Mid-upper-arm-circumference and mid-upper-arm circumference z-score: The best predictor of mortality

J. Rasmussen*, A. Andersen, A. B. Fisker, H. Ravn, M. Sodemann, A. Rodrigues, C. S. Benn, P. Aaby

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

43 Citations (Scopus)


Background/Objective:Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify children with high short-term mortality risk in Guinea-Bissau.Subjects/ Methods:The Bandim Health Project visits children 3-monthly until 3 years of age. MUAC is measured and deaths are registered. We studied a high-mortality cohort of children born in 1995-96 and a lower mortality cohort of children born in 2005-06. The prognostic ability of MUAC and MUAC z-score to predict mortality within 1 and 3 months after the MUAC assessment were compared by area under the receiver operating characteristic curve, sensitivity and positive predictive value.Results:Compared with MUAC z-score, MUAC identified as malnourished more girls than boys (prevalence ratio (PR)1.74 (1.52;2.01)) and more children aged 6-11 months than children aged 12-35 months (1.59 (1.38;1.82)). There was no difference in the prognostic ability of MUAC and MUAC z-score to predict mortality for children aged 6-35 months. The prognostic ability was higher when mortality was lower. MUAC performed well in the youngest infants.Conclusion:In the age group 6-35 months, MUAC and MUAC z-score had the same prognostic ability to predict short-term mortality. As MUAC is easier to use in field settings, there is no need to use MUAC z-score to identify children with a high-mortality risk.

Original languageEnglish
JournalEuropean Journal of Clinical Nutrition
Issue number9
Pages (from-to)998-1003
Number of pages6
Publication statusPublished - Sept 2012
Externally publishedYes


  • anthropometry
  • child mortality
  • child nutrition disorders/mortality
  • predictive value of tests


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