Assessment of nutritional status at the time of cancer diagnosis in pediatrics: comparison between MUAC Z-score and BMI-for-age in a public hospital in Argentina.
Estudio comparativo entre el MUAC z-score e IMC/edad en un hospital público de Argentina
Keywords:
Pediatrics, oncology, malnutritionAbstract
Background: Nutritional status at cancer diagnosis is a key determinant of clinical outcomes in pediatric oncology. Body mass index-for-age (BMI-for-age) may underestimate malnutrition due to disease-related alterations in body composition. Mid-upper arm circumference expressed as MUAC Z-score may provide a more sensitive assessment.
Methods: A retrospective, observational, cross-sectional study was conducted including 42 children and adolescents (1–18 years) diagnosed with cancer and hospitalized in the pediatric hemato-oncology unit of a public hospital in Argentina between January and December 2025. Nutritional status at diagnosis was assessed using MUAC Z-score and BMI-for-age according to World Health Organization references. Agreement between both indicators was evaluated using the weighted Kappa coefficient.
Results: According to MUAC Z-score, 47.6% of patients were malnourished at diagnosis (40.5% moderate and 7.1% severe malnutrition). In contrast, BMI-for-age identified no cases of malnutrition, classifying 57.1% of patients as eutrophic and 42.9% as overweight. Agreement between the two methods was low (weighted Kappa = 0.20). The predominant discrepancy pattern was underestimation of malnutrition by BMI-for-age.
Conclusions: MUAC Z-score identified a substantially higher prevalence of malnutrition compared with BMI-for-age, with low concordance between both indicators. Reliance on BMI-for-age alone may be insufficient for initial nutritional assessment in pediatric oncology. Systematic use of MUAC Z-score may improve early identification of nutritional impairment and support timely nutritional interventions.
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