Evaluating the Diagnostic Accuracy of CANS, Anthropometric, and Proportionality Indices for Fetal Malnutrition in Pakistan

Syeda Maryam Batool; Irum Javed; Salma Ghaffar; Nasir Zareen; Mahmood Ahmad Zahid; Syeda Shafaq Batool

doi:10.71104/jsogp.v14i2.651

Syeda Maryam Batool Professor Obstetrics department CMH Poonch Medical College Rawalkot
Irum Javed Assistant Professor, Department of Paediatrics, Poonch Medical College Rawalakot
Salma Ghaffar Associate Professor, Surgery, Poonch Medical College, AK CMH Rawalakot, AJK
Nasir Zareen Assistant Professor of Surgery CMH/SKBZ Hospital Poonch Medical College Rawalakot
Mahmood Ahmad Zahid Senior Registrar Anaesthesia, Poonch Medical College, SKBZ/CMH Rawalakot Azad Kashmir
Syeda Shafaq Batool Gynae department CMH Rawalakt

DOI: https://doi.org/10.71104/jsogp.v14i2.651

Keywords: Fetal Malnutrition, Neonatal Nutrition, Maternal Nutrition

Abstract

Background: Fetal Malnutrition (FM), a serious neonatal condition, is characterized by inadequate accumulation of subcutaneous fat and muscle, independent of birth weight for gestational age. This study aims to assess and compare the diagnostic accuracy of various nutritional assessment methods, including the Clinical Assessment of Nutritional Status (CANS) score, anthropometric measurements, and proportionality indices in identifying FM.

Methodology: This cross-sectional study included 320 live singleton newborns at Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawalakot, Azad Kashmir, Pakistan, from December 2022 to July 2023. The neonatal participants were comprehensively assessed in terms of the CANS score, anthropometric measurements (weight, length, and Body Mass Index_(BMI)), and proportionality indices such as the Ponderal Index (PI) and the Mid-Upper Arm Circumference to Head Circumference ratio (MUAC/HC). Diagnostic accuracy metrics (sensitivity, specificity, Positive Predictive Value [PPV], and Negative Predictive Value [NPV]) were calculated according to established FM diagnostic criteria.

Results: Among the 320 neonates considered in this study, 61.3% were male, and 25.6% were preterm. The mean birth weight was 2.61 Â± 0.73 kg, with a mean CANS score of 25.06 Â± 8.21. A significant association was observed between gestational age and nutritional status. Preterm neonates exhibited higher rates of FM, as measured by MUAC/HC, PI, and BMI (p < 0.001). Diagnostic accuracy assessments indicated that when the CANS score is considered a gold standard, it demonstrated perfect sensitivity and specificity for detecting FM, while BMI and PI showed lower but significant sensitivity and specificity. The combination of BMI and PI (among metrics excluding the CANS score) yielded the highest accuracy in FM detection, reducing diagnostic errors significantly.

Conclusions: FM prevalence was substantial in the studied population sample, particularly among preterm neonates. The CANS score remains a robust tool for FM detection and its incorporation with BMI and PI further enhances diagnostic accuracy. These findings highlight the importance of precise FM assessment and early optimization of neonatal nutritional intake to mitigate the detrimental sequalae of malnutrition.