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

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DOI: 10.1177/0884533616676597


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 agedCDC, 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.

Journal Title

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition





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MeSH Keywords

Adolescent; Adolescent Development; Adolescent Nutritional Physiological Phenomena; Arm; Body Size; Child; Child Development; Child Nutritional Physiological Phenomena; Child, Preschool; Cohort Studies; Female; Growth Charts; Humans; Infant; Infant Nutritional Physiological Phenomena; Male; Models, Biological; Nutrition Assessment; Nutrition Surveys; Nutritional Status; Sex Characteristics; United States


growth curve; malnutrition; nutrition assessment

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