Validity and predictability of Mid-Upper Arm Circumference for nutrition screening in outpatient preschoolers with cerebral palsy

Hongyu Zhou¹Tingting Peng¹Mou Wei^1,2Jingbo Zhang¹Yiting Zhao¹Wen Le^1,3Danxia Fan^1,4Shaihong Qiu¹Yuai Zheng¹Qiujin Lin¹Yun Zheng¹Liying Ma¹Li Jinling¹Jinhua Lu^1,5Hongmei Tang¹Lu He¹Kaishou Xu^1*

• ¹Department of Rehabilitation, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
• ²Neonatology department of The Women and Children's Medical Center affiliated with Guangzhou Medical University, Guangzhou, China
• ³Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
• ⁴School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
• ⁵Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China

Aim: Evaluating the nutritional status of children with cerebral palsy (CP) is difficult due to spasticity and contractures. Mid-upper arm circumference (MUAC) is a potential screening tool for malnutrition in children with CP, but its effectiveness is unproven. This study aims to provide evidence on the psychometric qualities of MUAC for clinical use and establish optimal cutoffs for preschoolers with CP.Methods: Children with CP aged 12-60 months (n=937) were recruited from 24 hospitals across 13 provinces in China for the cross-sectional study, while those had genetic or metabolic diseases were excluded. Weight, length/height and MUAC were obtained from participants. Weight and length/height were calculated into Z scores by using WHO Anthro software to assess the nutritional status. The sensitivity and specificity of the WHO-recommended MUAC cutoffs were calculated. The Spearman's rank correlation, Receiver operating characteristic (ROC) curve, and Youden Index were conducted to establish the optimal MUAC cutoffs for preschoolers with CP.Results: Compared to Z score cutoffs, WHO-recommended MUAC cutoffs showed high specificity but low sensitivity for malnutrition. MUAC significantly correlated with weight-for-length/height Z score (r=0.606), weight-for-age Z score (r=0.557), length/height-for-age Z score (r=0.276), and BMIfor-age Z score (r=0.575). The optimal MUAC cutoffs for mild, moderate, and severe undernutrition were 15.35cm, 15.05cm, and 14.35cm, respectively; the optimal cutoffs for overweight and obesity were 17.55cm and 20.4cm, respectively.Our study suggests that MUAC is a useful tool for screening the nutritional status of children with CP. However, the WHO-recommended MUAC cut-off may not be suitable for preschool with CP. We estimated that the optimal MUAC cutoffs were 15.35 cm for mild undernutrition, 15.05 cm for moderate undernutrition, and 14.35 cm for severe undernutrition, and 17.55 cm for overweight and 20.4 cm for obesity in preschool with CP.