study

Inadequate sleep and poor eating behaviours are associated with higher risk of childhood overweight and obesity. Less is known about the influence sleep has on eating behaviours and consequently body composition. Furthermore, whether associations differ in boys and girls has not been investigated extensively. We investigate associations between sleep, eating behaviours and body composition in cross-sectional analysis of 5-year-old children. Weight, height, BMI, mid upper arm circumference (MUAC), abdominal circumference (AC) and skinfold measurements were obtained. Maternal reported information on child's eating behaviour and sleep habits were collected using validated questionnaires. Multiple linear regression examined associations between sleep, eating behaviours and body composition. Sleep duration was negatively associated with BMI, with 1-h greater sleep duration associated with 0·24 kg/m² (B = 0·24, CI -0·42, -0·03, P = 0·026) lower BMI and 0·21 cm lower (B = -0·21, CI -0·41, -0·02, P = 0·035) MUAC. When stratified by sex, girls showed stronger inverse associations between sleep duration (h) and BMI (kg/m²) (B = -0·32; CI -0·60, -0·04, P = 0·024), MUAC (cm) (B = -0·29; CI -0·58, 0·000, P = 0·05) and AC (cm) (B = -1·10; CI -1·85, -0·21, P = 0·014) than boys. Positive associations for 'Enjoys Food' and 'Food Responsiveness' with BMI, MUAC and AC were observed in girls only. Inverse associations between sleep duration and 'Emotional Undereating' and 'Food Fussiness' were observed in both sexes, although stronger in boys. Sleep duration did not mediate the relationship between eating behaviours and BMI. Further exploration is required to understand how sleep impacts eating behaviours and consequently body composition and how sex influences this relationship.

Validation of mid-upper-arm-circumference cut-offs for assessment of overnutrition in Indian children and adolescents with type 1 diabetes

AIMS

Mid upper arm circumference (MUAC) measurement is an easy and low-cost method to determine nutritional status. MUAC cut-offs for screening for overnutrition in Indian children from 5 to 17 years age are recently published. We conducted this study to validate MUAC cut-offs against BMI to screen overnutrition in children with T1D in comparison with age-gender-matched healthy controls and to compare the predictive value of BMI and MUAC to assess adiposity.

METHODOLOGY

This cross sectional, observational study included 249 children and adolescents (5-17 years) with T1D attending a pediatric endocrine clinic along with same number of age and gender matched healthy controls. Demographic, anthropometric and body composition data were obtained using standardized protocols and questionnaires.

RESULTS

The co-relation between MUAC with BMI was significant for cases and controls and percent body fat with MUAC and BMI in T1D(r = 0.854,0.917 and 0.546,0.616). The AUC of MUAC to identify obesity based on BMI cut-offs for cases and controls and of BMI and MUAC for adiposity were similar(0.745,0.918 and 0.867,0.814). Sensitivity, specificity and PPV were significantly higher in controls than in cases.

CONCLUSION

MUAC is an accurate method to identify obesity and adiposity in T1D thereby reducing the risk of development of double diabetes.

The performance of mid-upper arm circumference for identifying children and adolescents with overweight and obesity: a systematic review and meta-analysis

OBJECTIVE

This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity.

DESIGN

Systematic review and meta-analysis.

SETTING

We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2-19 years were included.

PARTICIPANTS

A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses.

RESULTS

In boys, MUAC showed a pooled AUC of 0·92 (95 % CI 0·89, 0·94), sensitivity of 84·4 (95 % CI 84·6, 90·8) and a specificity of 86·0 (95 % CI 79·2, 90·8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0·93 (95 % CI 0·90, 0·95), sensitivity of 86·4 (95 % CI 79·8, 91·0), specificity of 86·6 (95 % CI 82·2, 90·1) when compared against overweight and obesity defined using BMI z-scores.

CONCLUSION

In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the 'golden standard' measure of excess adiposity.

Diagnostic Performance and Appropriate Cut-Offs of Different Anthropometric Indicators for Detecting Children with Overweight and Obesity

In the clinical settings, different anthropometric indicators like neck circumference (NC), waist circumference (WC), midupper arm circumference (MUAC), waist-to-height ratio (WHtR), and arm-to-height ratio (AHtR) have been suggested for evaluating overweight and obesity in children. The comparative ability of these indicators in Pakistan is yet unknown. This study is aimed at examining the validity of different anthropometric indicators of overweight and obesity simultaneously and at determining their superlative cut-off values that would correctly detect overweight and obesity in children. For this purpose, the dataset of anthropometric measurements height, weight, WC, MUAC, and NC of 5,964 Pakistani children, aged 5-12 years collected in a cross-sectional multiethnic anthropometric survey (MEAS), was used. Receiver operating characteristic (ROC) curve analysis was performed to assess the validity of different anthropometric indicators. The most sensitive and specific cut-off points, positive and negative predictive values of each indicator were also calculated. The results of the ROC curve indicated that all the studied indicators had a good performance but the indicators AHtR and WHtR had the highest value of the area under the curve (AUC) for the screening of children with overweight and obesity (AUC > 0.80). In the overall sample, AHtR, WHtR, MUAC, WC, and NC cut-off points indicative of overweight, in both boys and girls, were 0.14, 0.46, 18.41 cm, 62.86 cm, and 26.36 cm and 0.14, 0.47, 18.16 cm, 64.39 cm, and 26.54 cm, respectively; the corresponding values for obesity were 0.14, 0.47, 18.67 cm, 62.10 cm, and 26.36 cm and 0.14, 0.48, 20.19 cm, 64.39 cm, and 25.27 cm. We concluded that the sex-specific cut-off points for AHtR, WHtR, MUAC, WC, and NC can be used to diagnose overweight and obesity in Pakistani children.

Mid-upper arm circumference in pregnant women and birth weight in newborns as substitute for skinfold thickness: findings from the MAASTHI cohort study, India

BACKGROUND

Estimating total body fat in public hospitals using gold-standard measurements such as air displacement plethysmography (ADP), deuterium oxide dilution, or dual-energy X-ray absorptiometry (DXA) is unaffordable, and it is challenging to use skinfold thickness. We aimed to identify the appropriate substitute marker for skinfold thickness to estimate total body fat in pregnant women and infants.

METHODS

The study is part of a prospective cohort study titled MAASTHI in Bengaluru, from 2016 to 19. Anthropometric measurements such as body weight, head circumference, mid-upper arm circumference (MUAC), and skinfold thickness were measured in pregnant women between 14 and 36 weeks of gestational age; while measurements such as birth weight, head, chest, waist, hip, mid-upper arm circumference, and skinfold thickness were recorded for newborns. We calculated Kappa statistics to assess agreement between these anthropometric markers with skinfold thickness.

RESULTS

We found the highest amount of agreement between total skinfold thickness and MUAC (Kappa statistic, 0.42; 95 % CI 0.38-0.46) in pregnant women. For newborns, the highest agreement with total skinfold thickness was with birth weight (0.57; 95 % CI 0.52-0.60). Our results indicate that MUAC higher than 29.2 cm can serve as a suitable alternative to total skinfolds-based assessments for obesity screening in pregnancy in public facilities. Similarly, a birth weight cut-off of 3.45 kg can be considered for classifying obesity among newborns.

