Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study

Background: No studies have examined if mid-upper arm circumference (MUAC) can be an alternative screening tool for obesity in an international sample of children differing widely in levels of human development. Objective: Our aim is to determine whether MUAC could be used to identify obesity in children from 12 countries in five major geographic regions of the world. Methods: This observational, multinational cross-sectional study included 7337 children aged 9–11 years. Anthropometric measurements were objectively assessed, and obesity was defined according to the World Health Organization reference data. Results: In the total sample, MUAC was strongly correlated with adiposity indicators in both boys and girls (r > 0.86, p < 0.001). The accuracy level of MUAC for identifying obesity was high in both sexes and across study sites (overall area under the curve of 0.97, sensitivity of 95% and specificity of 90%). The MUAC cut-off value to identify obesity was ~25 cm for both boys and girls. In country-specific analyses, the cut-off value to identify obesity ranged from 23.2 cm (boys in South Africa) to 26.2 cm (girls in the UK). Conclusions: Results from this 12-country study suggest that MUAC is a simple and accurate measurement that may be used to identify obesity in children aged 9–11 years. MUAC may be a promising screening tool for obesity in resource-limited settings. Refereed/Peer-reviewed