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Nutr Clin Pract. 2017 Feb;32(1):68-76. doi: 10.1177/0884533616676597. Epub 2016 Nov 19.

Construction of Lambda, Mu, Sigma Values for Determining Mid-Upper Arm Circumference z Scores in U.S. Children Aged 2 Months Through 18 Years.

Author information

1
1 University of Missouri, Kansas City-School of Medicine and Section of Therapeutic Innovation, Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Missouri, USA.
2
2 Bioinformatics and Intelligent Computing, Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Missouri, USA.
3
3 Nutrition Services, Children's Mercy Hospital, Kansas City, Missouri, USA.

Abstract

BACKGROUND:

Mid-upper arm circumference (MUAC) has proven highly predictive of morbidity and mortality associated with malnutrition better, in some cases, than other growth indicators, including body mass index (BMI) z scores and weight-for-height z scores. A recent consensus statement recommended the inclusion of MUAC and MUAC z scores in the nutrition assessment of children in the United States; however, the requisite data to permit z score calculations for children aged >5 years have not been published.

OBJECTIVE:

This investigation was designed to generate lambda mu sigma (LMS) values to permit the calculation of MUAC z scores in U.S. children 2 months through 18 years of age.

DESIGN:

Anthropometric data from the Centers for Disease Control and Prevention (CDC) National Health and Nutrition Examination Survey (1999-2012) were used for model development (n = 28,995). Smoothed centiles were constructed and compared with previously described CDC percentiles. Independently collected MUAC data from 2 different U.S. studies were used for external validation (n = 1438).

STATISTICAL ANALYSES:

Goodness-of-fit was assessed visually and statistically by examining detrended quantile-quantile plots, Q statistics, and the distribution of z scores.

RESULTS:

The curves generated in this investigation fit the raw data well with no systematic bias and no sacrifice in fit for children aged <12 months. The curves were consistent with those published by the CDC, and the distribution z scores approximated 0 ± 1 in all age groups.

CONCLUSIONS:

These LMS values derived in this investigation can be used by clinicians to generate MUAC z scores for U.S. children.

KEYWORDS:

adolescent; child; growth curve; infant; malnutrition; nutrition assessment

PMID:
27856693
DOI:
10.1177/0884533616676597
[Indexed for MEDLINE]

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