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Reference ranges for midupper arm circumference, upper arm muscle area, and upper arm fat area in US children and adolescents aged 1-20 y.
Am J Clin Nutr. 2017 01; 105(1):111-120.AJ

Abstract

BACKGROUND

Midupper arm circumference (MUAC) has long been used in anthropometric assessments of nutritional status in field settings, especially in emergency situations, but percentile ranges for healthy, well-nourished children are currently unavailable.

OBJECTIVE

We developed reference curves for MUAC and derived measures of arm muscle area (AMA) and arm fat area (AFA) on the basis of the population used in the current CDC body mass index growth charts.

DESIGN

We analyzed cross-sectional MUAC and triceps (triceps skinfold thickness) data from 32,952 US children aged 1-20 y. Generalized additive models for location, scale, and shape were used to calculate semiparametric smoothed percentiles and L, M, and S coefficients needed for z-score estimation by age and sex. Equations were developed with the use of the height-for-age z score (HAZ) to adjust for the associations of stature with upper arm measures.

RESULTS

MUAC increased with age steadily throughout the growing period. For children <5 y old, lower percentile ranges varied markedly across age and sex such that the single cutoff (<11.5 or 12.5 cm) for field screening of acute malnutrition did not track along the same percentile. AFA and AMA growth patterns exhibited sex-specific trends including multiple distinct age-related inflections that were more pronounced in males for AFA-for-age than in females. HAZ and age were substantially and independently related with all arm measures.

CONCLUSIONS

The new reference percentile ranges for midupper arm measures for healthy children provide a useful nutritional assessment tool in a wide variety of settings. Height status (HAZ) has complex independent associations with arm measures irrespective of the distributional ranking by age and sex. Prediction equations that account for these effects further extend the practical use of the new curves.

Authors+Show Affiliations

Emory University Rollins School of Public Health and Global Health Institute, Atlanta, GA; yaw.addo@emory.edu.University of Minnesota, School of Public Health, Minneapolis, MN; and.The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

27806975

Citation

Addo, O Yaw, et al. "Reference Ranges for Midupper Arm Circumference, Upper Arm Muscle Area, and Upper Arm Fat Area in US Children and Adolescents Aged 1-20 Y." The American Journal of Clinical Nutrition, vol. 105, no. 1, 2017, pp. 111-120.
Addo OY, Himes JH, Zemel BS. Reference ranges for midupper arm circumference, upper arm muscle area, and upper arm fat area in US children and adolescents aged 1-20 y. Am J Clin Nutr. 2017;105(1):111-120.
Addo, O. Y., Himes, J. H., & Zemel, B. S. (2017). Reference ranges for midupper arm circumference, upper arm muscle area, and upper arm fat area in US children and adolescents aged 1-20 y. The American Journal of Clinical Nutrition, 105(1), 111-120. https://doi.org/10.3945/ajcn.116.142190
Addo OY, Himes JH, Zemel BS. Reference Ranges for Midupper Arm Circumference, Upper Arm Muscle Area, and Upper Arm Fat Area in US Children and Adolescents Aged 1-20 Y. Am J Clin Nutr. 2017;105(1):111-120. PubMed PMID: 27806975.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reference ranges for midupper arm circumference, upper arm muscle area, and upper arm fat area in US children and adolescents aged 1-20 y. AU - Addo,O Yaw, AU - Himes,John H, AU - Zemel,Babette S, Y1 - 2016/11/02/ PY - 2016/07/19/received PY - 2016/09/28/accepted PY - 2016/11/4/pubmed PY - 2017/6/10/medline PY - 2016/11/4/entrez KW - arm KW - nutritional assessment KW - percentiles KW - references KW - stature SP - 111 EP - 120 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 105 IS - 1 N2 - BACKGROUND: Midupper arm circumference (MUAC) has long been used in anthropometric assessments of nutritional status in field settings, especially in emergency situations, but percentile ranges for healthy, well-nourished children are currently unavailable. OBJECTIVE: We developed reference curves for MUAC and derived measures of arm muscle area (AMA) and arm fat area (AFA) on the basis of the population used in the current CDC body mass index growth charts. DESIGN: We analyzed cross-sectional MUAC and triceps (triceps skinfold thickness) data from 32,952 US children aged 1-20 y. Generalized additive models for location, scale, and shape were used to calculate semiparametric smoothed percentiles and L, M, and S coefficients needed for z-score estimation by age and sex. Equations were developed with the use of the height-for-age z score (HAZ) to adjust for the associations of stature with upper arm measures. RESULTS: MUAC increased with age steadily throughout the growing period. For children <5 y old, lower percentile ranges varied markedly across age and sex such that the single cutoff (<11.5 or 12.5 cm) for field screening of acute malnutrition did not track along the same percentile. AFA and AMA growth patterns exhibited sex-specific trends including multiple distinct age-related inflections that were more pronounced in males for AFA-for-age than in females. HAZ and age were substantially and independently related with all arm measures. CONCLUSIONS: The new reference percentile ranges for midupper arm measures for healthy children provide a useful nutritional assessment tool in a wide variety of settings. Height status (HAZ) has complex independent associations with arm measures irrespective of the distributional ranking by age and sex. Prediction equations that account for these effects further extend the practical use of the new curves. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/27806975/Reference_ranges_for_midupper_arm_circumference_upper_arm_muscle_area_and_upper_arm_fat_area_in_US_children_and_adolescents_aged_1_20_y_ DB - PRIME DP - Unbound Medicine ER -