Mid-upper Arm Circumference Measurements Research Articles

A short report on the mid-upper arm circumference (muac) pattern in children in Jos

Objective : This study was done to report the mid-upper arm circumference (MUAC) pattern in children aged 2-5 years in Jos. Study Population and Methods : Data was collected in May 2002 and permission was granted for this study to be carried out. Children were selected from both groups of sexes (males and females). A tape measure was used; this is strictly speaking, a Population Study so every child aged five years and below was recruited in this study. 173 pupils (89males and 84females) had MUAC measurements taken. Results :The Mean (±SEM) MUAC by age distribution: 15.8 ± 0.68 cm and 16 ± 0 cm for males and females 2 year old respectively (p th percentile) and 18cm (95 th percentile), while for females 14.4cm and 17.6cm represented 5 th percentile for 3 year olds and 95 th percentile for 5 year olds respectively. Conclusion : In this study, the mean MUAC values of the age groups varied between 15.8 ± 0.68cm and 17.4 ± 0.84 cm, while 5 th to 95 th percentile values ranged between 14.4cm to 18cm across both sexes. The lowest mean and percentile values of MUAC for both males and females are higher than 13cm. Therefore an upward review of cut off points for MUAC should be considered in future. Keywords : school children, mid upper arm circumference (muac), percentiles, fixed cut-off points Highland Medical Research Journal Vol. 3(2) 2005: 121-127

Development of a novel nutrition screening tool for use in elderly South Africans

To develop a nutrition screening tool for use in older South Africans. A cross-sectional validation study in 283 free-living and institutionalised black South Africans (60+ years). Trained field-workers administered a 24-hour recall and the Mini Nutritional Assessment (MNA) screening tool, and performed anthropometric measurements and physical function tests. Cognitive function was assessed using a validated version of the Six-Item Cognitive Impairment Test. Biochemical indicators assessed included serum albumin, haemoglobin, ferritin, vitamin B12, red-blood-cell folate, cholesterol and vitamin C. The MNA was used as the gold standard against which a novel screening tool was developed using a six-step systematic approach, namely: correspondence analysis; identification of key questions; determination of internal consistency; correlational analyses with objective measures; determination of reference cut-off values for categories of nutritional risk; and determination of sensitivity and specificity. The new screening tool includes nine separate concepts, comprising a total of 14 questions, as well as measurement of mid-upper arm circumference. The new tool score was positively associated with level of independence in either basic activities of daily living (r = 0.472) or the more complex instrumental activities of daily living (r = 0.233). A three-category scoring system of nutritional risk was developed and shown to significantly characterise subjects according to physical function tests, level of independence and cognitive function. The new tool has good sensitivity (87.5%) and specificity (95.0%) compared with the MNA scoring system. It has a very high negative predictive value (99.5%), which means that the tool is unlikely to falsely classify subjects as well nourished/at risk when they are in fact malnourished. A novel screening tool has been shown to have content-, construct- and criterion-related validity, and the individual items have been shown to have good internal consistency. Further validation of the tool in a new population of elderly Africans is warranted.

Performance Status of Male and Female Advanced Cancer Patients Is Independently Predicted by Mid-Upper Arm Circumference Measurement

In the advanced cancer patient, performance status has considerable prognostic power. Karnofsky performance status, together with variables reported to influence its score, was measured in advanced gastrointestinal cancer patients (n = 148). For male and female patients, age, body mass index, weight loss, triceps skinfold thickness, mid-upper arm circumference, albumin, C-reactive protein, and tumor type and stage were regressed against Karnofsky performance status. On multiple regression analysis, only mid-upper arm circumference and logsub10; C-reactive protein in men (r2 = 0.462, P < 0.0001) and only mid-upper arm circumference and weight loss in women (r2 = 0.485, P < 0.01) were independent predictors of Karnofsky performance status. There was a significant partial correlation, with gender as a covariable, between logsub10; C-reactive protein and albumin (r = -0.530, P < 0.0001) and mid-upper arm circumference (r = -0.269, P = 0.035) and weight loss (r = 0.286, P = 0.024). The results of the present study indicate that mid-upper arm circumference is a major factor that influences performance status in male and female patients with advanced gastrointestinal cancer.

