Identifying acute malnutrition – do we have an answer for policy makers?

It is thought that 178 million children are underweight worldwide, and 20 million suffer from severe acute malnutrition each year, which carries a higher mortality. Growth parameters below a nominal cut-off indicate acute or chronic malnutrition, which are used as indicators for commencing therapeutic nutritional intervention in individuals and populations. The World Health Organization and United Nation Children Fund recommend the use of a cut-off for weight-for-height of below −2 standard deviations and – 3 standard deviations for moderate and severe malnutrition respectively. In conjunction with weight-for-height the World Health Organization also suggests the use of mid upper arm circumference using a cut-off point of < 115 mm to define severe malnutrition and < 125 mm for moderate malnutrition. As these parameters influence the level of nutritional support provided to children in need it is important to ensure that the right measures are used to identify those that require nutritional support. There has been debate around using only mid-upper-arm- circumference for the identification of children with malnutrition, as studies indicated this measure to be an easy, reliable method with good sensitivity and specificity, however concern has been raised whether arm circumference alone is a reliable marker to identify children with malnutrition. As recently reported in BMC Nutrition, Grellety & Golden performed a study to assess the relationship between the two measures, particularly with respect to regional and body differences between populations and the subsequent implications for the accurate identification of malnutrition. This study found significant differences in the populations identified with malnutrition using either method. As such a recommendation was made by the authors to continue to use both mid-upper-arm-circumference and weight-for-height, as they complement each other and better account for country and population differences when used together.