Mid-upper arm circumference and diabetes/prediabetes in children and adolescents: A cross-sectional study using NHANES data

Mid-upper arm circumference (MUAC) is a simple anthropometric measure proposed as a marker of adiposity and cardiometabolic risk, but its relationship with diabetes and prediabetes in children and adolescents has not been fully characterized. This study assessed the association between MUAC and glycemic status in a nationally representative pediatric sample. We performed a cross-sectional analysis of pooled data from the 1999 to 2018 NHANES cycles, including 27,543 children and adolescents (age 6–19 years), of whom 2165 were classified as having diabetes or prediabetes by standard laboratory and self-report criteria. MUAC was measured at the midpoint of the right upper arm. Survey-weighted logistic regression models evaluated MUAC as both a continuous and categorical (quartiles) predictor of diabetes/prediabetes, adjusting for age, sex, race, education, poverty‑income ratio, body mass index, elevated blood pressure, and dyslipidemia. Restricted cubic spline analysis examined nonlinearity; subgroup analyses tested robustness. Higher MUAC was independently associated with higher odds of diabetes/prediabetes: per 1‑cm increase odds ratio: 1.04 (95% confidence interval [CI]: 1.01–1.08; P = .020). Versus Q 1, adjusted odds ratios were Q 2 2.57 (95% CI: 1.81–3.67), Q 3 2.40 (95% CI: 1.60–3.61), Q 4 2.49 (95% CI: 1.57–3.97) (all P < .001). Restricted cubic spline revealed a significant non‑linear association ( P ‑nonlinearity <.001) with an inflection near MUAC ≈ 25.6 cm, above which odds increased more steeply. Subgroup analyses indicated stronger associations in females and in children <14 years. Associations remained consistent across the analyses. In this large, nationally representative sample of children and adolescents, elevated MUAC was independently associated with higher odds of diabetes and prediabetes, with evidence of a nonlinear dose–response and a threshold near 25.6 cm. Prospective studies are needed to validate cutoffs and explore the potential role of MUAC as a risk marker for dysglycemia.