Article open access publication

Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment

BMC Nutrition, Springer Nature, ISSN 2055-0928

Volume 2, 1, 2016

DOI:10.1186/s40795-016-0101-7, Dimensions: pub.1038014529,



  1. (1) Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Lääkärinkatu 1, 33014, Tampere, Finland
  2. (2) University of Copenhagen, grid.5254.6, KU
  3. (3) Action Against Hunger UK, SE10 8JA, London, UK
  4. (4) Médecins Sans Frontières, grid.452586.8
  5. (5) Université Libre de Bruxelles, grid.4989.c
  6. (6) Valid International (United Kingdom), grid.487390.1
  7. (7) International Rescue Committee, grid.420433.2
  8. (8) Kenya Medical Research Institute, grid.33058.3d
  9. (9) Alliance for International Medical Action, Dakar, Senegal
  10. (10) Tampere University, grid.502801.e
  11. (11) Catholic University of Louvain, grid.7942.8
  12. (12) Médecins Sans Frontières, grid.452593.c
  13. (13) 01300, Contrevoz, France
  14. (14) University Settlement, grid.430564.0
  15. (15) Médecins Sans Frontières, grid.452373.4
  16. (16) London School of Hygiene & Tropical Medicine, grid.8991.9
  17. (17) University of Malawi, grid.10595.38
  18. (18) Washington University in St. Louis, grid.4367.6
  19. (19) Brixton Health, SY17 5RJ, Llawryglyn, Powys, UK
  20. (20) Médecins Sans Frontières, grid.497562.b
  21. (21) Médecins Sans Frontières, grid.452780.c
  22. (22) Accion Contra el Hambre, 28002, Madrid, Spain
  23. (23) DG ECHO, Bureau régional Afrique de l’Ouest, Dakar, Sénégal


Severe acute malnutrition (SAM) is currently defined by the WHO as either a low mid-upper arm circumference (i.e. MUAC <115 mm), a low weight-for-height z-score (i.e. WHZ <− 3), or bilateral pitting oedema. MUAC and WHZ do not always identify the same children as having SAM. This has generated broad debate, as illustrated by the recent article by Grellety & Golden (BMC Nutr. 2016;2:10). Regional variations in the proportion of children selected by each index seem mostly related to differences in body shape, including stuntedness. However, the practical implications of these variations in relation to nutritional status and also to outcome are not clear. All studies that have examined the relationship between anthropometry and mortality in representative population samples in Africa and in Asia have consistently showed that MUAC is more sensitive at high specificity levels than WHZ for identifying children at high risk of death. Children identified as SAM cases by low MUAC gain both weight and MUAC in response to treatment. The widespread use of MUAC has brought enormous benefits in terms of the coverage and efficiency of programs. As a large high-risk group responding to treatment, children with low MUAC should be regarded as a public health priority independently of their WHZ. While a better understanding of the mechanism behind the discrepancy between MUAC and WHZ is desirable, research in this area should not delay the implementation of programs aiming at effectively reducing malnutrition-related deaths by prioritising the detection and treatment of children with low MUAC.

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