CONCLUSION

Mid-upper arm circumference and birth weight can be used as markers of skinfold thickness, reflecting total body fat in pregnant women and the infant, respectively. These two anthropometric measurements could substitute for skinfold thickness in low- and middle-income urban India settings.

Reference centile curves for mid-upper arm circumference for assessment of under- and overnutrition in school-aged Indian children and adolescents

OBJECTIVES

Malnutrition is common in developing countries and is not restricted to young children. It has been suggested that measuring mid-upper arm circumference (MUAC) is an easy, accurate, and low-cost method of identifying malnutrition in the early stages. The aims of this study were to construct age- and sex-specific MUAC reference centiles, and to define and validate cutoffs for assessment of under- and overnutrition in Indian children 5 to 17 y of age.

METHODS

This was a cross-sectional, multicentric, observational study conducted in seven schools in seven states from June 2018 to November 2019. The study included 6680 healthy 5- to17-y-old children. MUAC was measured using non-stretch tapes (UNICEF). Sex-specific MUAC percentiles were computed for age and height. Cutoffs for MUAC z-scores for thinness and overnutrition were defined and validated for healthy school children (n = 726) and children with cancer (n = 500).

RESULTS

Reference centiles for MUAC for age (and height) for boys and girls are presented. Cutoffs defined for thinness and for obesity were -0.7 and +1.5 z-score, respectively (corresponding to 25th and 95th percentiles of the MUAC for age/height). For ease of use, rounded cutoffs for thinness were 16 and 18.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both sexes, and a cutoff of 22 cm in boys and 20 cm in girl from 15 to 17 y of age. For obesity, 20 and 25.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both girls and boys and a rounded cutoff of 29 cm in boys and 27 cm in girls from 15 to17 y are proposed.

CONCLUSIONS

We presented MUAC percentiles and cutoffs for screening for thinness and overnutrition in Indian children from 5 to 17 y of age. These data may also be used in children with cancer and other chronic disorders with growth failure.

Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis

BACKGROUND & AIMS

The association between nutritional status at pediatric intensive care unit (PICU) admission with clinical outcomes remains unclear. We conducted this systematic review to summarize the overall impact of PICU admission body mass index (BMI) on clinical outcomes.

METHODS

We searched the following medical databases from inception through May 2020: PubMed, Excerpta Medica database (Embase), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science. We included studies on patients ≤18 years old admitted to a PICU that investigated the effect of BMI on mortality, PICU or hospital length of stay (LOS), or duration of mechanical ventilation (MV). Classification of underweight, overweight, and obese were based on each study's criteria.

RESULTS

There was a total of 21,558 patients from 20 included studies. 12,936 (60.0%), 2965 (13.8%), 2182 (10.1%), 3348 (15.5%) were normal weight, underweight, overweight, and obese patients, respectively. Relative to normal weight patients, underweight (OR 1.32, 95% CI 0.89-1.98; p = 0.171) and overweight/obese patients (OR 1.10, 95% CI 0.86-1.42; p = 0.446) did not have an increase risk in mortality. There was also no difference in duration of MV, PICU and hospital LOS between all three weight categories. Included studies were heterogeneous and lacked standardized nutritional categorization. Sensitivity analysis including only studies that used BMI z-scores as nutritional classification (n = 5) revealed that underweight patients had higher odds of mortality compared to patients with normal weight (OR 1.61, 95% CI 1.35-1.92; p < 0.001); studies that used percentiles as classification did not reveal any differences in mortality. Sensitivity analysis including only studies containing mixed PICU cohorts (i.e., excluding specialized cohorts e.g., congenital heart surgeries, burns) revealed higher mortality odds in underweight patients (OR 1.53, 95% CI 1.25-1.87; p < 0.001) and overweight/obese patients (OR 1.51, 95% CI 1.14-2.01; p = 0.004) relative to normal weight patients.

CONCLUSIONS

Our systematic review did not reveal any association between PICU admission BMI status and outcomes in critically ill children. Further investigation with standardized nutrition status classification on admission, stratified by patient subgroups, is needed to clarify the association between nutritional status and clinical outcomes of PICU patients.

Diagnostic performance of mid-upper arm circumference to identify overweight and obesity in children and adolescents: a protocol for a systematic review and meta-analysis

INTRODUCTION

Mid-upper arm circumference (MUAC) has been suggested as an alternative screening tool to identify overweight and obesity in children and adolescents. Several studies have examined the diagnostic performance of MUAC to identify overweight and obesity in children and adolescents. However, the existing literature shows a considerable variability in measures of diagnostic performance and hence makes it difficult to direct clinical and public health practice. Therefore, this systematic review and meta-analysis aimed to synthesise evidence on the performance of MUAC to identify overweight and obesity in children and adolescents.

METHODS AND ANALYSIS

A systematic search of databases including PubMed, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO will be conducted. The search will cover all studies until 1 April 2021. Grey literature will also be retrieved from Google Scholar. Titles and abstracts will be screened by two independent reviewers. The Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used to assess the risk of bias and clinical applicability of each study. To assess possible publication bias, we will use Deeks' funnel plot. We will investigate the sources of heterogeneity by visual inspection of the paired forest plots and summary receiver operating characteristic plots. The pooled summary statistics for the area under the curve, sensitivities, specificities, likelihood ratios and diagnostic ORs with 95% CI will be reported.

ETHICS AND DISSEMINATION

The underlying study is based on published articles thus does not require ethical approval. The findings of the systematic review and meta-analysis will be published in a peer-reviewed journal and disseminated in different scientific conferences and seminars.

PROSPERO REGISTRATION NUMBER

CRD42020183148.

Use of Anthropometry Versus Ultrasound for the Assessment of Body Fat and Comorbidities in Children With Obesity

OBJECTIVES

We aimed to examine the association between abdominal fat measured by ultrasound and anthropometric indices in children with obesity, and those with normal weight. We also examined the association between anthropometry and fat measures in the prediction of comorbidities in children with obesity.

METHODS

Forty children with body mass index of >95th percentile were included as cases, and a comparable group of 32 healthy average-weight peers were included as controls in this study. All children underwent clinical assessment, anthropometric measures, and evaluation of abdominal subcutaneous fat (SCF) and visceral fat by ultrasound. Fasting blood sugar, serum transaminases, and lipid profile of all the included children were also evaluated.

RESULTS

Children with obesity had a mean age of 8.7 ± 2.9 years (range 3-13). The SCF and intraperitoneal fat (IPF) values correlated well with each other and with anthropometric measurements in children with obesity. Among all the included cases, 90% were metabolically unhealthy, 70% had hypertension, 52.5% had dyslipidemia, and 22.5% had echogenic liver. Anthropometric measures, abdominal SCF and IPF were higher in children with complications. SCF was observed as a good predictor for hepatic echogenicity among the measured ultrasound parameters (P: 0.03, odds ratio 4.6). The best cutoff value for SCF in cases with hepatic echogenicity was 23.2 mm with an overall accuracy of 80%.

CONCLUSIONS

In children with obesity, abdominal SCF and IPF correlated well with anthropometric measures and were higher in children with comorbidities. This finding, however, did not predict comorbidities apart from those with echogenic liver.

Mid-upper arm circumference as a screening tool for identifying adolescents with thinness

OBJECTIVE

To evaluate the performance of mid-upper arm circumference (MUAC) to identify thinness in the late adolescence period (aged 15-19 years) in Ethiopia.

