title: Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia.
abstract: BACKGROUND
  Early identification of children <5 yrs with acute malnutrition is a priority. Acute malnutrition is defined by the World Health Organization as a mid-upper-arm circumference (MUAC) <12.5 cm or a weight-for-height Z-score (WHZ) <-2. MUAC is a simple and low-cost indicator to screen for acute malnutrition in communities, but MUAC cut-offs currently recommended by WHO do not identify the majority of children with weight-for-height Z-score (<-2 (moderate malnourished) or r<-3 (severe malnourished). Also, no cut-offs for MUAC are established for children >5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition.
  
  
  METHODS
  To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011-2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children <5yrs and thinness for children ≥5yrs as gold standards. Among the highest values of AUC, the cut-off with the highest sensitivity and a false positive rate ≤33% was selected as the optimal cut-off.
  
  
  RESULTS
  Optimal cut-off values increased with age. Boys had higher cut-offs than girls, except in the 8-10.9 yrs age range. In children <2yrs, the cut-off was lower for stunted children compared to non stunted children. Sensitivity of MUAC to identify WHZ<-2 and <-3 z-scores increased from 24.3% and 8.1% to >80% with the new cut-offs in comparison with the current WHO cut-offs.
  
  
  CONCLUSIONS
  Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level.
authors: Institut de Recherche pour le Developpement, UMR 204, IRD/Montpellier1/Montpellier2/SupAgro (Nutripass), Montpellier, France.
authors: Marion
authors: M
authors: Fiorentino
authors: National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia.
authors: Prak
authors: P
authors: Sophonneary
authors: UNICEF, Maternal Child Health and Nutrition section, Phnom Penh, Cambodia.
authors: Arnaud
authors: A
authors: Laillou
authors: World Food Program, Phnom Penh, Cambodia.
authors: Sophie
authors: S
authors: Whitney
authors: Independent consultant, Phnom Penh, Cambodia.
authors: Richard
authors: R
authors: de Groot
authors: Institut de Recherche pour le Developpement, UMR 204, IRD/Montpellier1/Montpellier2/SupAgro (Nutripass), Montpellier, France.
authors: Marlène
authors: M
authors: Perignon
authors: Ministry of Agriculture, Forestry and Fisheries, FiA Administration DFPTQ, Phnom Penh, Cambodia.
authors: Khov
authors: K
authors: Kuong
authors: Institut de Recherche pour le Developpement, UMR 204, IRD/Montpellier1/Montpellier2/SupAgro (Nutripass), Montpellier, France.
authors: Jacques
authors: J
authors: Berger
authors: Institut de Recherche pour le Developpement, UMR 204, IRD/Montpellier1/Montpellier2/SupAgro (Nutripass), Montpellier, France.
authors: Frank T
authors: FT
authors: Wieringa
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001132:Arm / Q000033:anatomy & histology; D001827:Body Height; D001835:Body Weight; D002160:Cambodia; D002648:Child; D015362:Child Nutrition Disorders / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods; D009749:Nutrition Surveys; D012016:Reference Values; D012680:Sensitivity and Specificity; D000067011:Severe Acute Malnutrition / Q000175:diagnosis*; D012737:Sex Factors