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. 2021 Oct;24(15):4777-4785.
doi: 10.1017/S1368980021002913. Epub 2021 Jul 12.

Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees

David Ce Philpott  1 , Valérie Belchior-Bellino  2 , Mija Ververs  3
Affiliations

Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees

David Ce Philpott et al. Public Health Nutr. 2021 Oct.

Abstract

Objective: BMI is a time-intensive measurement to assess nutritional status. Mid-upper arm circumference (MUAC) has been studied as a proxy for BMI in adults, but there is no consensus on its optimal use.

Design: We calculated sensitivity, specificity and area under receiver operating characteristic curve (AUROCC) of MUAC for BMI < 18·5, <17 and <16 kg/m2. We designed a system using two MUAC cut-offs, with a healthy (non-thin) 'green' group, a 'yellow' group requiring BMI measurement and a 'red' group who could proceed directly to treatment for thinness.

Setting: We retrospectively analysed monitoring data collected by the International Committee of the Red Cross in places of detention.

Participants: 11 917 male detainees in eight African countries.

Results: MUAC had excellent discriminatory ability with AUROCC: 0·87, 0·90 and 0·92 for BMI < 18·5, BMI < 17 and BMI < 16 kg/m2, respectively. An upper cut-off of MUAC 25·5 cm to exclude healthy detainees would result in 64 % fewer detainees requiring BMI screening and had sensitivity 77 % (95 % CI 69·4, 84·7) and specificity 79·6 % (95 % CI 72·6, 86·5) for BMI < 18·5 kg/m2. A lower cut-off of MUAC < 21·0 cm had sensitivity 25·4 % (95 % CI 11·7, 39·1) and specificity 99·0 % (95 % CI 97·9, 100·0) for BMI < 16 kg/m2. An additional 50 kg weight requirement improved specificity to 99·6 % (95 % CI 99·0, 100·0) with similar sensitivity.

Conclusions: A MUAC cut-off of 25·5 cm, above which detainees are classified as healthy and below receive further screening, would result in significant time savings. A cut-off of <21·0 cm and weight <50 kg can identify some detainees with BMI < 16 kg/m2 who require immediate treatment.

Keywords: BMI; Male detainees in sub-Saharan Africa; Malnutrition; Mid-upper arm circumference; Sensitivity and specificity; Thinness.

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Figures

Fig. 1
Fig. 1
Example MUAC tool
Fig. 2
Fig. 2
Flow of participants through study
Fig. 3
Fig. 3
Proposed management schema
See this image and copyright information in PMC

References

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