Peer-reviewed article

Anthropometric profile, severity, and concordance of MUAC and BMI-for-age classification among clinically screened pediatric patients at a tertiary care hospital in south Rajasthan: A hospital-based cross-sectional study.

Dinesh Kumar, Anukrman Singh, S S More · 5 Oct 2026

Abstract

INTRODUCTION: Undernutrition remains a leading contributor to childhood morbidity and mortality in India, and southern Rajasthan - with a large rural and tribal catchment - carries a disproportionate burden. Data describing the anthropometric profile of malnourished children who actually reach tertiary care in this region are limited. AIM: To characterise the anthropometric profile and severity of malnutrition among children undergoing clinical screening at a tertiary care hospital in South Rajasthan, to classify nutritional status using age- and sex-specific WHO z-scores, to assess agreement between mid-upper arm circumference (MUAC) and BMI-for-age classification, and to examine associations between anthropometric, dietary, demographic and behavioural variables. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted in the Department of Pediatrics of a tertiary care teaching hospital in Udaipur, Rajasthan, over four months of data collection. One hundred and twenty-five children aged 6 months to 18 years, identified as malnourished on clinical screening, were enrolled by consecutive sampling. Weight, height, body mass index (BMI) and mid-upper arm circumference (MUAC) were measured by standard technique; habitual pre-illness dietary energy and protein intake were obtained by recall and compared with age-appropriate recommended allowances. Non-parametric tests, Chi-square, Spearman correlation and Cohen's kappa were used, with P < 0.05 considered significant. RESULTS: Of 125 children undergoing clinical screening (mean age 3.37 ± 3.02 years; 59.2% male; 76.0% rural), age- and sex-specific WHO BMI-for-age z-scores (WHO Child Growth Standards for 6-60 months; WHO Growth Reference 2007 for 61-228 months) classified 31 (24.8%) as wasted and 78 (62.4%) as severely wasted, together 87.2%; 16 (12.8%) were normal. Mean BMI was 12.05 ± 1.45 kg/m2 and mean MUAC 12.77 ± 2.23 cm. In the subgroup aged 6-59 months for whom WHO MUAC cut-offs are validated (n = 102), MUAC classified 31 (30.4%) as severe and 24 (23.5%) as moderate acute malnutrition; among the 91 children in this subgroup classified as wasted or severely wasted by BMI-for-age z-score, 42 (46.2%) had a MUAC value in the normal range. Agreement between MUAC and z-score-based BMI classification in this subgroup was negligible (linear-weighted κ = 0.02; unweighted κ = 0.03). Percentage calorie deficit correlated inversely with MUAC (ρ = -0.608, P < 0.001), an association that persisted after adjusting for age (partial ρ = -0.583, P < 0.001), but not with BMI. No demographic factor reached significance; age group approached it (P = 0.051). CONCLUSION: Among children undergoing clinical screening at this tertiary care centre in South Rajasthan, malnutrition was severe and predominantly acute on z-score-based BMI-for-age classification. Fixed MUAC cut-offs performed poorly outside the 6-59 month band for which they are validated, and a substantial proportion of children with acute malnutrition on BMI-for-age were not flagged by MUAC. These findings support the consideration of complementary anthropometric assessment - using MUAC alongside BMI/weight-for-height and age- and sex-specific WHO z-scores rather than raw cut-offs - particularly in primary and referral care settings serving a wide paediatric age range.