DESIGN

We conducted a school-based cross-sectional study. The receiver operating characteristics curve was used to examine the validity of MUAC compared with BMI Z-score to identify adolescents with thinness (BMI Z-score <-2 sd).

SETTINGS

Fifteen high schools (grade 9-12) located in Addis Ababa, Ethiopia.

PARTICIPANTS

A total of 851 adolescent (456 males and 395 females) were included in the study.

RESULTS

The prevalence of thinness and severe thinness among high-school adolescents in Addis Ababa was 9·5 % (95 % CI 7·7, 11·7 %). The overall AUC for MUAC against BMI Z-score <-2 SD was 0·91 (95 % CI 0·88, 0·93). The optimal MUAC cut-offs to identify thinness were 23·3 cm for males and 22·6 cm for females. These cut-off points give high sensitivity and specificity for both males (a sensitivity of 87·9 % and a specificity of 75·9 %) and females (a sensitivity of 100 % and a specificity 88·2 %).

CONCLUSIONS

MUAC has a comparable level of accuracy with BMI Z-score to identify thinness in adolescents aged 15-19 years. Hence, MUAC could be used as an alternative tool for surveillance and screening of thinness among adolescents aged 15-19 years. The optimum cut-off proposed by this study may incorrectly include a large number of adolescents when used in a relatively well-nourished population. In this situation, it would be necessary to choose a cut-off with greater positive predictive value.

The range of non-traditional anthropometric parameters to define obesity and obesity-related disease in children: a systematic review

Obesity is defined as an abnormal/excessive accumulation of body fat, associated with health consequences. Although overall obesity does confer a significant threat to the health of individuals, the distribution of body fat, especially abdominal/central obesity is of greater importance. For practical reasons, proxy anthropometric measurements have been developed to identify central obesity, however, major limitations are noted in these traditional measurements. The present study aims to evaluate the literature, to identify and describe non-traditional anthropometric measurements of overweight and obesity in children. The current systematic review was conducted in accordance with the PRISMA guidelines, and the search was undertaken in the PubMed^® database, using MeSH (Medical Subject Headings) terms. Data extracted from each study were: (a) details of the study, (b) anthropometric parameter(s) evaluated in the study and its details, (c) study methods, (d) objectives of the study and/or comparisons, and (e) main findings/conclusions of the study. The search yielded a total of 3697 articles, of which 31 studies were deemed eligible to be included. The literature search identified 13 non-traditional anthropometric parameters. Data on non-traditional anthropometric parameters were derived from 24 countries. Majority were descriptive cross-sectional studies (n = 29), while sample size varied from 65 to 23,043. Non-traditional anthropometric parameters showed variable correlation with obesity and/or related metabolic risk factors. Some parameters involved complex calculations, while others were based on a single anthropometric measurement or derived from traditional measures. Most studies lacked comparison with a 'gold standard' assessment of body fat, hence further research is required to determine their accuracy and precision.

Differentiating effects of socio-economic factors on relative weight and nutritional status in Polish schoolchildren across intergenerational changes

OBJECTIVE

The aim of this study was an assessment of the effects of urbanisation level, family size and parental education on body mass index (BMI) and mid-upper arm circumference (MUAC) among Polish schoolchildren in cross-sectional surveys conducted between 1966 and 2012.

DESIGN

The analysis involved schoolchildren measured in four Polish Anthropological Surveys (1966, 1978, 1988 and 2012). Socio-economic factors involved: urbanisation level (city, town and village), family size (one child, two children, three children, four or more children), and father's and mother's education (lower and higher education).

SETTING

Regions in Poland - cities: Warsaw, Lodz and Wroclaw; towns: Bystrzyca Klodzka, Pinczow, Siemiatycze, Wolsztyn and their rural surroundings.

PARTICIPANTS

A total sample consisted of 63 757 children (31 774 boys and 31 983 girls) aged 7-18 years.

RESULTS

Between 1966 and 1988, both BMI and MUAC had significantly higher values in children from cities, in families with one child and with higher parental education (P < 0·05). However, MUAC revealed significant differences between particular socio-economic groups more frequently than BMI. In 2012, urbanisation level and parental education ceased to show a differentiating effect on both indicators, while family size remained a significant social factor for both measures (BMI: P < 0·05; MUAC: P < 0·01).

CONCLUSIONS

Since MUAC reflected socio-economic differences more frequently than BMI, it could be a more sensitive and reliable anthropometric measure revealing the effects of socio-economic factors on children's nutritional status.

Thinness and fecundability: Time to pregnancy after adolescent marriage in rural Bangladesh

Undernutrition may affect fecundability, but few studies have quantified this relationship. In rural Bangladesh, where newlywed couples face strong pressures to become pregnant, we assessed fecundability, estimated by time to pregnancy (TTP), and its association with preconceptional thinness among nulligravid, newlywed female adolescents. During 2001-2002, 5,516 newlywed women aged 12-19 years participated in a home-based, 5-weekly surveillance system for 5-6 years to enrol pregnant women into an antenatal vitamin A or β-carotene supplementation trial. Thinness was defined as a left mid-upper arm circumference (MUAC) ≤21.5 versus >21.5 cm. At each visit, staff obtained a monthly history of menstruation. Report of amenorrhea prompted a human chorionic gonadotropin urine test to confirm pregnancy. We derived hazard ratios (with 95% confidence intervals [CI]) for pregnancy and Kaplan-Meier curves for TTP. Ages of women at marriage and pregnancy detection (mean ± standard deviation) were 15.3 ± 1.9 and 17.0 ± 1.9 years, respectively. A total of 82.7% of thinner and 87.3% of better nourished women became pregnant. The unadjusted and multivariable relative hazard of ever becoming pregnant was 0.84 (95% CI [0.78, 0.89]) and 0.86 (95% CI [0.81, 0.92]), respectively, and TTP was 12 weeks longer (median [95% CI]: 63 [58-68] vs. 51 [49-54]) in women whose MUAC was ≤21.5 versus >21.5 cm. In rural Bangladesh, thin adolescent newlywed girls have a lower probability of becoming pregnant and experience a longer time to pregnancy.

Understanding menstrual characteristics from the perspective of reproductive energetics: a study on the adolescent Oraon tribal populations

The energetic costs of ovarian functions rely on the oxidizable fuels synthesized from carbohydrate, protein and fat that contribute to body’s fat storage. Energy deficient diet in association with low body fat may disrupt normal ovulatory function and lead to several menstrual irregularities. We examined the association of nutritional status with menstrual characteristics among a group of adolescent Oraon tribal population of West Bengal, India. We selected 301 adolescent girls, aged 10-19 years. Information on socio-demographic status, menstrual characteristics and assessment of the dietary intake and nutritional status were collected following standard protocol. ‘Healthy weight’ participants more likely reported irregularity in periods and skipping of menstrual cycle and shorter cycle length. Multivariate analysis revealed PBF has inverse association with PMS, duration of discharge and skipping of cycle (p<0.05); carbohydrate intake has direct association with duration of menstrual discharge (p<0.05); increased dietary fat intake has direct association with skipping of cycle, but not with BMI (p<0.05); increase in MUAC has direct association with dysmenorrhoea (p<0.05). Conclusion: Our study indicates energy deficiency does alter the menstrual characteristics of the Oraon adolescent girls.

