Evaluation of the relationship between nutrition and calf circumference measurement in followed-up children aged 1–5 years (12–60 months) at the primary care level

Objective: Nutritional factors play a role in approximately 45% of deaths in children under the age of five. Therefore, early identification of children with nutritional deficiencies is crucial. In this study, we aimed to investigate the usability of calf circumference measurement in assessing the nutritional status of children, to evaluate the correlation between this measurement and other anthropometric indicators, and to examine nutritional differences between the central and district areas of Manisa province. Materials and Methods: A total of 210 children aged 1–5 years who were healthy and had no chronic diseases and who presented to family health centers in the central and district areas of Manisa province for any reason were included in the study. Weight, height, mid-upper arm circumference (MUAC), and calf circumference measurements were taken. Body mass index (BMI), weight-for-age (WFA), weight-for-height (WFH), height-for-age (HFA), and MUAC z-scores were calculated. Correlation analyses were conducted to assess the compatibility among the measurements, and ROC analysis was used to determine cut-off values of calf circumference for predicting malnutrition and obesity. Results: Of the 210 participants, 51.4% were girls and 48.6% were boys, with a mean age of 37.8 ± 15.2 months. The average duration of breastfeeding was 14.6 ± 8.46 months, and the average age of transition to complementary feeding was 5.99 ± 1.77 months. According to Olcay Neyzi reference values, the prevalence of malnutrition was found to be 10% based on WFH, 18.6% based on WFA, 17.6% based on HFA, and 17.2% based on MUAC z-scores. The rates of overweight and obesity were found to be 19.1% based on WFH, 21.5% based on BMI, and 12.3% based on MUAC z-scores. No statistically significant difference in nutritional status was found between Manisa's central and district areas. A moderate correlation was observed between WFH and MUAC z-scores, while a high correlation was found between WFA and MUAC z-scores. There was a strong correlation between BMI and WFH in assessing obesity. Formula feeding was significantly associated with obesity based on MUAC z-scores, while malnutrition was more frequent in those not receiving formula. Calf circumference measurements yielded significant age- and sex-specific cut-off values for malnutrition and obesity. For malnutrition, the cut-off values for boys were: age 1: 18.9 cm, age 2: 19.7 cm, age 3: 20.3 cm, age 4: 20.8 cm; and for girls: age 1: 19 cm, age 2: 19.3 cm, age 3: 20.5 cm, age 4: 21.1 cm. For obesity, the cut-off values for boys were: age 1: 20.7 cm, age 2: 21.2 cm, age 3: 22.4 cm, age 4: 22.2 cm; and for girls: age 1: 20.5 cm, age 2: 20.6 cm, age 3: 22.5 cm, age 4: 23.2 cm.