Anthropometric predictors of mortality in undernourished adults in the Ajiep Feeding Programme in Southern Sudan

Irena, Abel Hailu; Ross, David A.; Salama, Peter; Collins, Steve

doi:10.3945/ajcn.112.055095

Cited by 9 publications

(4 citation statements)

References 13 publications

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“…36 For predicting mortality among adults in a famine setting, the AUC was statistically significantly greater for MUAC (0.71) than for body mass index (0.57). 37 In this study we did not aim to examine the ability of MUAC to detect overweight and obesity, and these were rare in our validation datasets. However, several studies, including one comprising data from 12 countries, report a close correlation between MUAC and body mass index in this age group, likely due to its concordance with fat mass, [31][32][33][34] and have suggested diagnostic cut-off values.…”

Section: Growth Referencesmentioning

confidence: 99%

A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study

Mramba

Ngari

Mwangome

et al. 2017

BMJ

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Objectives To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality. Design Growth curve construction and longitudinal cohort study. Setting United States and international growth data, and cohorts in Kenya, Uganda, and Zimbabwe. Participants The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES) US population datasets (age 5-25 years), which were used to construct the 2007 WHO growth reference for body mass index in this age group, were merged with an imputed dataset matching the distribution of the WHO 2006 growth standards age 2-6 years. Validation data were from 685 HIV infected children aged 5-17 years participating in the Antiretroviral Research for Watoto (ARROW) trial in Uganda and Zimbabwe; and 1741 children aged 5-13 years discharged from a rural Kenyan hospital (3.8% HIV infected). Both cohorts were followed-up for survival during one year. Main outcome measures Concordance with WHO 2006 growth standards at age 60 months and survival during one year according to MUAC-for-age and body mass index-for-age z scores. Results The new growth curves transitioned smoothly with WHO growth standards at age 5 years. MUAC-for-age z scores of −2 to −3 and less than−3, compared with −2 or more, was associated with hazard ratios for death within one year of 3.63 (95% confidence interval 0.90 to 14.7; P=0.07) and 11.1 (3.40 to 36.0; P<0.001), respectively, among ARROW trial participants; and 2.22 (1.01 to 4.9; P=0.04) and 5.15 (2.49 to 10.7; P<0.001), respectively, among Kenyan children after discharge from hospital. The AUCs for MUAC-for-age and body mass index-for-age z scores for discriminating subsequent mortality were 0.81 (95% confidence interval 0.70 to 0.92) and 0.75 (0.63 to 0.86) in the ARROW trial (absolute difference 0.06, 95% confidence interval −0.032 to 0.16; P=0.2) and 0.73 (0.65 to 0.80) and 0.58 (0.49 to 0.67), respectively, in Kenya (absolute difference in AUC 0.15, 0.07 to 0.23; P=0.0002). Conclusions The MUAC-for-age z score is at least as effective as the body mass index-for-age z score for assessing mortality risks associated with undernutrition among African school aged children and adolescents. MUAC can provide simplified screening and diagnosis within nutrition and HIV programmes, and in research.

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Section: Growth Referencesmentioning

confidence: 99%

A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study

Mramba

Ngari

Mwangome

et al. 2017

BMJ

View full text Add to dashboard Cite

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“…Since both the average weight and height were lower among food-insecure women, the difference in BMI, which is, in fact, a ratio of the two, might have lost statistical significance. Moreover, several studies indicate that MUAC may be more sensitive to socioeconomic changes, better at detecting undernutrition, and superior prognostic indicator than BMI [71][72][73][74][75][76][77], and thus show a larger effect size. This can explain the statistical significance for MUAC and a lack of it for BMI in this study.…”

