RESUMEN
OBJECTIVE: (i) To assess diagnostic accuracy of mid-upper arm circumference (MUAC) for screening thinness and severe thinness in Indian adolescent girls aged 10-14 and 15-19 years compared with BMI-for-age Z-score (BAZ) <-2 and <-3 as the gold standard and (ii) to identify appropriate MUAC cut-offs for screening thinness and severe thinness in Indian girls aged 10-14 and 15-19 years. DESIGN: Cross-sectional, conducted October 2016-April 2017. SETTING: Four tribal blocks of two eastern India states, Chhattisgarh and Odisha. PARTICIPANTS: Girls (n 4628) aged 10-19 years. Measurements included height, weight and MUAC to calculate BAZ. Standard diagnostic accuracy tests, receiver-operating characteristic curves and Youden index helped arrive at MUAC cut-offs at BAZ < -2 and <-3, as gold standard. RESULTS: Mean MUAC and BMI correlation was positive (0·78, P = 0·001 and r 2 = 0·61). Among 10-14 years, MUAC cut-off corresponding to BAZ < -2 and BAZ < -3 was ≤19·4 and ≤18·9 cm. Among 15-19 years, corresponding values were ≤21·6 and ≤20·7 cm. For both BAZ < -2 and BAZ < -3, specificity was higher in 15-19 v. 10-14 years. State-wise variations existed. MUAC cut-offs ranged from 17·7 cm (10 years) to 22·5 cm (19 years) for BAZ < -2, and from 17·0 cm (10 years) to 21·5 cm (19 years) for BAZ < -3. Single-age area under the curve range was 0·82-0·97. CONCLUSIONS: Study provides a case for use of year-wise and sex-wise context-specific MUAC-cut-offs for screening thinness/severe thinness in adolescents, rather than one MUAC cut-off across 10-19 years, depending on purpose and logistic constraints.