Performance of mid-upper arm circumference as a screening tool for identifying adolescents with overweight and obesity

Background

Adolescent overweight and obesity is a global public health problem, associated with an increased risk of metabolic syndrome. Recently, mid-upper arm circumference (MUAC) has been suggested as a screening tool to identify overweight and obesity among school-age children and early adolescents (5–14 years). However, little is known about the potential use of MUAC in the late adolescence period (15–19 years). Therefore, the present study aimed to evaluate the performance of MUAC to identify overweight (including obesity) in the late adolescence period in Ethiopia.

Methods

We conducted a cross-sectional study among 851 adolescents aged 15 to 19 years. We collected anthropometric data including MUAC, weight and height with the help of trained field workers. The receiver operating characteristic (ROC) curve analysis was used to examine the validity of MUAC compared to BMI Z score in identifying adolescents with overweight or obesity. Furthermore, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), proportion of correctly classified, positive, and negative likelihood ratio for the proposed optimal cut-offs.

Results

MUAC was strongly correlated with BMI Z score with a correlation coefficient (r) of 0.81 (95% CI; 0.79–0.84). The optimal MUAC cut-off for identifying adolescents with overweight or obesity was 27.7 cm for males and 27.9 cm for females. The area under the ROC curve (AUC) was 0.96 (95% CI; 0.93–0.98) for males and 0.96 (95% CI; 0.94–0.98) for females. The accuracy level of MUAC to identify adolescents with overweight (including obesity) was high for both sexes (overall a sensitivity of 91.1% and a specificity of 90.3%).

Conclusions

MUAC has relatively equivalent accuracy with BMI Z score to identify overweight and obesity in adolescents. Hence, MUAC could be used as an alternative tool for surveillance and screening of overweight in adolescents aged 15–19 years.

Association between 9-minute walk/run test and obesity among children and adolescents: evidence for criterion-referenced cut-points

Background

Criterion-referenced cut-points for field-based aerobic fitness for children and adolescents are lacking. This study aimed to determine the associations between aerobic fitness and obesity to propose criterion-referenced cut-points for boys and girls (6–17 years).

Methods

A total of 61,465 children and adolescents aged 11.2 ± 2.0 years were recruited from 27 sites (all 26 states and Federal District) across Brazil. Aerobic fitness was assessed using 9-min walk/run test reported as distance attained during the test. Body mass index was calculated from measured height and weight and was used to identify obesity.

Results

The distance covered in the 9-min walk/run test (area under curve > 0.65) had satisfactory predictive ability for obesity. Sensitivity and specificity were moderate (>60%) to strong (>70%) for all age- and sex-specific cut-points. For boys, the optimal physical performance cut-points were, approximately, 1,200 m from 6 to 8 years, 1,300 m from 9 to 11 years, 1,380 m from 12 to 14 years, 1,520 m from 15 to 17 years. For girls, the best cut-points were, approximately, 1,070 m from 6 to 8 years, 1,160 m from 9 to 11 years and 1,200 m from 12 to 17 years.

Conclusions

The 9-min walk/run test had satisfactory predictive ability for obesity in children and adolescents. The physical fitness cut-points proposed in the present study varied according to age and sex and could be useful and practical tools to identify low levels of physical fitness in children and adolescents in Brazil.

Use of Mid-Upper Arm Circumference (MUAC) to Predict Malnutrition among Sri Lankan Schoolchildren

The double burden of malnutrition (under- and overnutrition) is a serious public health issue in childhood. The mid-upper arm circumference (MUAC) is a simple tool for screening nutritional status, but studies of the optimal cutoff to define malnutrition are limited. This study aimed to explore the prediction of malnutrition by MUAC in Sri Lankan schoolchildren. The participants were 538 students (202 boys, 336 girls) aged 5–10 years. Spearman’s rank correlation was calculated for MUAC and both body-mass-index-for-age z-score (BAZ) and height-for-age z-score (HAZ). Receiver operating characteristic (ROC) analysis was conducted to assess the ability of MUAC to correctly classify malnutrition, after stratifying for age and birth weight. MUAC correlated significantly with BAZ (r = 0.84) and HAZ (r = 0.35). The areas under the ROC curve for thinness, overweight, obesity, and stunting were 0.88, 0.97, 0.97, and 0.77, respectively. The optimal MUAC cutoff values for predicting thinness and stunting were 167.5 mm and 162.5 mm, respectively; the optimal cutoffs for predicting overweight and obesity were 190.5 mm and 218.0 mm, respectively. These cutoffs differed after stratification by age group and birth weight. Our results confirm MUAC to be a useful tool for monitoring growth in schoolchildren.

Double burden of malnutrition among Indian schoolchildren and its measurement: a cross-sectional study in a single school

OBJECTIVE

This cross-sectional study set in a single school on the outskirts of a large city aimed to document the extent of double burden of malnutrition (coexistence of overnutrition and undernutrition) among Indian schoolchildren from lower socioeconomic groups, and to determine if mid-upper arm circumference (MUAC) can be used as a proxy for body mass index (BMI).

SUBJECTS

The total number of participants was 1444, comprising 424 girls and 1020 boys belonging to playgroups and grades 1 to 7.

MEASUREMENTS

Anthropometric measurements, such as participants' MUAC, height and weight were measured using standard techniques. Descriptive statistics for BMI and MUAC were obtained based on gender; z-scores were computed using age-specific and sex-specific WHO reference data. The distribution of variables was calculated for three groups: girls, boys and all participants. Homogeneous subsets for BMI and MUAC were identified in the three groups. Age-wise comparisons of BMI and MUAC were conducted for each gender.

MAIN OUTCOME MEASURES

(1) To know if MUAC and BMI are correlated among boys and girls. (2) To study BMI and MUAC z-score distribution among the participants.

RESULTS

MUAC was positively correlated with BMI in both boys and girls. The following BMI z-score distribution was observed: severe acute malnutrition (SAM), 5 (0.3%); moderate acute malnutrition (MAM), 146 (10.1%) and undernourished, at risk of MAM/SAM, 141 (9.8%); obese, 21 (1.5%); overweight, 36 (2.5%) and pre-obese, 136 (9.4%). The distribution of categories of children based on MUAC z-scores was: SAM, 7 (0.5%); MAM, 181 (12.5%) and undernourished, at risk of MAM/SAM, 181 (12.5%); obese, 19 (1.3%); overweight, 178 (12.3%) and pre-obese, 135 (9.3%).

CONCLUSIONS

SAM/MAM/undernourished states and obesity/overweight/pre-obese states, indicating undernutrition more than overweight, coexist among Indian schoolchildren from lower middle/lower socioeconomic categories. BMI and MUAC were significantly correlated. MUAC identifies both undernutrition and overnutrition by early detection of aberrant growth.

Do Gestational Obesity and Gestational Diabetes Have an Independent Effect on Neonatal Adiposity? Results of Mediation Analysis from a Cohort Study in South India

Purpose

Neonates born to mothers with obesity or gestational diabetes mellitus (GDM) have an increased chance of various metabolic disorders later in life. In India, it is unclear whether maternal obesity or GDM is related to offspring adiposity. We aimed to understand the independent effect of maternal obesity and GDM with neonatal adiposity and whether GDM has a mediating effect between maternal obesity and neonatal adiposity.

