Discriminatory ability of mid-upper arm circumference in identifying overweight and obese adolescents: Findings from the comprehensive national nutrition survey, India

Background: Overweight and obesity during adolescence is an important public health problem. However, little is known about the age-and sex-specific mid-upper arm circumference (MUAC) cut-offs for identifying overweight and obese adolescents. Objectives: The present study was planned to assess diagnostic performance of MUAC in identifying overweight and obese adolescents and estimating age specific MUAC cut-offs, separately for males and females, taking body mass index for age Z-score (BAZ) as the gold standard. Methods: The present study is secondary data analysis using Comprehensive National Nutrition Survey, India, on 31,471 adolescents. The, area under curve receiver operating characteristic curve (AUC), and Youden Index were used to estimate MUAC cut-offs for overweight (BAZ > +1) and obesity (BAZ > +2). Results: The MUAC cut-offs to identify overweight were: For 10–14 years– 22.9/23.4 cm, for 15–19 years – 27.0/25.6 cm for males and females, respectively; and for obesity were: For 10–14 years – 24.5/25.1, for 15–19 years – 28.5/28.0 cm for males and females, respectively. For overweight, among males, the age-specific cut-off ranged between 21.2 cm (10 years) and 29.8 (19 years), and for females ranged between 21.2 cm (10 years) and 26.7 cm (19 years). For obesity, it ranged between 22.4 cm (10 years) and 31.1 cm (18 years) for males, and 23.9 cm (10 years) to 26.9 cm (19 years) for females. For obesity, AUC ranged between 0.81 and 0.92, indicating good to excellent diagnostic accuracy. Conclusion: Age- and sex-specific MUAC cut-offs could be considered as a screening tool for identifying overweight and obese adolescents