Mid-upper-arm-circumference and mid-upper-arm circumference z-score: the best predictor of mortality?

Eur J Clin Nutr. 2012 Sep;66(9):998-1003. doi: 10.1038/ejcn.2012.95. Epub 2012 Jul 18.


Background/objective: Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify children with high short-term mortality risk in Guinea-Bissau.

Subjects/methods: The Bandim Health Project visits children 3-monthly until 3 years of age. MUAC is measured and deaths are registered. We studied a high-mortality cohort of children born in 1995-96 and a lower mortality cohort of children born in 2005-06. The prognostic ability of MUAC and MUAC z-score to predict mortality within 1 and 3 months after the MUAC assessment were compared by area under the receiver operating characteristic curve, sensitivity and positive predictive value.

Results: Compared with MUAC z-score, MUAC identified as malnourished more girls than boys (prevalence ratio (PR)=1.74 (1.52;2.01)) and more children aged 6-11 months than children aged 12-35 months (1.59 (1.38;1.82)). There was no difference in the prognostic ability of MUAC and MUAC z-score to predict mortality for children aged 6-35 months. The prognostic ability was higher when mortality was lower. MUAC performed well in the youngest infants.

Conclusion: In the age group 6-35 months, MUAC and MUAC z-score had the same prognostic ability to predict short-term mortality. As MUAC is easier to use in field settings, there is no need to use MUAC z-score to identify children with a high-mortality risk.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Area Under Curve
  • Arm / anatomy & histology*
  • Child Mortality*
  • Child, Preschool
  • Cohort Studies
  • Female
  • Guinea-Bissau
  • Humans
  • Infant
  • Male
  • Nutritional Status / physiology*
  • Predictive Value of Tests
  • ROC Curve
  • Sensitivity and Specificity