Methods

We recruited a cohort of 1120 women (between April 2016 and February 2019) from the public hospitals in Bangalore, India, who voluntarily agreed to participate and provided written informed consent. The primary outcome was neonatal adiposity, defined as the sum of skinfold thickness >85^th percentile. Exposure included maternal obesity, defined as >90^th percentile of skinfold thickness. GDM, the potential mediator, was classified using the World Health Organization criteria by oral glucose tolerance test. Binary logistic regression was applied to test the effect of maternal obesity and GDM on neonatal adiposity, adjusting for potential confounders. We used Paramed command in STATA version 14 for analyzing mediating effects.

Results

We found that maternal obesity (odds ratio (OR)=2.16, 95% CI 1.46, 3.18) and GDM (OR=2.21, 95% CI1.38, 3.52) have an independent effect on neonatal adiposity. GDM significantly mediates 25.2% of the total effect between maternal obesity and neonatal adiposity, (natural direct effect OR = 1.16 95% CI 1.04, 1.30) with significant direct effect of maternal obesity (natural direct effect OR = 1.90 95% CI 1.16, 3.10) and significant total effect (OR=2.20 95% CI 1.35, 3.58).

Conclusion

We showed that maternal obesity and GDM are independently associated with offspring adiposity. Also, GDM mediates the association of maternal obesity on adiposity in children. Interventions focused on obesity prevention in women, and effective screening and management of GDM may contribute to reducing childhood obesity in India.

Nutritional status among young adolescents attending primary school in Tanzania: contributions of mid-upper arm circumference (MUAC) for adolescent assessment

Background

Adolescence is a critical time of development and nutritional status in adolescence influences both current and future adult health outcomes. However, data on adolescent nutritional status is limited in low-resource settings. Mid-upper arm circumference (MUAC) has the potential to offer a simple, low-resource alternative or supplement to body mass index (BMI) in assessing nutrition in adolescent populations.

Methods

This is secondary data analysis, from a cross-sectional pilot study, which analyses anthropometric data from a sample of young adolescents attending their last year of primary school in Pwani Region and Dar es Salaam Region, Tanzania (n = 154; 92 girls & 62 boys; mean age 13.2 years).

Results

The majority of adolescents (75%) were of normal nutritional status defined by BMI. Significantly more males were stunted than females, while significantly more females were overweight than males. Among those identified as outside the normal nutrition ranges, there was inconsistency between MUAC and BMI cut-offs. Bivariate analyses indicate that BMI and MUAC show a positive correlation for both female and male participants, and the relationship between BMI and MUAC was more strongly correlated among adolescent females.

Conclusions

Further studies are needed with more nutritionally and demographically diverse populations to better understand the nutritional status of adolescents and the practical contribution of MUAC cut-offs to measure adolescent nutrition.

Determination of overnutrition using mid-upper arm circumference in comparison with bioelectrical impedance analysis in children and adolescents in Benin, Nigeria

Purpose

The prevalence of overweight and obesity in children and adolescents is on the increase in developing countries. Therefore, a cheap, accessible and simple screening tool such as the mid-upper arm circumference (MUAC) is required for the prompt assessment. The purpose of this paper is to determine the usefulness of MUAC in assessing overnutrition in comparison with bioelectrical impedance analysis (BIA).

Design/methodology/approach

Participants included 1,067 children aged 6–18 years recruited from private and public schools in Egor Local Government Area in Benin City, Nigeria. Body fat was estimated by BIA using a Tanita scale, whereas the MUAC was measured with a non-elastic tape. Receiver operating characteristic analysis was used to test the ability of MUAC to determine children and adolescents identified as overweight and obese by BIA.

Findings

The prevalence of overnutrition by MUAC (12.4 percent – overweight 6.0 percent and obesity 6.4 percent) was comparable to that by BIA (12.3 percent – overweight 5.4 percent, obesity 6.9 percent). There was a significant correlation between MUAC and body fat percentage, fat mass, fat mass index and fat-free mass index in both males and females (p=0.000).

Research limitations/implications

This study, in contrast to most other studies on the use of MUAC in the assessment of overnutrition, has the advantage of using BIA cut-offs values against body mass index which does not assess body fat composition. BIA is, however, not the gold standard in the measurement of body fat composition. The optimal MUAC cut-off values of this study may not be representative of the entire country because of its restriction to Benin. Similar studies from different parts of Nigeria will be required to validate this smoothed MUAC percentiles for use in the screening of children and adolescents for overnutrition.

Originality/value

MUAC compares well with BIA in this study and can be a useful, alternative and practical screening tool for assessing obesity in the resource-poor setting.

Mid-upper arm circumference and body mass index as different screening tools of nutritional and weight status in Polish schoolchildren across socio-political changes

Intergenerational changes in many biological traits are indicators of environmental conditions. One of such anthropometric measures is the mid-upper arm circumference (MUAC) which estimates nutritional status. Likewise, Body Mass Index (BMI) is widely used as an anthropometric indicator of relative weight. The aim of this study was to reveal secular trends in MUAC and BMI, as biological indicators of changing living conditions, between 1966 and 2012 among Polish children from different socioeconomic groups. Total sample involved 64 393 schoolchildren aged 7–18 years, investigated in 4 Surveys (1966, 1978, 1988, 2012). Overall socioeconomic status (SES) was divided into two categories: lower and higher (including: urbanization, family size, parental education). Results showed that MUAC and BMI differed significantly with respect to the year of survey, sex and SES category. Both measures were higher within higher SES group compared to the lower one until 1988, while in 2012 convergence of these indicators in both SES categories was observed. Both the year of survey, sex, SES category and interactions between them had higher impact on MUAC than BMI (measured by effect size). Our findings revealed that long-term socioeconomic changes affect MUAC more noticeably than BMI. Therefore MUAC may be a more accurate screening tool.

Is mid-upper arm circumference in Dutch children useful in identifying obesity?

BACKGROUND

Mid-upper arm circumference (MUAC) is suggested as being a valid measure in detecting overweight/obesity in children and adolescents, due to the strong relation with weight. We examined this relation and compared MUAC to body mass index (BMI) according to the International Obesity Task Force (IOTF) in children.

METHODS

Anthropometric data including MUAC were collected in 2009 by trained healthcare professionals in the context of the fifth Dutch Nationwide Growth Study, in a sample of 6167 children (2891 boys and 3276 girls) aged 2-18 years of Dutch origin. We propose MUAC SDS cut-off values for overweight and obesity, and compared MUAC with BMI IOTF in sex-specific and age-specific categories (2-5, 6-11, 12-18 years).

RESULTS

The area under the curve is used as a measure of diagnostic accuracy; the explained variance (R²) is good to excellent (0.88-0.94). Sensitivity ranges from 51.8% to 95.3% and specificity from 71.4% to 93.8%. Across age and gender groups, 65.1% to 89.0% participants are classified by both MUAC and BMI as normal weight, overweight or obese. We constructed three equations to predict weight using MUAC, with small differences between observed and predicted weight with an explained variance ranging from 0.88 to 0.94.

CONCLUSIONS

Compared with BMI, MUAC is a valid measure for detecting overweight and obesity and thus a good alternative for BMI. When weight has to be estimated, it can be accurately predicted using MUAC. Based on our observations, we recommend developing diagrams with international (IOTF) cut-offs for MUAC SDS similar to BMI.

