The validity of mid-upper arm circumference as an indicator of low BMI in population screening for undernutrition: a study among adult slum dwellers in eastern India

Das, Priyanka; Khatun, Argina; Bose, Kaushık; Chakraborty, Raja

doi:10.1017/s1368980018001301

Cited by 17 publications

(34 citation statements)

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“…These findings suggest that MUAC could be used as a screening tool for adult underweight in a low-resource setting, the same way BMI is currently being used. Other studies have found similar correlations in adult populations [ 2 , 7 , 10 – 15 ] and with a high correlation across ethnicity and sex. While there is consensus about the usefulness of MUAC, the optimal cutoff to detect underweight is still not determined.…”

Section: Discussionsupporting

confidence: 71%

“…The cutoff can be described by YI, and with this method, we found that a MUAC of 24.5 cm would be the cutoff best associated with a BMI < 18.5 kg/m 2 . Other studies also using YI found that the MUAC cutoff should be between 21.9–25.1 cm [ 7 , 11 , 13 , 15 , 16 ]. However, we believe the optimal cutoff should not be determined strictly based on an equation, but instead take into account the setting it is to be used in.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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 ).

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…We then examined the diagnostic accuracy of MUAC in predicting low BMI, using MUAC cut-offs in increments of 0 GUI-HIV (13) Guinea-Bissau 2007-2009 ART-naïve, HIV-infected patients in Guinea-Bissau 1055 GUI-TBC (27) Guinea-Bissau 2014 Healthy controls and household contacts of TB patients in Guinea-Bissau 769 IND-BKW (28) India 2014-2016 Adult male brick-kiln workers in Murishdabad district, West Bengal, India 501 IND-FSD (9) India 2006 Female slum dwellers in Midnapore Town, West Bengal, India 333 IND-IDU (29) India 2007 Current and former male IDU in Chennai, Tamil Nadu, India 374 IND-MSD (10) India [2003][2004] Male slum dwellers in Kolkata, India 474 IND-ORA (30) India 2007 Oraon men of Gumla District, Jharkhand, India 205 IND-SDW (31) India (33) South Africa 2002 Free-living and institutionalised elderly black South Africans in Cape Town, South Africa…”

Section: Statistical Analysesmentioning

confidence: 99%

Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)

Tang

Chung

Dong

et al. 2020

Public Health Nutr.

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Objective: To determine if a global mid-upper arm circumference (MUAC) cut-off can be established to classify underweight in adults (men and non-pregnant women). Design: We conducted an individual participant data meta-analysis (IPDMA) to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cut-offs for identifying underweight among adults (defined as BMI < 18·5 kg/m2). Measures of diagnostic accuracy were determined every 0·5 cm across MUAC values from 19·0 to 26·5 cm. A bivariate random effects model was used to jointly estimate SENS and SPEC while accounting for heterogeneity between studies. Various subgroup analyses were performed. Setting: Twenty datasets from Africa, South Asia, Southeast Asia, North America and South America were included. Participants: All eligible participants from the original datasets were included. Results: The total sample size was 13 835. Mean age was 32·6 years and 65 % of participants were female. Mean MUAC was 25·7 cm, and 28 % of all participants had low BMI (<18·5 kg/m2). The area under the receiver operating characteristic curve for the pooled dataset was 0·91 (range across studies 0·61–0·98). Results showed that MUAC cut-offs in the range of ≤23·5 to ≤25·0 cm could serve as an appropriate screening indicator for underweight. Conclusions: MUAC is highly discriminatory in its ability to distinguish adults with BMI above and below 18·5 kg/m2. This IPDMA is the first step towards determining a global MUAC cut-off for adults. Validation studies are needed to determine whether the proposed MUAC cut-off of 24 cm is associated with poor functional outcomes.

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“…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.…”

Section: Research About Muac Cut-off Point For Detecting Malnutritionmentioning

confidence: 99%

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

2021

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Body mass index is commonly used for detecting malnutrition. At certain conditions, body mass index cannot be measured, so mid-upper arm circumference can be an alternative measurement for detecting malnutrition. Several studies have proposed the cut-off point of mid-upper arm circumference in adults along with its sensitivity, specificity, and area under the ROC curve (AUC). This article aims to describe the diagnostic test for malnutrition using the upper arm circumference in adults and summarize the results of the related studies.

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The validity of mid-upper arm circumference as an indicator of low BMI in population screening for undernutrition: a study among adult slum dwellers in eastern India

Abstract: Results supported the validity of the WHO-recommended MUAC cut-offs for adults. There is still a need to establish statistically appropriate MUAC cut-offs to predict undernutrition and morbidity.

Cited by 17 publications

References 50 publications

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

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

Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)

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

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