Abstract
BackgroundUndernourished 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.MethodsA 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.ResultsA 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/m2 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.ConclusionMUAC 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/m2).
Highlights
Undernourished people have an increased risk of premature mortality from both infectious and noncommunicable diseases
54 were excluded; 26 were underage, 9 had edema, 16 were pregnant and 3 had missing data for analysis. This yielded a total of 302 participants of which 90 had rheumatic heart disease (RHD)
This study found a strong correlation between BMI and Mid-upper arm circumference (MUAC) in both male and non-pregnant female adults in Nepal, and a statistically-derived MUAC cutoff for an underweight equivalent to BMI < 18.5 kg/m2 of 24.5 cm with similar results in men and women
Summary
Undernourished people have an increased risk of premature mortality from both infectious and noncommunicable diseases. Body-Mass-Index (BMI) is today the most commonly used marker of nutritional status 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. The World Health Organization has recommended body mass index (BMI) to assess nutritional status in adults [1], despite difficulties assessing fat-free mass In chronic undernutrition, the body loses both fat mass and fat-free mass. Is BMI challenged when used as an indicator of chronic undernutrition [3], MUAC outperforms BMI when comparing the ability to predict all-cause mortality [4, 5]. BMI, no matter the setting, often is difficult to perform on very ill and immobile patients
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