Thank you very much Mark - The implications of the findings are huge for India and we have India based evidence finally - the discussion section is very well summarised. Hope that the technical group currently formalising the CMAM guidelines for the country takes note.

Dear Dr Charulatha Banerjee,

This is indeed a very important paper. It does shows clearly that children with a low MUAC have a high risk of death in Indian children as well. This is consistent with previous studies from Bangladesh which showed similar results (1) (2) (3).

It is not clear to me why in the discussion the authors recommend to use when possible WHZ in addition to MUAC. The article does not present data to support this point. As a reminder, a previous study suggested it is more appropriate to use MUAC with a higher cut off than adding WHZ when the objective is to detect most effectively children with a high risk of death (4).

1. Bairagi R. On validity of some anthropometric indicators as predictors of mortality. Am J Clin Nutr. nov 1981;34(11):2592‑4.

2. Alam N, Wojtyniak B, Rahaman MM. Anthropometric indicators and risk of death. Am J Clin Nutr. mai 1989;49(5):884‑8.

3. Briend A, Wojtyniak B, Rowland MG. Arm circumference and other factors in children at high risk of death in rural Bangladesh. Lancet Lond Engl. 26 sept 1987;2(8561):725‑8.

4. Briend A, Maire B, Fontaine O, Garenne M. Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children. Matern Child Nutr. janv 2012;8(1):130‑3.
 

Estimados todos.

Excelente tema. Hoy, 5 años después de esta conversacion, en Colombia se sigue dando esta discusión que, como Andre, tampoco entiendo. En mi país, se sigue insistiendo en que el perímetro  braquial medio < 11.5 cm, es un "indicador complementario" de desnutrición aguda severa; a pesar que las directrices nacionales (y de OMS) rezan: indicador PT <-3 DE o edema bilateral o PBM <11.5 cm

Dear all.

Excellent topic. Today, 5 years after this conversation, in Colombia there is still this discussion that, like Andre, I do not understand either. In my country, it is still insisted that mid-upper arm circumference < 11.5 cm, is a "complementary indicator" of severe acute malnutrition; despite the fact that national (and WHO) guidelines state: PT indicator <-3 SD or bilateral edema or PBM <11.5 cm