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Meta-Analysis
. 2020 Dec;23(17):3104-3113.
doi: 10.1017/S1368980020000397. Epub 2020 Aug 17.

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

Alice M Tang  1 , Mei Chung  1 , Kimberly R Dong  1 , Paluku Bahwere  2 , Kaushik Bose  3 , Raja Chakraborty  4 , Karen Charlton  5   6 , Priyanka Das  3 , Mihir Ghosh  3 , Md Iqbal Hossain  7 , Phuong Nguyen  8 , Cecilie B Patsche  9   10 , Tania Sultana  7 , Megan Deitchler  11 , Zeina Maalouf-Manasseh  12
Affiliations
Meta-Analysis

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

Alice M Tang et al. Public Health Nutr. 2020 Dec.

Abstract

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.

Keywords: Cut-off; Individual participant data meta-analysis; Low BMI; Mid-upper arm circumference; Nutritional screening; Underweight.

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Figures

Fig. 1
Fig. 1
Receiver operating characteristic curve for all studies included in the individual participant data meta-analysis (IPDMA) combined. Area under the receiver operating characteristic curve = 0·91
See this image and copyright information in PMC

Comment in

  • Global mid-upper arm circumference cut-offs for adults: a call to action.
    Maalouf-Manasseh Z, Remancus S, Milner E, Fenlason L, Quick T, Patsche CB, Bose K, Collins S, Ververs M, Walia S, Escobar-Alegria J, Chung M, Tang AM. Maalouf-Manasseh Z, et al. Public Health Nutr. 2020 Dec;23(17):3114-3115. doi: 10.1017/S1368980020000385. Epub 2020 Aug 26. Public Health Nutr. 2020. PMID: 32844737 Free PMC article.

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