{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:14:15Z","timestamp":1785417255827,"version":"3.56.0"},"reference-count":44,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"unspecified","delay-in-days":338,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Public Health Nutr."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1368980025101523_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To assess anthropometric failure prevalence using a composite index of anthropometric failure and evaluate the concordance of mid-upper arm circumference (MUAC) with weight for length z score (WLZ) in identifying acute malnutrition in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1368980025101523_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>We used data from a pre-proof-of-concept (pre-POC) study conducted in 2022\u20132023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1368980025101523_as3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>The study was conducted in the Vellore district in Tamil Nadu, South India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1368980025101523_as4\">\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>We included all children aged 5\u201319 months who were pre-screened for the pre-POC study and had available data on weight, length, MUAC, date of birth and child sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1368980025101523_as5\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 663 children were available for analysis, with a mean age of 11\u00b74 months. The prevalence of underweight, stunting and wasting was 23\u00b78 %, 24\u00b73 % and 16\u00b76 %, respectively. 36\u00b77 % of the children had at least one form of anthropometric deficit, and 8\u00b72 % showed severe deficits. We found a fair agreement between MUAC and WLZ values (kappa = 0\u00b732) and a poor agreement of kappa = 0\u00b719 and 0\u00b710 with weight for age z score (WAZ) and length for age z score (LAZ), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1368980025101523_as6\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The prevalence of malnutrition remains a significant public health concern in South India, with rates consistent with previous literature. MUAC and WLZ cutoffs by the WHO identify different groups with acute malnutrition. Community-based studies using WLZ criteria can adopt screening with higher MUAC cutoffs, followed by WLZ or, alternatively, WAZ alone, as low WAZ covers most participants with low MUAC and WLZ, providing better feasibility. However, the optimal measurement for risk identification requires further exploration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1368980025101523","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T11:05:46Z","timestamp":1764932746000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Burden of anthropometric failures and concordance of mid-upper arm circumference with weight for length z score in identifying malnutrition among under 2-year-old children in Southern India"],"prefix":"10.1017","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2357-0403","authenticated-orcid":false,"given":"Midhun","family":"Sasikumar","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/033003e23","id-type":"ROR","asserted-by":"publisher"}],"name":"Tampere University"},{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Marconi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"Hakola","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/033003e23","id-type":"ROR","asserted-by":"publisher"}],"name":"Tampere University"},{"name":"Finnish Institute for Health and Welfare"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sowndharya","family":"Pandian","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshaya","family":"Vasudevan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zavid","family":"Miyandad","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata Raghava","family":"Mohan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suvi M.","family":"Virtanen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/033003e23","id-type":"ROR","asserted-by":"publisher"}],"name":"Tampere University"},{"name":"Finnish Institute for Health and Welfare"},{"name":"Tampere University Hospital, Wellbeing Services County of Pirkanmaa"},{"name":"Tampere University and Tampere University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"S1368980025101523_ref4","first-page":"5","article-title":"Anthropometric