Fat-to-Muscle Ratio: A New Anthropometric Indicator as a Screening Tool for Metabolic Syndrome in Young Colombian People

Fat-to-muscle ratio has been proposed as an alternative approach for assessing body fat. The objective of this study was to explore fat-to-muscle ratio thresholds in metabolic syndrome (MetS) diagnosis; it was hypothesised that the fat-to-muscle ratio is a good predictive indicator of MetS in a large population of young Colombian adults. For this purpose, a cross-sectional study was conducted on 1416 subjects (66.6% female), aged from 18.1 to 25.1. As part of the study, measurements of the subjects’ anthropometric indicators, serum lipid indices, blood pressure, and fasting plasma glucose were taken. Body composition was measured through bioelectrical impedance analysis (BIA). A new variable (ratio of fat mass to muscle mass, in kg) was calculated. Following the International Diabetes Federation (IDF) definition, MetS includes three or more metabolic abnormalities. Receiver operating characteristic (ROC) curves and logistic regression determined the discriminatory ability of the fat-to-muscle ratio to predict MetS. According to the IDF, the best fat-to-muscle ratio cut-off point for detecting MetS in men was 0.225 kg, with an area under the curve (AUC) of 0.83, sensitivity of 80%, and specificity of 70%. For women, the fat-to-muscle ratio cut-off point was 0.495 kg, the AUC was 0.88, and the sensitivity and specificity were 82% and 80%, respectively. In conclusion, our results showed that the fat-to-muscle ratio cut-off points from ROC analyses demonstrate good discriminatory power for detecting MetS in young Colombian adults.

Cardiorespiratory fitness in children: Evidence for criterion-referenced cut-points

INTRODUCTION

Criterion-referenced cut-points for field-based cardiorespiratory fitness for children (CRF) are lacking. This study determined: (a) the association between CRF and obesity, (b) the optimal cut-points for low CRF associated with obesity in children, and (c) the association between obesity and peak oxygen uptake ([Formula: see text]) estimated from the 20-m shuttle run test using two different prediction equations.

METHODS

A total of 8,740 children aged 10.1±1.2 were recruited from 11 sites across Canada. CRF was assessed using 20mSRT reported as running speed at the last completed stage, number of completed laps and predicted [Formula: see text], which was estimated at the age by sex level using the Léger et al. and FitnessGram equations. Body mass index and waist circumference z-scores were used to identify obesity. Receiver operating characteristic (ROC) curves and logistic regression determined the discriminatory ability of CRF for predicting obesity.

RESULTS

20mSRT had satisfactory predictive ability to detect obesity estimated by BMI, WC, and BMI and WC combined (area under the curve [AUC]>0.65). The FitnessGram equation (AUC>0.71) presented somewhat higher discriminatory power for obesity than the equation of Léger et al. (AUC>0.67) at most ages. Sensitivity was strong (>70%) for all age- and sex-specific cut-points, with optimal cut-points in 8- to 12-year-olds for obesity identified as 39 mL•kg-1•min-1 (laps: 15; speed: 9.0 km/h) and 41 mL•kg-1•min-1 (laps: 15-17; speed: 9.0 km/h) for girls and boys, respectively.

CONCLUSIONS

20mSRT performance is negatively associated with obesity and CRF cut-points from ROC analyses have good discriminatory power for obesity.

Thresholds of physical activity associated with obesity by level of sedentary behaviour in children

BACKGROUND

It is unknown whether moderate-to-vigorous physical activity (MVPA) thresholds for obesity should be adapted depending on level of sedentary behaviour in children.

OBJECTIVE

The objective of the study is to determine the MVPA thresholds that best discriminate between obese and non-obese children, by level of screen time and total sedentary time in 12 countries.

METHODS

This multinational, cross-sectional study included 6522 children 9-11 years of age. MVPA and sedentary time were assessed using waist-worn accelerometry, while screen time was self-reported. Obesity was defined according to the World Health Organization reference data.

RESULTS

Receiver operating characteristic curve analyses showed that the best thresholds of MVPA to predict obesity ranged from 53.8 to 73.9 min d^-1 in boys and from 41.7 to 58.7 min d^-1 in girls, depending on the level of screen time. The MVPA cut-offs to predict obesity ranged from 37.9 to 75.9 min d^-1 in boys and from 32.5 to 62.7 min d^-1 in girls, depending on the level of sedentary behaviour. The areas under the curve ranged from 0.57 to 0.73 ('fail' to 'fair' accuracy), and most sensitivity and specificity values were below 85%, similar to MVPA alone. Country-specific analyses provided similar findings.

CONCLUSIONS

The addition of sedentary behaviour levels to MVPA did not result in a better predictive ability to classify children as obese/non-obese compared with MVPA alone.

Mid-upper-arm circumference as a screening measure for identifying children with elevated body mass index: a study for Pakistan

Purpose

Mid-upper-arm circumference (MUAC) is considered an alternative screening method for obesity. The aims of this investigation were to examine the ability of MUAC to correctly identify children with elevated body mass index (BMI) and to determine the best MUAC cutoff point for identification of children with high BMI.

Methods

Anthropometric measurements (height, weight, and MUAC) from a cross-sectional sample of 7,921 Pakistani children aged 5–14 years were analyzed. Pearson correlation coefficients between MUAC and other anthropometric measurements were calculated. Receiver operating characteristic curve analysis was used to determine the optimal MUAC cutoff point for identifying children with high BMI.

Results

Among 7,921 children, the mean (±standard deviation) age, BMI, and MUAC were 10.00 (±2.86 years), 16.16 (±2.66 kg/m²), and 17.73 (±2.59 cm), respectively. The MUAC had a strong positive correlation with BMI. The optimal MUAC cutoff points indicating elevated BMI in boys ranged from 16.76 to 22.73, while the corresponding values in girls ranged from 16.38 to 20.57.

Conclusion

MUAC may be used as a simple indicator of overweight/obesity in children, with reasonable accuracy in clinical settings.

Arm Circumference-to-Height Ratio as a Situational Alternative to BMI Percentile in Assessing Obesity and Cardiometabolic Risk in Adolescents

OBJECTIVE

To determine whether arm circumference-to-height ratio (AHtR) predicts adolescents' cardiometabolic risk and how its predictive statistics compare to those of body mass index (BMI) percentile.

METHODS

Pooled data for adolescents (N = 12,269, 12-18 years) from the National Health and Nutrition Examination Survey, U.S., 1999-2014, were analyzed. For each of the eight cardiometabolic variables, borderline-risk and high-risk were considered unhealthy, and being unhealthy on any variable was considered "unhealthy overall" in terms of cardiometabolic risk. Area under the curve and R ² were used to compare BMI percentile and AHtR for accuracy in predicting risk.

RESULTS

Female AHtR ≥ 0.19 and BMI percentile ≥ 94 and male AHtR ≥ 0.16 and BMI percentile ≥ 64 predicted a probability of >0.7 being unhealthy overall. AHtR predicted overall risk and unhealthy levels of six variables more accurately than BMI percentile. Significant differences were overall risk (χ ² = 4.18; p=0.041), total cholesterol (χ ² = 8.68; p=0.003), glycated hemoglobin (χ ² = 5.24; p=0.022), and systolic pressure (χ ² = 5.10; p=0.024). AHtR had higher accuracy in predicting high-density cholesterol, fasting glucose, glycated hemoglobin, and systolic/diastolic pressures plus higher specificity in predicting all variables except triglycerides. BMI percentile had higher sensitivity for all variables. Sensitivity and accuracy were higher for males. No significant race/ethnicity differences were observed.

