Mid Upper Arm Circumference reference curve for mortality in adolescents--need for more validation
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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
Mid Upper Arm Circumference reference curve for mortality in adolescents--need for more validation
The authors have made a good start in constructing curves for MUAC for age, boys and girls separately for -19 years. This will make it easier to classify nutritional status by primary health care workers at the community level. They have taken the references values based on the US national surveys -- viz. The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES), US population datasets (age 5-25 years) -- which were used for 2007 World Health Organization growth reference for BMI. The findings suggest the sensitivity for death at cut off less than -2 z scores as 72% (95% confidence interval: 57% to 84%) for MUAC –for –age z score. The sensitivity seems to be on the lower side for correlation with mortality, probably due to lesser number of deaths. Further, the validation study done on HIV infected children might not actually reflect the children in the general population and this might not be representative for children at large. The findings need more validation studies with children of varied malnourished states/grades and that too in different populations including South Asia.
Competing interests:
No competing interests
08 August 2017
Mongjam Meghachandra Singh
Director-Professor
Reeta Devi
Department of Community Medicine, Maulana Azad Medical College, New Delhi & co-author: School of Health Sciences, Indira Gandhi National Open University, New Delhi (India)
Department of Community Medicine, Maulana Azad Medical College, New Delhi & co-author: School of Health Sciences, IGNOU, New Delhi (India)
Rapid Response:
Mid Upper Arm Circumference reference curve for mortality in adolescents--need for more validation
The authors have made a good start in constructing curves for MUAC for age, boys and girls separately for -19 years. This will make it easier to classify nutritional status by primary health care workers at the community level. They have taken the references values based on the US national surveys -- viz. The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES), US population datasets (age 5-25 years) -- which were used for 2007 World Health Organization growth reference for BMI. The findings suggest the sensitivity for death at cut off less than -2 z scores as 72% (95% confidence interval: 57% to 84%) for MUAC –for –age z score. The sensitivity seems to be on the lower side for correlation with mortality, probably due to lesser number of deaths. Further, the validation study done on HIV infected children might not actually reflect the children in the general population and this might not be representative for children at large. The findings need more validation studies with children of varied malnourished states/grades and that too in different populations including South Asia.
Competing interests: No competing interests