Arm circumference to height-ratio (AHtR) – an alternate tool to identify overweight and obesity in children aged 5-12 years

Background and Objective: Childhood obesity is one of the major national health concerns. World Health Organisation (WHO) recommends Body mass index (BMI) as the standard epidemiological measurement of obesity. The BMI is not quite independent of stature, especially at the younger ages. Hence, an alternative tool like arm-circumference-to-height ratio (AHtR) is necessitated. The aim of this study was to evaluate the accuracy of AHtR as an alternate tool to identify overweight and obesity in children aged 5-12 years. Methods: This study was conducted in the Paediatrics Out-Patient Department of a tertiary care teaching center over 12 months (June 2020-May 2021) in Puducherry, India. Children between 5-12 years were included using the convenience sampling method. Their height, weight and mid-upper arm circumference (MUAC) were noted. BMI, AHtR, BMI-z scores and MUAC-z scores were calculated. All variables were analyzed in SPSS 23.0. Receiver operating characteristic (ROC) curve analysis was served to identify the age and gender-specific AHtR cut-offs to identify overweight and obesity. Results: This study was conducted on 1169 children (623 (53.2%)=boys and 546 (46.7%)=girls). The accuracy levels of AHtR for obesity were determined by area under curve (AUC) which was 0.962 for boys (cut-off=0.155) and 0.949 for girls (cut-off=0.175) between 5-12 years of age. BMI (kappa=0.605 and p<0.01) and MUAC (kappa=0.631 and p<0.01) significantly correlated with AHtR across all age groups. Conclusion: AHtR is a simple, inexpensive, reliable, and accurate index to detect overweight and obesity in 5-12-year-old children. It serves as a useful alternative tool for BMI.