Evaluation of the Relationship Between Calf Circumference Measurement and Nutrition in Children Aged 1-5 Years (12-60 Months) Followed Up in Primary Care

Objective: This study aims to evaluate the feasibility of using measurement of calf circumference as an alternative method for assessing malnutrition status in children aged 1-5 years presenting to primary health care services.Method: Measurements of weight, height, mid-upper arm circumference (MUAC), and calf circumference were taken, and body mass index (BMI), weight-for-age, weight-for-height (WFH), height-for-age (HFA), and MUAC Z-scores were calculated for 210 study participants aged 1-5 years.Agreement between anthropometric measurements was assessed using Kappa agreement analysis.Receiver operating characteristic analysis was performed to determine cut-off values for calf circumference so as to discriminate between undernutrition and obesity.Results: According to Olcay Neyzi reference values, the prevalence rates of undernutrition were calculated as indicated based on WFH (10%), WAG (18.6%),HFA (17.6%), and MUAC (17.2%)Z-scores.The prevalence rates of overweight/obesity were estimated as indicated according to WFH (19.1%),BMI (21.5%), and MUAC (12.3%)Z-scores.Moderate agreement was observed between WFH and MUAC Z-scores, while high agreement was found between WAG and MUAC Z-scores.A high level of agreement was also observed between BMI and WFH in the assessment of obesity.Calf circumference Z-score cut-off values of ≥0.433 for obesity (area under the curve 0.83-0.84)and ≤-0.523 for malnutrition (area under the curve 0.77-0.88)were identified, with wide 95% bootstrap confidence intervals.Conclusion: Calf circumference measurement can be a practical tool for assessing nutritional status in children; however, the recommended cut-off values need to be validated in independent populations.