reference data for children and adults: United States, 2003\u20132006","volume":"10","author":"McDowell","year":"2008","journal-title":"Natl Health Statistics Rep"},{"key":"S1368980025101523_ref8","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1177\/15648265060273S302","article-title":"A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs","volume":"27","author":"Myatt","year":"2006","journal-title":"Food Nutr Bull"},{"key":"S1368980025101523_ref9","unstructured":"9. USAID Advancing Nutrition (2022) Growth Monitoring and Promotion (Internet). https:\/\/www.advancingnutrition.org\/sites\/default\/files\/2022-10\/usaid-an-growth-monitoring-2022.pdf (accessed 08 November 2024)."},{"key":"S1368980025101523_ref18","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.tjnut.2024.11.001","article-title":"Acceptability of microbiota-directed complementary foods in treating Indian children with moderate acute malnutrition \u2013 eACT-MAM pre-proof of concept study","volume":"155","author":"Marconi","year":"2025","journal-title":"J Nutr"},{"key":"S1368980025101523_ref15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/j.1740-8709.2011.00340.x","article-title":"Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children","volume":"8","author":"Briend","year":"2011","journal-title":"Matern Child Nutr"},{"key":"S1368980025101523_ref24","unstructured":"24. WHO Anthro Survey Analyser and Other Tools (Internet) (2024). https:\/\/www.who.int\/tools\/child-growth-standards\/software (accessed 08 July 2024)."},{"key":"S1368980025101523_ref20","unstructured":"20. seca 354 \u2013 Digital Baby Scale Also Converts to a Flat Scale for Children (Internet) (2024). https:\/\/www.seca.com\/en_us\/products\/all-products\/product-details\/seca354.html (accessed 30 July 2024)."},{"key":"S1368980025101523_ref11","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1017\/S1368980017004165","article-title":"Mid-upper arm circumference in detection of weight-for-height Z-score below \u20133 in children aged 6\u201359 months","volume":"21","author":"Kapil","year":"2018","journal-title":"Public Health Nutr"},{"key":"S1368980025101523_ref1","unstructured":"1. World Health Organization (2014) Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition. Report No: WHO\/NMH\/NHD\/14.1. Geneva: World Health Organization."},{"key":"S1368980025101523_ref12","doi-asserted-by":"crossref","first-page":"e13217","DOI":"10.1111\/mcn.13217","article-title":"Determinants of maternal low mid-upper arm circumference and its association with child nutritional status among poor and very poor households in rural Bangladesh","volume":"17","author":"Haque","year":"2021","journal-title":"Matern Child Nutr"},{"key":"S1368980025101523_ref3","unstructured":"3. Government of India Press Information Bureau (2021) Malnutrition-Free India (Internet). https:\/\/pib.gov.in\/Pressreleaseshare.aspx?PRID=1781673 (accessed 14 January 2025)."},{"key":"S1368980025101523_ref31","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/1471-2458-13-87","article-title":"Burden of childhood diseases and malnutrition in a semi-urban slum in southern India","volume":"13","author":"Sarkar","year":"2013","journal-title":"BMC Public Health"},{"key":"S1368980025101523_ref41","doi-asserted-by":"crossref","first-page":"11795565211049904","DOI":"10.1177\/11795565211049904","article-title":"Anthropometric criteria for identifying infants under 6 months of age at risk of morbidity and mortality: a systematic review","volume":"15","author":"Hoehn","year":"2021","journal-title":"Clin Med Insights Pediatr"},{"key":"S1368980025101523_ref32","unstructured":"32. Government of India \/ NITI Aayog (2022) Vellore-Tamil Nadu (Internet). https:\/\/www.niti.gov.in\/sites\/default\/files\/2022-07\/Vellore-Tamil%20Nadu.pdf (accessed 20 August 2024)."},{"key":"S1368980025101523_ref43","unstructured":"43. Walters, T , Sibson, V & McGrath, M (2012) Mid Upper Arm Circumference and Weight-for-Height Z-Score as Indicators of Severe Acute Malnutrition: A Consultation of Operational Agencies and Academic Specialists to Understand the Evidence, Identify Knowledge Gaps and to Inform Operational Guidance (Internet). https:\/\/www.ennonline.net\/sites\/default\/files\/muac-wfh-reportweb.pdf (accessed 26 July 2025)."