BMC Nutrition just published a comment that we wrote about a paper published a few months ago by Grellety and Golden.

The link to the original article:

https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-016-0049-7

and for our comment:

http://bmcnutr.biomedcentral.com/articles/10.1186/s40795-016-0101-7

This comment is published with a response from Grellety and Golden (same link).

We appreciate Grellety and Golden’s support expressed in their response to MUAC-based programmes when there are large numbers of malnourished children to treat and when health services are overwhelmed.

However, when responding to our comment, Grellety and Golden summarise it in a few points that do not accurately reflect what our carefully thought through position is.  We felt it was important to clarify this for readers of this forum.

The interpretation reflected in point 6 in particular is of particular concern to us. We never claimed that “Children who have a low WHZ can easily be identified for treatment by increasing the cut-off point for MUAC”. We just referred to the identification of children with a high risk of death, not to those with a low WHZ. ROC curves show that the sensitivity of the detection of high risk children can be done more efficiently for the same specificity level (ie without increasing patient numbers) by slightly increasing MUAC rather than by including WFH as additional criterion. Data also show that mortality does not decline for MUAC above 125 mm.

Other comments do not address directly our main original points and we see nothing in Golden and Grellety’s response which challenges our main conclusion reflected in the title of our comment:

“Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment”.

André Briend, on behalf of the group of authors