The performance of mid-upper arm circumference for identifying children and adolescents with overweight and obesity: a systematic review and meta-analysis

Objective: This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity. Design: Systematic review and meta-analysis. Setting: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2-19 years were included. Participants: A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses. Results: In boys, MUAC showed a pooled AUC of 0 center dot 92 (95 % CI 0 center dot 89, 0 center dot 94), sensitivity of 84 center dot 4 (95 % CI 84 center dot 6, 90 center dot 8) and a specificity of 86 center dot 0 (95 % CI 79 center dot 2, 90 center dot 8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0 center dot 93 (95 % CI 0 center dot 90, 0 center dot 95), sensitivity of 86 center dot 4 (95 % CI 79 center dot 8, 91 center dot 0), specificity of 86 center dot 6 (95 % CI 82 center dot 2, 90 center dot 1) when compared against overweight and obesity defined using BMI z-scores. Conclusion: In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the 'golden standard' measure of excess adiposity.