},{"key":"S1368980025101523_ref26","doi-asserted-by":"crossref","first-page":"1081139","DOI":"10.3389\/fped.2023.1081139","article-title":"The significance of MUAC z-scores in diagnosing pediatric malnutrition: a scoping review with special emphasis on neurologically disabled children","volume":"11","author":"Ayd\u0131n","year":"2023","journal-title":"Front Pediatr"},{"key":"S1368980025101523_ref7","doi-asserted-by":"crossref","first-page":"e003023","DOI":"10.1136\/bmjgh-2020-003023","article-title":"\u2018Severe malnutrition\u2019: thinking deeply, communicating simply","volume":"5","author":"Kerac","year":"2020","journal-title":"BMJ Glob Health"},{"key":"S1368980025101523_ref13","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40795-016-0049-7","article-title":"Weight-for-height and mid-upper-arm circumference should be used independently to diagnose acute malnutrition: policy implications","volume":"2","author":"Grellety","year":"2016","journal-title":"BMC Nutr"},{"key":"S1368980025101523_ref14","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s40795-016-0101-7","article-title":"Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment","volume":"2","author":"Briend","year":"2016","journal-title":"BMC Nutr"},{"key":"S1368980025101523_ref5","unstructured":"5. Kesari, A & Noel, JY (2024) Nutritional Assessment (Internet). StatPearls. Treasure Island, FL: StatPearls Publishing; available at https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK580496\/ (accessed 08 November 2024)."},{"key":"S1368980025101523_ref35","unstructured":"35. Press Information Bureau (2022) Malnutrition among Children (Internet). https:\/\/pib.gov.in\/PressReleasePage.aspx?PRID=1806601 (accessed 20 August 2024)."},{"key":"S1368980025101523_ref27","unstructured":"27. ScienceDirect Topics Kappa Statistics \u2013 An Overview | (Internet) (2024). https:\/\/www.sciencedirect.com\/topics\/nursing-and-health-professions\/kappa-statistics (accessed 30 December 2024)."},{"key":"S1368980025101523_ref33","unstructured":"33. International Institute for Population Sciences (IIPS) & ICF (2021) National Family Health Survey (NFHS-5), 2019\u201321: Tamil Nadu. Mumbai: IIPS."},{"key":"S1368980025101523_ref34","unstructured":"34. International Institute for Population Sciences (IIPS) & ICF (2021) National Family Health Survey (NFHS-5), 2019\u201321: District Fact Sheet \u2013 Vellore, Tamil Nadu (Internet). Mumbai: IIPS."},{"key":"S1368980025101523_ref19","unstructured":"19. CTRI Clinical Trials Registry \u2013 India (CTRI) (Internet) (2024). https:\/\/ctri.nic.in\/Clinicaltrials\/login.php (accessed 30 July 2024)."},{"key":"S1368980025101523_ref40","doi-asserted-by":"crossref","first-page":"e843","DOI":"10.1016\/S2214-109X(25)00045-2","article-title":"Infant-level and child-level predictors of mortality in low-resource settings: the WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort","volume":"13","author":"Ahmed","year":"2025","journal-title":"Lancet Glob Health"},{"key":"S1368980025101523_ref23","unstructured":"23. INTERGROWTH-21st Anthropometry Group (2012) Anthropometry Handbook (Internet). https:\/\/www.medscinet.net\/Interbio\/Uploads\/ProtocolDocs\/Draft%20Anthropometry%20Handbook.pdf (accessed 08 July 2024)."},{"key":"S1368980025101523_ref16","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/978-1-4419-1788-1_6","volume-title":"Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease","author":"Nandy","year":"2012"},{"key":"S1368980025101523_ref30","unstructured":"30. Posit Support (2024) Citing RStudio (Internet). https:\/\/support.posit.co\/hc\/en-us\/articles\/206212048-Citing-RStudio (accessed 08 July 2024)."},{"key":"S1368980025101523_ref10","first-page":"CD010102","article-title":"Growth monitoring and promotion (GMP) for children in low and middle income countries","author":"Liu","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"S1368980025101523_ref38","doi-asserted-by":"crossref","first-page":"881","DOI":"10.9745\/GHSP-D-20-00450","article-title":"Accuracy of using mid-upper arm circumference to detect wasting among children aged 6\u201359 months in Nepal","volume":"9","author":"Lamsal","year":"2021","journal-title":"Glob Health Sci Pract"},{"key":"S1368980025101523_ref25","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13690-019-0370-0","article-title":"Assessing effectiveness of a novel mid-upper arm circumference z-score tape in a community setting in Guatemala","volume":"77","author":"Miller","year":"2019","journal-title":"Arch Public