Section: Discussionmentioning

confidence: 99%

Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh

et al. 2021

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Food insecurity may affect women’s health; however, pertinent research is scant among pregnant women. This study investigated the association of household food insecurity (HFI) with the nutritional status and mental health of 672 early-gestation (5–16 weeks) pregnant women with a singleton fetus, who participated in the screening activity of a community-based trial (NCT04868669) in Matlab, Bangladesh. Height (cm), weight (kg), body mass index (kg/m2), mid-upper arm circumference (MUAC) (cm), depression, anxiety, and stress were the outcomes studied. HFI was assessed using the Household Food Insecurity Access Scale. Women’s depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scales-21. Propensity score matching based weighted multivariable linear and logistic regression were used to evaluate the independent association of HFI with the outcomes. In adjusted models, pregnant women from food-insecure households in rural Matlab were on average 2.0 cm shorter (β = −2.0, 95% CI: −3.3, −0.7), 2.0 kg lighter (β = −2.0, 95% CI: −3.4, −0.7), and had 0.6 cm lower MUAC (β = −0.6, 95% CI: −1.1, −0.1) than their food-secure counterparts. HFI was associated with higher odds of depression (OR = 3.3, 95% CI: 1.8, 5.9), anxiety (OR = 6.1, 95% CI: 3.7, 10.0), and stress (OR = 4.8, 95% CI: 1.6, 14.2) among the women. Public health measures should focus on ensuring proper nutrition during the critical growth periods of life, pregnancy, and external environmental shocks, to mitigate the adverse effects of HFI on women’s health.

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“…Furthermore, although evidence is available from very few studies in adults, MUAC may be better than BMI for predicting risk of adverse outcomes including death. For example in adults with very severe acute malnutrition in a famine setting, [34]; in adult acute admissions to London Hospitals [35] and deaths during TB treatment in adult HIV positive patients under demographic surveillance in Guinea Bissau [36]. Finally, it is likely that MUAC may be more responsive in detecting changes in nutritional status as a result of therapeutic feeding or intervention and therefore represent a simple tool for patient monitoring compared to repeated weight measurements, but little published data is currently available [30].…”

Section: Discussionmentioning

confidence: 99%

Performance of alternative measures to body mass index in the assessment of moderate and severe under-nutrition among acutely unwell patients hospitalized in a TB ward in the Philippines: A cross-sectional study

et al. 2019

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Body mass index (BMI) kg/m 2 is a key screening tool for under-nutrition in adults, but difficult to obtain in immobile or unwell patients, particuarly in low resource settings, due to inability to accurately measure both weight and height. Mid-upper arm circumference (MUAC) is used to assess under-nutrition in children under 5 years but no standardised cut-off values exist for adults. In a cohort of adult Filipino patients admitted to a tuberculosis ward we assessed (i) cut-offs for MUAC to predict moderate under-nutrition (BMI <17kg/m 2 ), (ii) the performance of limb lengths to predict height and; (iii) associations of body fat percentage from skinfolds and hand grip-strength with BMI. In 303 patients with MUAC and BMI at admission, aged 18–80 years (mean = 45.5, SD:14.8), BMI ranged from 11.2–30.6 kg/m 2 and 141 (46.5%) had BMI <17.0 kg/m 2 . Using receiver operator curves, MUAC cut-offs were identified as <20.5cm for males (sensitivity: 89%, specificity: 84%) and <18.5cm for females (sensitivity: 91%, specificity: 89%), for BMI<17.0 kg/m 2 . Using published equations, knee height had the lowest mean difference between predicted and measured heights compared to ulnar or demi-span: (-0.98 cm, 95% CI: -1.51/-0.44). Both grip-strength and body fat percentage were positively associated with BMI, in separate linear regression models with exposure-age-sex interactions (adjusted-R-squared values: 0.15, 0.66, respectively). MUAC can predict moderate acute under-nutrition with high positive predictive value. Further research is required to determine the performance of alternative measures to BMI to predict mortality or adverse outcomes in acutely unwell patients.

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Anthropometric predictors of mortality in undernourished adults in the Ajiep Feeding Programme in Southern Sudan

Cited by 9 publications

References 13 publications

A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study

A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study

Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh

Performance of alternative measures to body mass index in the assessment of moderate and severe under-nutrition among acutely unwell patients hospitalized in a TB ward in the Philippines: A cross-sectional study

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