Body composition unaltered for African women classified as 'normal but vulnerable' by body mass index and mid-upper-arm-circumference criteria.

To test the hypothesis that 'normal but vulnerable' adults, as defined by body mass index (BMI) in combination with mid-upper-arm-circumference (MUAC), are closer to normal than to malnourished ones. For that purpose body composition measurements were compared between normal and low BMI categories and according to MUAC value in an African context and for different age groups. Reanalysis of data from a previous cross-sectional cluster sample nutrition survey. A rural area of the Republic of Congo, Central Africa. A representative sample (n=544) of non-pregnant women. Arm muscle area was calculated from measurements of triceps skinfold thickness and MUAC. Peripheral body fat was assessed by the sum of four skinfold thicknesses. The ratio of resistance at high and low frequencies was derived from whole body measurement of multifrequency bioelectrical impedance analysis and used as the extracellular to total body water ratio index. The prevalence of thinness decreased from 18.7% as defined by BMI alone to 9.0% as defined by BMI and MUAC. This difference was due to the group of subjects classified as 'normal but vulnerable' (9.7%). Prevalence of thinness increased with age when assessed by BMI alone, but no longer when assessed by BMI and MUAC. Comparison with the BMI> or =18.5 kg/m(2) category showed that in 'normal but vulnerable' subjects lower BMI was accompanied by lower both fat and lean compartments, in absolute values, but the equilibrium of body water compartments was not altered. In BMI<18.5 women, low MUAC was associated with altered lean tissues, at peripheral and whole body level, whereas fat tissue did not differ. 'Normal but vulnerable' subjects appeared as 'thin but healthy' rather than malnourished, at all ages, even though their BMI was lower than 18.5 kg/m(2). The new classification of thinness based on BMI and MUAC provides a more specific index of nutritional status when restricting the thin category to more at-risk subjects.

The effects of malaria control on nutritional status in infancy

Both malaria and undernutrition are major causes of paediatric mortality and morbidity in sub-Saharan Africa. The introduction of insecticide-treated bed nets (ITBN) during a randomized controlled trial on the Kenyan coast significantly reduced severe, life-threatening malaria and all-cause childhood mortality. This paper describes the effects of the intervention upon the nutritional status of infants aged between 1 and 11 months of age. Seven hundred and eighty seven infants who slept under ITBN and 692 contemporaneous control infants, were seen during one of three cross-sectional surveys conducted during a one year period. Standardized weight-for-age and mid-upper arm circumference measures were significantly higher among infants who used ITBN compared with control infants. Whether these improvements in markers of nutritional status were a direct result of concomitant reductions in clinical malaria episodes remains uncertain. Never-the-less evidence suggests that even moderate increases in weight-for-age scores can significantly reduce the probability of mortality in childhood and ITBN may provide additional gains to child survival beyond their impressive effects upon malaria-specific events.

The Use of Mid-upper-arm Circumference to Monitor Nutritional Rehabilitation Programmes in Rural Bangladesh

A mid-upper-arm circumference (MUAC) under 120 mm has been associated with a 10-fold increased risk of infant and child mortality from malnutrition in Bangladesh. The potential use of MUAC for the detection of moderate changes in nutritional status over short periods of time was tested in an International Center for Diarrheal Diseases Research Bangladesh study. Enrolled were 548 children under 5 years of age admitted to a nutrition rehabilitation unit during 1986-90 with MUACs under 120 mm. The mean stay in the unit was 19.1 days. Correlations between MUAC and weight measurements on admission to a nutrition rehabilitation unit during the stay and at discharge were analyzed. Children who remained in the unit for more than 7 days showed significant improvements in mean weight and MUAC values between admission and discharge. Weight and MUAC values were significantly correlated at both time points. These findings indicate that nutrition rehabilitation programs should use MUAC measurements both to detect malnourished children in the community and to evaluate the impact of nutritional interventions.

A longitudinal study of the growth of matched pairs of vegetarian and omnivorous children, aged 7-11 years, in the north-west of England.

