Concordance between MUAC and WLZ in identifying malnutrition among children in South India

Abstract Background To assess the prevalence of anthropometric failure using a composite index of anthropometric failure and to evaluate the concordance of mid-upper arm circumference (MUAC) with weight for length z score (WLZ) in identifying children with malnutrition. Methods We used pre-screening data from a pre-proof-of-concept (pre-POC) study conducted in 2022-23. This pre-POC study evaluated the acceptability of a novel food supplement among Indian children with uncomplicated moderate acute malnutrition in urban wards of Vellore district in Tamil Nadu, South India. We included all children in the age group 5-19 months who were pre-screened for the pre-POC study with available data on weight, height, MUAC, date of birth, and child sex. Results A total of 663 children were available for the analysis. The prevalence of underweight, stunting, and wasting was 23.8%, 24.3%, and 16.6%, respectively. We found a fair agreement between MUAC and WLZ values (Kappa = 0.32) and a poor agreement of Kappa = 0.19 and 0.10 with weight for age z score and length for age z score, respectively. Conclusions The prevalence of any form of malnutrition is still a public health issue of concern in South India, with a constantly higher rate in concordance with previous literature. MUAC and WLZ cutoffs identify a different group of children with acute malnutrition. Larger community-based studies with WLZ cutoffs as inclusion criteria for malnutrition can adopt a step-wise approach, including initial screening of children with a higher cutoff value of MUAC, followed by WLZ for better feasibility. Key messages • The burden of moderate acute malnutrition (MAM) remains a significant public health concern in low- and middle-income countries (LMICs) such as India. • MUAC and WLZ identify different children as malnourished, suggesting that while not definitive, anthropometric measures can serve as case definitions.