Health"},{"key":"S1368980025101523_ref17","volume-title":"Guideline: Assessing and Managing Children at Primary Health-Care Facilities to Prevent Overweight and Obesity in the Context of the Double Burden of Malnutrition: Updates for the Integrated Management of Childhood Illness (IMCI)","year":"2017"},{"key":"S1368980025101523_ref36","doi-asserted-by":"crossref","first-page":"e0273634","DOI":"10.1371\/journal.pone.0273634","article-title":"Validating the diagnostic performance of MUAC in screening moderate acute malnutrition and developing an optimal cut-off for under five children of different regions in Ethiopia","volume":"17","author":"Lambebo","year":"2022","journal-title":"PLOS ONE"},{"key":"S1368980025101523_ref39","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s40795-019-0301-z","article-title":"Concordance between estimates of acute malnutrition measured by weight-for-height and by mid-upper arm circumference after age adjustment: population-representative surveys from humanitarian settings","volume":"5","author":"Leidman","year":"2019","journal-title":"BMC Nutr"},{"key":"S1368980025101523_ref44","doi-asserted-by":"crossref","first-page":"887","DOI":"10.2471\/BLT.12.109009","article-title":"Mid-upper arm circumference at age of routine infant vaccination to identify infants at elevated risk of death: a retrospective cohort study in the Gambia","volume":"90","author":"Mwangome","year":"2012","journal-title":"Bull World Health Organ"},{"key":"S1368980025101523_ref29","unstructured":"29. FAQ Citing Stata Software, Documentation, and FAQs | Stata (Internet) (2024). https:\/\/www.stata.com\/support\/faqs\/resources\/citing-software-documentation-faqs\/ (accessed 08 July 2024)."},{"key":"S1368980025101523_ref22","unstructured":"22. seca 212 \u2013 Measuring Tape for Head Circumference of Babies and Toddlers (Internet). https:\/\/www.seca.com\/en_us\/products\/all-products\/product-details\/seca212.html (accessed 30 July 2024)."},{"key":"S1368980025101523_ref6","unstructured":"6. Casadei, K & Kiel, J (2024) Anthropometric Measurement (Internet). StatPearls. Treasure Island, FL: StatPearls Publishing; available at https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537315\/ (accessed 30 January 2024)."},{"key":"S1368980025101523_ref21","unstructured":"21. seca 417 \u2013 Light and Stable Measuring Board for Mobile Use (Internet) (2024). https:\/\/www.seca.com\/en_us\/products\/all-products\/product-details\/seca417.html (accessed 30 July 2024)."},{"key":"S1368980025101523_ref37","doi-asserted-by":"crossref","first-page":"e101159","DOI":"10.1371\/journal.pone.0101159","article-title":"Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups","volume":"9","author":"Laillou","year":"2014","journal-title":"PLOS ONE"},{"key":"S1368980025101523_ref28","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1136\/emermed-2017-206735","article-title":"What is an ROC Curve","volume":"34","author":"Hoo","year":"2017","journal-title":"Emergency Med J"},{"key":"S1368980025101523_ref2","unstructured":"2. WHO (2023) Levels and Trends in Child Malnutrition: UNICEF\/WHO\/World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2023 Edition (Internet). https:\/\/www.who.int\/publications-detail-redirect\/9789240073791 (accessed 01 May 2024)."},{"key":"S1368980025101523_ref42","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1017\/S136898002300023X","article-title":"Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts","volume":"26","author":"Khara","year":"2023","journal-title":"Public Health Nutr"}],"container-title":["Public Health Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1368980025101523","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T11:30:00Z","timestamp":1767699000000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1368980025101523\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"alternative-id":["S1368980025101523"],"URL":"https:\/\/doi.org\/10.1017\/s1368980025101523","relation":{},"ISSN":["1368-9800","1475-2727"],"issn-type":[{"value":"1368-9800","type":"print"},{"value":"1475-2727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided that no alterations are made and the original article is properly cited. The written permission of Cambridge University Press or the rights holder(s) must be obtained prior to any commercial use and\/or adaptation of the article.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e210"}}