To assess the ability of a meat free diet to support normal growth of children. A one year longitudinal observational case--comparison study of growth. Children were recruited mainly through schools from Merseyside and all measurements were taken in their homes. Fifty 'free-living' children following meat free diets, aged 7-11 y (expected to be pre-pubertal), were compared with a control group of 50 omnivores matched for age, sex and ethnic group. None. Height, weight, upper arm skinfold thicknesses and mid-upper arm circumference measurements were taken at baseline and one year later. The increments over one year were each analysed using a multiple stepwise regression model which derived predicted increments controlled for a variety of factors other than the diet factor. Of all the anthropometric measurements examined only the predicted height increment of the vegetarians was slightly greater than that of the omnivores (difference in predicted height increment = 0.47 cm, P = 0.05). This difference was only apparent after allowing for father's height, maternal smoking habit and number of siblings. A tendency for the vegetarians to be leaner than the omnivores was not significant at the 5% level and both the vegetarian and omnivorous groups lay close to the 50th percentiles for both height and weight (Child Growth Foundation, 1994). The results suggest that these children who followed a meat free diet and conventional lifestyles grew at least as well as children who ate meat.

Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991-1992 famine. Recommendations for standardization of methods

<h3>Objectives.</h3> —To evaluate the various survey methods used in Somalia between 1991 and early 1993 while assessing documentation of mortality and malnutrition rates and common causes of morbidity and mortality. <h3>Data Sources.</h3> —Twenty-three population surveys were identified from the Center for Public Health Surveillance for Somalia, the United Nations Children's Fund, and other humanitarian organizations. <h3>Study Selection.</h3> —Only surveys with defined populations and apparently systematic methodology that focused on mortality, morbidity, and/or nutritional status were included. <h3>Results.</h3> —Extensive methodological differences were found among the 23 surveys. Target populations and sampling strategies varied widely. Twelve studies were considered not reproducible. Of the 16 studies assessing mortality, only eight assessed cause of death. Use of units of measurement and inclusion of denominators in rate calculations were inconsistent. None of the studies provided confidence intervals around the point estimates of the rates. Of the 11 studies providing information on morbidity, none provided case definitions. And in the 16 studies reporting nutritional status, a variety of measurement methods and definitions of malnutrition were used. Three studies presented information based on midupper-arm circumference measurements, and 10 presented weight-for-height data below 70% and 80% of the reference median; only four studies presented z scores. <h3>Conclusions.</h3> —While the results of some studies may have influenced policy and program management decisions, their effects may have been limited by failure to adequately document results and by differences among studies in objectives, design, parameters measured, methods of measurement, definitions, and analysis methods. We recommend that agencies conducting population studies in emergency situations define clear study objectives, use standard sampling and data collection methods, and ensure precise written documentation of study objectives, methods, and results. (<i>JAMA</i>. 1994;272:371-376)

A New Reference for the Mid-upper Arm Circumference?

This article compares the Jelliffe method of mid-upper arm circumference measurement to the Gerver method. The Jelliffe method of nutritional status assessment in children is usually accepted as a reference. However Gervers anthropometric survey in 1979-1980 provides percentiles for mid-upper arm circumference measurements from 0-18 years for both males and females. In Gervers survey 2555 Dutch children between the ages of 0-19 years were measured. Except at 12 48 and 60 months of age the measurements for the boys were greater than those of the girls. Comparisons are made between the 2 surveys; the Gerver P50 measurements were about 0.5 cm above Jelliffes standards. This observation is attributed to the better nutritional status of the Dutch children. To avoid confusion with changing references and to allow comparison with past measurements it is recommended that the Jelliffe measurement of 16.5 continue to serve as age--constant reference when determining the nutritional status of children. However the Gerver measurements can be utilized for determining over-nutrition. For ages 18 cm and >19 cm respectively. For ages >4 years the P90 value was >19 cm and the P97 value was >20 cm.