CONCLUSIONS

Without needing adjustment for age and weight, AHtR can predict some cardiometabolic risk factors of adolescents, especially of males, more accurately than BMI percentile, thus facilitating population risk estimation and early interventions. Further research is required to validate these findings in younger children.

Mid-Upper-Arm Circumference and Arm-to-Height Ratio to Identify Obesity in School-Age Children

BACKGROUND

In resource-poor settings, anthropometric parameters are evaluated as potential alternatives to the body mass index (BMI) for detecting overweight and obesity in children. To this end, the mid-upper-arm circumference (MUAC) and the mid-upper-arm circumference-to-height ratio (AHtR) were evaluated as proxies to BMI in Thai school-age children.

STUDY DESIGN

An observational, cross-sectional study was performed on school-aged children.

PARTICIPANTS

Children in grades 1 through 6 at all public elementary schools in the Ongkharak district, Nakhon Nayok, Thailand during May and June 2013 were included. This is a rural district with low per capita income.

METHODS

Weight, height, and MUAC were measured in school-age children and analyzed to identify optimal cut-off values for MUAC and AHtR for detection of overweight and obesity in comparison to BMI. Receiver operating characteristic (ROC) curve analysis determined the validity of MUAC and AHtR use.

RESULTS

Data from 3,618 children, aged 6.0-12.99 years, were analyzed. MUAC correlated with age and height (P < 0.001), but especially with body weight (r = 0.888 to 0.914) and BMI (r = 0.859 to 0.908) in both genders, while AHtR correlated with body weight and BMI (P < 0.001), but not with age. Cut-off values of MUAC for obesity diagnosis ranged from 18.9 to 25.5 cm for boys and from 19.8 to 25.4 cm for girls. Accuracy was excellent for both boys (AUC = 0.952-0.991) and girls (AUC = 0.917-0.990). Cut-off of MUAC for overweight diagnosis ranged from 17.2 to 22.4 cm for boys (AUC = 0.883-0.965) and from 18.0 to 23.2 cm for girls (AUC = 0.905-0.931). AHtR cut-off values for obesity and overweight diagnosis at 0.16 and 0.145, respectively, were determined with excellent diagnostic accuracy (AUC ranged from 0.920 to 0.975).

CONCLUSION

MUAC and AHtR were reliable tools to detect overweight and obesity in Thai school-age children. Cut-off points for MUAC were age and gender specific, while AHtR at 0.16 and 0.145 were the optimal values for both genders, independent of age. These anthropometric measurements showed excellent accuracy in predicting overweight and obesity with high specificity and sensitivity.

Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study

BACKGROUND

No studies have examined if mid-upper arm circumference (MUAC) can be an alternative screening tool for obesity in an international sample of children differing widely in levels of human development.

OBJECTIVE

Our aim is to determine whether MUAC could be used to identify obesity in children from 12 countries in five major geographic regions of the world.

METHODS

This observational, multinational cross-sectional study included 7337 children aged 9-11 years. Anthropometric measurements were objectively assessed, and obesity was defined according to the World Health Organization reference data.

RESULTS

In the total sample, MUAC was strongly correlated with adiposity indicators in both boys and girls (r > 0.86, p < 0.001). The accuracy level of MUAC for identifying obesity was high in both sexes and across study sites (overall area under the curve of 0.97, sensitivity of 95% and specificity of 90%). The MUAC cut-off value to identify obesity was ~25 cm for both boys and girls. In country-specific analyses, the cut-off value to identify obesity ranged from 23.2 cm (boys in South Africa) to 26.2 cm (girls in the UK).

CONCLUSIONS

Results from this 12-country study suggest that MUAC is a simple and accurate measurement that may be used to identify obesity in children aged 9-11 years. MUAC may be a promising screening tool for obesity in resource-limited settings.

Association between Blood Pressure and Birth Weight among Rural South African Children: Ellisras Longitudinal Study

The aim of this cross-sectional study was to investigate the association between birth weight, underweight, and blood pressure (BP) among Ellisras rural children aged between 5 and 15 years. Data were collected from 528 respondents who participated in the Ellisras Longitudinal Study (ELS) and had their birth weight recorded on their health clinic card. Standard procedure was used to measure the anthropometric measurements and BP. Linear regression was used to assess BP, underweight variables, and birth weight. Logistic regression was used to assess the association of hypertension risks, low birth weight, and underweight. The association between birth weight and BP was not statistically significant. There was a significant (p < 0.05) association between mean BP and the sum of four skinfolds (β = 0.26, 95% CI 0.15-0.23) even after adjusting for age (β = 0.18, 95% CI 0.01-0.22). Hypertension was significantly associated with weight for age z-scores (OR = 5.13, 95% CI 1.89-13.92) even after adjusting for age and sex (OR = 5.26, 95% CI 1.93-14.34). BP was significantly associated with the sum of four skinfolds, but not birth weight. Hypertension was significantly associated with underweight. Longitudinal studies should confirm whether the changes in body weight we found can influence the risk of cardiovascular diseases.

A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study

Objectives To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality.Design Growth curve construction and longitudinal cohort study.Setting United States and international growth data, and cohorts in Kenya, Uganda, and Zimbabwe.Participants The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES) US population datasets (age 5-25 years), which were used to construct the 2007 WHO growth reference for body mass index in this age group, were merged with an imputed dataset matching the distribution of the WHO 2006 growth standards age 2-6 years. Validation data were from 685 HIV infected children aged 5-17 years participating in the Antiretroviral Research for Watoto (ARROW) trial in Uganda and Zimbabwe; and 1741 children aged 5-13 years discharged from a rural Kenyan hospital (3.8% HIV infected). Both cohorts were followed-up for survival during one year.Main outcome measures Concordance with WHO 2006 growth standards at age 60 months and survival during one year according to MUAC-for-age and body mass index-for-age z scores.Results The new growth curves transitioned smoothly with WHO growth standards at age 5 years. MUAC-for-age z scores of -2 to -3 and less than-3, compared with -2 or more, was associated with hazard ratios for death within one year of 3.63 (95% confidence interval 0.90 to 14.7; P=0.07) and 11.1 (3.40 to 36.0; P<0.001), respectively, among ARROW trial participants; and 2.22 (1.01 to 4.9; P=0.04) and 5.15 (2.49 to 10.7; P<0.001), respectively, among Kenyan children after discharge from hospital. The AUCs for MUAC-for-age and body mass index-for-age z scores for discriminating subsequent mortality were 0.81 (95% confidence interval 0.70 to 0.92) and 0.75 (0.63 to 0.86) in the ARROW trial (absolute difference 0.06, 95% confidence interval -0.032 to 0.16; P=0.2) and 0.73 (0.65 to 0.80) and 0.58 (0.49 to 0.67), respectively, in Kenya (absolute difference in AUC 0.15, 0.07 to 0.23; P=0.0002).Conclusions The MUAC-for-age z score is at least as effective as the body mass index-for-age z score for assessing mortality risks associated with undernutrition among African school aged children and adolescents. MUAC can provide simplified screening and diagnosis within nutrition and HIV programmes, and in research.

Role of Mid-Upper Arm Circumference for Determining Overweight and Obesity in Children and Adolescents

INTRODUCTION

The prevalence of obesity in adolescents and children has risen to alarming levels globally and this has led to serious public health consequences.

