Mid-upper arm circumference as an indicator of underweight in adults: a cross-sectional study from Nepal

Abstract

Background Undernourished people have an increased risk of premature mortality from both infectious and non-communicable diseases. Aside from screening purposes, assessment of nutritional status is a useful tool in management and evaluation of various chronic diseases. Body-Mass-Index (BMI) is today the most commonly used marker of nutritional status however, this method presents a challenge in many low resource settings and immobile patients. Mid-upper arm circumference (MUAC) is another anthropometric measure that requires minimal equipment and little training. So far, MUAC cutoffs for undernutrition are well established in children < 5 years but there is still no consensus for a specific cutoff in adults. The objective of this study was to compare MUAC with BMI and suggest a MUAC cut-off corresponding to a BMI of 18.5 kg/m2 to identify underweight in adults. Methods A cross-sectional study was conducted at two urban public hospitals in Nepal. The following variables where collected: MUAC, weight, height, sex, age and self-reported medical history. Exclusion criteria: < 19 years of age, pregnancy and oedema. Sensitivity and specificity for a MUAC value corresponding to BMI < 18.5 was calculated. ROC analysis was performed for male and female as well as Pearson’s correlation of MUAC and BMI. Results A total of 302 people between 18 and 86 years of age, 197 women and 105 men, were included. Of these, 90 people suffered from rheumatic heart disease. MUAC was highly correlated with BMI in both women r = 0.889 and men r = 0.846. Best statistically derived MUAC cutoff corresponding to a BMI < 18.5 kg/m 2 was 24.5 cm (Youdens Index = 0.75; sensitivity 92.86; specificity 82.48), with high predictive value (AUROCC> 0.9). The setting based optimal MUAC cutoff was also 24.5 cm. No considerable variation was found in sex- and disease specific subgroups. Conclusion MUAC is strongly correlated with BMI in adults in Nepal. For simplicity, a MUAC of 24.5 cm is the optimal statistically and setting based cutoff in both women and men to identify underweight (BMI < 18.5 kg/m 2 ).

High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique

“…Both MUAC cut-offs, <24 and <25 cm, identified more Tanzanian, male and the elderly (≥65 years) farmers with underweight, but again with a consequently lower specificity. A recent study in 302 female and male chronically ill and healthy adults from two urban public hospitals in Nepal suggested a MUAC cut-off of 24.5 cm (according to highest Youden's Index) for both sexes to identify underweight [33].…”

Validating mid-upper arm circumference (MUAC) cut off points as an indicator of nutritional status among nine tribal populations of India

“…On the other hand, a MUAC of 24 cm was proposed as appropriate in a study from the Southern India (Rodrigues et al 1994), among the Oraon tribal men from another eastern Indian state (Chakraborty et al 2011), and also among the slum dwellers of eastern India (Chakraborty et al 2009a(Chakraborty et al , 2009c. Thorup et al (2020) reported that MUAC of 24.5 cm was found to be the most appropriate to predict CED status together for both men and women in Nepal. On the basis of such findings, indicating higher MUAC cut off values than the universally proposed values by WHO, it was also argued that such tendency was perhaps due to the diverse ethnic origin and variation in body fat patterning and differences in the relationship between BMI and body fat across populations (Chakraborty et al 2009c).…”

“…Considering such operational problem with BMI, the mid-upper arm circumference (MUAC) is strongly recommended as an alternative measurement to assess undernutrition in infants, children and adults WHO, UNICEF 2019) and even in pregnant women (Fakier et al 2017). It is mostly because MUAC is a simple, non-invasive measurement requiring simple equipment, i.e., a tape measure, and thus, suitable for epidemiological and clinical settings, particularly, in resource-limited set up (Das et al 2018;Thorup et al 2020;WHO 2004). Besides, MUAC shows consistently a high correlation with BMI across age (Das et al 2018;Tang et al 2020).…”

A diagnostic test for malnutrition in adults: mid-upper arm circumference towards body mass index: A literature review

“…Various studies have shown a significant correlation between MUAC and BMI, it is known that individuals with low MUAC are likely to have a low BMI. 4,6,[18][19][20][21][22][23] Research conducted by Brito et al 8 on 1373 inpatients at a hospital in Spain, showed that there was a correlation between BMI and MUAC with r = 0.78 (p <0.001). The cut-off point value for detecting malnutrition obtained from this study was 22.5 cm for both men and women.…”