Association Between Weight for Age and Mid-upper Arm Circumference Measurement: Findings from Malawi

Anthropometric methods involving measurement of weight-for-height, height-for-age, weight-for-age, and mid-upper arm circumference have been extensively researched to identify an appropriate method of monitoring infant and child growth. Many countries have adopted weight for age as the main practical method. The Malawi Ministry of Health introduced weight for age based upon WHO recommended standards as a growth indicator in 1973. There are, however, difficulties in making the practice widely used at community level. In the present study, confined to the four urban areas of Malawi, a comparison was made between the weight-for-age (W/A) and mid-upper arm circumference (MUAC) measurements. A very good correlation was observed between the two methods of screening for identification of undernourished children from 4 months of age onwards. Correct use of MUAC was found to be as effective as W/A in detecting undernutrition.

ARM CIRCUMFERENCE AND OTHER FACTORS IN CHILDREN AT HIGH RISK OF DEATH IN RURAL BANGLADESH

Mid upper arm circumference (MUAC) was measured monthly for 6 months in about 5000 children aged 6-36 months from rural Bangladesh. Children who would die within 1 month of screening could be identified with 94% specificity and 56% sensitivity—almost twice the sensitivity achieved by other anthropometric screening schemes for this level of specificity. Specificity was slightly improved when the absence of breast-feeding, concurrent diarrhoea, oedema, and acute respiratory infection were taken into account. Children at high risk of death can be detected by monthly measurement of MUAC, which may be used in poor communities where interventions have to be selective.

Estimation of the mid-upper arm circumference measurement error

The mid-upper arm circumference measurement error was estimated in order to assess the usefulness of this measurement for detecting small changes in a patient's arm circumference during hospitalization. In a study having a 3 X 3 X 2 factorial design, 10 trained observers recorded 1,560 measurements from 52 healthy adult subjects selected to represent three factors: sex, age, and weight for height. Each observer obtained three independent measurements from every subject. By analysis of variance, the variation between different observers' measurements of the same subject was estimated with 95% confidence to be less than or equal to 2.8% for men and less than or equal to 3.8% for women. This variation was unaffected by age but decreased with decreasing weight for height in women (p less than .05). Variation between each observer's repeated measurements of the same subject was estimated with 95% confidence to be less than or equal to 1.1% and was unaffected by sex, age, or weight for height. It was concluded that the smallest detectable change in arm circumference is 7.8% for men and 9.8% for women when successive measurements are recorded by different observers. However, arm circumference changes as small as 2.2% can be detected in both men and women when successive measurements are obtained by the same observer.

Evaluating upper arm anthropometric measurements

Jelliffe's standards for evaluating measurements of mid-upper arm circumference, triceps skinfold thickness, and mid-upper arm muscle circumference of American adults were compared with percentile distributions developed from the first Health and Nutrition Examination Survey (NHANES I). These comparisons show that the standards poorly represent the adult U.S. population. Replacement of the standards with updated sex-specific values is not recommended, as (a) no single value for each arm parameter can be considered as "normal" for men or women of all ages and (b) the expression of arm measurements as percentages of standards is an inappropriate method of evaluation. Instead, measurements should be evaluated by comparison with age- and sex-specific percentile distributions developed from the NHANES I.

NEONATAL OBESITY

Anthropometric measurements of mid-upper arm circumference and the sum of skin fold thicknesses at 8 sites (SSFT) were obtained in 49 term infants [gestational age (GA) 38-42 wks] within 72 hra of birth. There were 4 SGA, 32 AGA and 13 LGA infants. Infants of diabetic mothers were excluded. 5/13 LGA infants had SSFT's >4 standard deviations X̄=48.7mm, range 44.8 to 51.0mm) above the mean for AGA infants X̄=27.0mm, S.D.±4.2mm). This group of 5 was classified as obese. The other 8/13 had SSFT's X̄=33.0mm, range 26.4 to 37.5mm) <3 S.D. above the AGA mean and were classified non-obese. Maternal weight at term (MWT), maternal weight gain (MWG), and each infant's cross-sectional mid-arm muscle area (MA), fat area (FA) and the FA/MA were computed. There was no significant difference between obese and non-obese groups for MA (p>.05) or MWG (p>.1). Birthweight (BW), FA, FA/MA and MWT were significantly different in the two groups.These data indicate (1) a sub-group of LGA infants can be defined as obese, (2) Increased weight in larger LGA infants is due primarily to increased fat, (3) obesity in LGA infants correlates more closely with MWT than MWG.