AIM

To assess the use of Mid-Upper Arm Circumference (MUAC) in the identification of overweight and obesity in North Indian children and adolescents.

MATERIALS AND METHODS

The study was conducted in Bareilly district of Uttar Pradesh, India, from October 2014 to November 2015. Anthropometric data (weight, height and MUAC) was collected from a cross-sectional sample of 875 children aged 5-14 year old. Receiver Operating Characteristic (ROC) curve analysis determined the validity of MUAC as a proxy for determining overweight and obesity.

RESULTS

Area Under the Curve (AUC) results were generally high (0.92 - 0.98). The accuracy level of MUAC for identifying obesity was high in both sexes and across age groups (overall AUC of 0.95, sensitivity of 95% and specificity of 90%). The MUAC cut-off to identify BMI defined obesity was 18.8 cm and 19.4 cm for boys and girls of 5-9 age group; 23 cm and 23.3 cm for boys and girls of 10-14 age group.

CONCLUSION

MUAC may have potential for clinical and surveillance applications as an accurate yet simple and widely available indicator of overweight and obesity in children and adolescents in resourcepoor settings.

A simple equation to estimate body fat percentage in children with overweightness or obesity: a retrospective study

Background

Dual-energy X-ray absorptiometry (DXA) provides separate measurements of fat mass, fat-free mass and bone mass, and is a quick, accurate, and safe technique, yet one that is not readily available in routine clinical practice. Consequently, we aimed to develop statistical formulas to predict fat mass (%) and fat mass index (FMI) with simple parameters (age, sex, weight and height).

Methods

We conducted a retrospective observational cross-sectional study in 416 overweight or obese patients aged 4–18 years that involved assessing adiposity by DXA (fat mass percentage and FMI), body mass index (BMI), sex and age. We randomly divided the sample into two parts (construction and validation). In the construction sample, we developed formulas to predict fat mass and FMI using linear multiple regression models. The formulas were validated in the other sample, calculating the intraclass correlation coefficient via bootstrapping.

Results

The fat mass percentage formula had a coefficient of determination of 0.65. This value was 0.86 for FMI. In the validation, the constructed formulas had an intraclass correlation coefficient of 0.77 for fat mass percentage and 0.92 for FMI.

Conclusions

Our predictive formulas accurately predicted fat mass and FMI with simple parameters (BMI, sex and age) in children with overweight and obesity. The proposed methodology could be applied in other fields. Further studies are needed to externally validate these formulas.

Outcome of nutritional screening in the acute paediatric setting

INTRODUCTION

Multiple nutritional risk assessment tools are available, but there are limited data on their application in the acute setting. We explored the validity of two tools in a tertiary Children's Hospital's acute unit and the cohort's nutritional status using WHO definitions.

METHODS

Prospective study n=300 (median 38 months; 44.6% female; 25.7% ≤12 months). Participants had standard anthropometry measured, all were screened using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), the Paediatric Malnutrition Screening Tool (PMST) (modified STAMP) and 125 were additionally screened using the Paediatric Yorkhill Malnutrition Screening (PYMS) tool.

RESULTS

The percentages with medium/high nutritional risk were as follows: STAMP 73.1%, PMST 79.3% and PYMS 30%. Height/weight were normally distributed with: 3.4% stunted (height-for-age z-score <-2); aged ≤ 5 years, 6.8% wasted (weight-for-height z-score (WHZ) <-2), 17.9% overweight (WHZ 1-2) and 6.2% obese (WHZ >2); aged >5 years, 5.8% thin (body mass index (BMI)-z-score (BAZ) <-2), 17.3% overweight (BAZ 1-2) and 5.8% obese (BAZ >2). The tools showed poor specificity and variable sensitivities when compared with WHO malnutrition criteria, with positive predictive values of <50%. κ-Analysis also showed poor agreement between the tools and the WHO cut-offs.

CONCLUSION

These results suggest that nutritional screening tools have poor sensitivity and are difficult to interpret in the acute setting. It may be more effective to include the assessment of weight and height and nutritional intake in the context of the acute presentation as part of routine clinical assessment rather than relying on screening tools to identify those at risk.

Evaluation of the relative accuracy of anthropometric indicators to assess body fatness as measured by air displacement plethysmography in Indian women

OBJECTIVE

To assess the relative accuracy of anthropometric indicators of body fatness or adiposity as compared to the percent fat measured by air displacement plethysmography in Indian women with normal body mass index (BMI).

METHODS

Percent body fat was assessed using the BodPod in 58 women, aged 30-56 years. The relative accuracy of anthropometric indicators of body fatness like BMI, waist-stature-ratio (WSR), waist-thigh-ratio (WTR), waist-hip-ratio (WHR), and circumferences at arm, neck, chest, waist, hip, and thigh were tested using an ROC curve analysis.

RESULTS

Seventy-nine percent women had excess body fat (≥30%). Among the 10 indicators tested, BMI and arm circumference (AC) demonstrated high accuracy (AUC > 0.9) to assess body fatness with derived cutoffs of 21.2 kg/m(2) and 24.2 cm, respectively. WSR and circumferences at neck, chest, waist, hip, and thigh showed moderate accuracy to assess body fatness, whereas WHR and WTR demonstrated poor accuracy.

CONCLUSIONS

BMI and AC were the best performing indicators of adiposity among the indicators studied. AC, being a single measurement, is practical and a good choice. Am. J. Hum. Biol. 28:743-745, 2016. © 2016 Wiley Periodicals, Inc.

The role of TGF-β1 869 T > C and PPAR γ2 34 C > G polymorphisms, fat mass, and anthropometric characteristics in predicting childhood obesity at birth: A cross-sectional study according the parental characteristics and newborn's risk for child obesity (the newborns obesity's risk) NOR study

This study proposed to establish a correlation between the risk score for child obesity and anthropometric, genetic, and bioimpedance characteristics in mothers and newborns, and to assess the discriminant ability for anthropometric parameters to classify over-fatness (defined by bioimpedance body fatness %) in pregnant women.We performed a cross-sectional study on 388 couples (mother and father) and their newborns admitted in a Tertiary Hospital from Romania. The measured parameters for mothers and their newborns were risk percentage for child obesity, anthropometric characteristics (mid-upper arm circumference [MUAC], tricipital skinfold thickness [TST] of mother and newborn), genetic polymorphisms (human peroxisome proliferator-activated receptor γ [PPARγ2] 34 C > G and transforming growth factor-beta 1 [TGF-β1] 869 T > C gene polymorphisms in both mothers and newborns), and mother's bioimpedance characteristics (fat mass [FM] %).The obesity risk score according to standard predictable Northern Finland Birth Cohort equation was in our study 4.07%. We found a monotone positive significant correlation between the newborn's risk of childhood obesity and the mother's TST (P = 0.01), as well as a tendency toward statistical significance concerning correlation with mother's MUAC (P = 0.053), without any correlations with the mothers' bioimpedance parameters and also a positive correlation between the newborn's risk of childhood obesity and the newborn's anthropometrical characteristics like body mass index (BMI), MUAC, and TST (P < 0.001). We observed that the calculated newborn's risk percentage for child obesity was greater for the variant allele of the TGF-β1 869 T > C polymorphism and also for the wild-type C allele of the PPARγ2 34 C > G gene polymorphism. Our study indicated that the best predictors for over-fatness are BMI and MUAC (P = 0.01 < 0.02 and P = 0.019 < 0.02, respectively).