Use of mid-upper arm circumference measurement for children with disabilities

Children with disabilities are routinely excluded from malnutrition guidelines, assessment tools, nutrition programming, and the general global conversation. This systematic review analysed current evidence regarding the use of mid-upper arm circumference (MUAC) among children (aged six months to 18 years) with disabilities. The review followed PRISMA guidelines, searching four databases between 1990 and 2021, with 32 papers included in the final analysis. Most of the included studies (91%) were observational. Key findings from across 26 countries indicate that MUAC is commonly and routinely used as part of nutritional assessment for children with disabilities, but that MUAC measurement methods, references, and cutoffs were inconsistent. Due to limitations in the available research, it was not possible to compare MUAC’s ability to identify high-risk children with disabilities in comparison to other anthropometric measures or to children without disabilities.

The pooled study sample was weighted toward certain disability subtypes, although nine studies included multiple disability types. Cerebral palsy was observed in 44% of studies, as well as intellectual impairment (19%), visual impairment (9%), and autism spectrum disorder (9%), to name a few. This highlights the need for further research into specific, underrepresented groups to expand the evidence base and better understand how varying disabilities may impact MUAC measurement accuracy. It is also important to note that the evidence for, and use of, MUAC has evolved during the selected time period – which makes it harder to compare between these studies.

However, due to its simplicity and ease of use, MUAC does present as a potentially valuable part of nutritional assessment for children with disabilities of all ages. What is clear from this research is that there is an urgent need to identify standardised methods and references to identify malnutrition and monitor the nutritional status of millions of children with disabilities as we work to create more inclusive systems.

“WHO guidelines are highly regarded and used to develop malnutrition protocols worldwide, but the lack of disability-specific recommendations leaves children with disabilities underserved.”