Determination of overnutrition using mid-upper arm circumference in comparison with bioelectrical impedance analysis in children and adolescents in Benin, Nigeria

Abstract

Purpose The prevalence of overweight and obesity in children and adolescents is on the increase in developing countries. Therefore, a cheap, accessible and simple screening tool such as the mid-upper arm circumference (MUAC) is required for the prompt assessment. The purpose of this paper is to determine the usefulness of MUAC in assessing overnutrition in comparison with bioelectrical impedance analysis (BIA). Design/methodology/approach Participants included 1,067 children aged 6–18 years recruited from private and public schools in Egor Local Government Area in Benin City, Nigeria. Body fat was estimated by BIA using a Tanita scale, whereas the MUAC was measured with a non-elastic tape. Receiver operating characteristic analysis was used to test the ability of MUAC to determine children and adolescents identified as overweight and obese by BIA. Findings The prevalence of overnutrition by MUAC (12.4 percent – overweight 6.0 percent and obesity 6.4 percent) was comparable to that by BIA (12.3 percent – overweight 5.4 percent, obesity 6.9 percent). There was a significant correlation between MUAC and body fat percentage, fat mass, fat mass index and fat-free mass index in both males and females (p=0.000). Research limitations/implications This study, in contrast to most other studies on the use of MUAC in the assessment of overnutrition, has the advantage of using BIA cut-offs values against body mass index which does not assess body fat composition. BIA is, however, not the gold standard in the measurement of body fat composition. The optimal MUAC cut-off values of this study may not be representative of the entire country because of its restriction to Benin. Similar studies from different parts of Nigeria will be required to validate this smoothed MUAC percentiles for use in the screening of children and adolescents for overnutrition. Originality/value MUAC compares well with BIA in this study and can be a useful, alternative and practical screening tool for assessing obesity in the resource-poor setting.

The performance of mid-upper arm circumference for identifying children and adolescents with overweight and obesity: a systematic review and meta-analysis

“…Only two studies have compared the discriminatory ability of MUAC with total body fat which was measured with bioelectrical impendency. A high level of discriminatory ability of MUAC has been reported by both studies (18,44) . None of the studies have assessed the discriminatory performance of MUAC with the four-compartment model, the known golden standard to measure total body fat.…”

“…Most studies used an 85th percentile (Z score > 1 þ SD) cut-off of BMI growth curves for overweight and a 95th percentile cut-off (Z score > 2 þ SD) of BMI curve for obesity. Both studies that use bioelectrical impendency classify participants with 85th percentile as overweight (18,44) . The cut-off points of MUAC values for defining overweight and obesity varied substantially between studies (see online supplementary material, Supplemental Table S4).…”

“…All of the studies were cross-sectional and were published from 2013 to 2021. They were conducted in twenty-one countries including Brazil (36) , China (37) , Netherlands (38) , Ethiopia (20) , India (39)(40)(41) , Indonesia (42) , Nigeria (43,44) , Pakistan (25,45) , Seri Lanka (24) , South Africa (46,47) , Thailand (48) , Turkey (49,50) , Trinidad and Tobago (51) and twelve countries (17) (Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the UK and the USA) (n 1). The number of participants varied substantially between studies (range from 211 to 31 471), with a pooled population of 54 381 children and adolescents.…”

“…Studies used different reference methods: three studies used bioelectrical impendency (18,44) ; two used waist circumferences (49,52) ; the rest used BMI. Most studies used an 85th percentile (Z score > 1 þ SD) cut-off of BMI growth curves for overweight and a 95th percentile cut-off (Z score > 2 þ SD) of BMI curve for obesity.…”

Malnutrition in Children of Growing Age and the Associated Health Concerns

“…Hypertension is one of these problems, which increases the risk of long-term cardiovascular illnesses and early mortality. According to the studies in Nigeria among school-aged children, the obese children had a considerably greater proportion of children with blood pressure in the pre-hypertension and hypertension range (Oriaifo et al 2019). One of the key factors contributing to a poor pregnancy outcome is maternal obesity or over-nutrition.…”