Original Article|Articles in Press

Cutoff values for calf circumference to predict malnutrition in children and adolescents with malignant neoplasms: a new parameter for assessment?

Open AccessPublished:March 14, 2023DOI:
      This paper is only available as a PDF. To read, Please Download here.


      • 1.
        Childhood cancer usually causes changes in nutritional status;
      • 2.
        Innovative methods to identify early malnutrition are needed;
      • 3.
        Calf circumference is a simple, inexpensive, easy-to-apply, painless method that can help identify decreased muscle mass;
      • 4.
        Cutoff values for Calf circumference for children and adolescents with cancer will be very useful in clinical practice.


      Background & Aims

      Malnutrition in children and adolescents with cancer is a common finding, which tends to worsen during antineoplastic treatment. Anthropometric measurements are able to identify muscle wasting, such as calf circumference. This study aimed to propose cutoff values for calf circumference to identify malnutrition in children and adolescents with malignant neoplasms.


      A cross-sectional study, which included all children and adolescents, (ages 0 - 19 years old) with malignant neoplasms, evaluated from October 2015 to April 2017, at a Paediatric Oncology Institute's outpatient clinic. Biochemical and anthropometric parameters were collected, besides clinical data, sex and age. Receiver Operating Characteristic Curve were constructed to determine the best cutoff value for malnutrition identification, considering Body Mass Index as gold standard. The significance level was p<0.05.


      1794 cases (56.35% male) were selected. Cutoff values for calf circumference, in centimeters (cm) to identify undernutrition, according to the age range, in years, for males, were: 0 -1y: ≤17.2cm; 2-5y: ≤ 18.8cm; 6-9y: ≤23.9cm; 10-12y: ≤25.3 cm; 13-15y: ≤28.2cm; 16-19y: ≤32.0cm; and for females:0-1 y: ≤15.4 cm; 2-5y: ≤18.9 cm; 6-9 y: ≤ 24.1 cm; 10-12 y: ≤ 24.4cm; 13-15y: ≤ 29.1cm; 16-19 y: ≤30.2cm;(p<0,001). Malnutrition was observed in 30.14% of the sample, considering classification by calf circumference, and in 13.3%, considering the BMI z-score. There is association among malnutrition according to calf circumference, and biochemical parameters (albumin and total protein), p<0.05.


      Calf circumference is a good parameter of malnutrition in children and adolescents with cancer, besides being simple and easy to apply.


      Abreviations:CC (Calf Circumference), BMI (Body Mass Index), AC (Arm Circumference), AMA (Arm Muscle Area), ROC (Receiver Operating Characteristic), AUC (Area Under the Curve), CI (Confidence Interval), SM (Skeletal Muscle)