Using middle upper arm circumference to assess severe adult malnutrition during famine

Abstract

Objectives: To examine the use of middle upper arm circumference measurement (MUAC [cm]) and body mass index measurement (BMI [kg/m2]) in the screening of severely malnourished adults during famine.

Design: Nonrandomized cohort study, correlating measurements of MUAC and BMI.

Setting: The Concern Worldwide adult feeding center in the village of Ayod in south Sudan. The area has experienced several years of war, leading to severe famine during early 1993.

Participants: A total of 98 adult inpatients belonging to the Nuer tribe. Criteria for entry into the study were prior admission to the feeding center and the ability to stand and have a BMI measured.

Main outcome measures: A comparison of the ease of use of MUAC and BMI assessments, and a correlation of MUAC and BMI measurements.

Results: An MUAC measurement was easier to perform on severely malnourished adults than BMI assessment. For MUAC, the patient could be standing, sitting, or, in extreme cases, lying. For BMI, patients were required to stand. Measuring BMI requires a height board, weighing scales, and mathematical calculations; to measure MUAC, only a tape measure is required. A correlation between measurements of MUAC and BMI was demonstrated (r=0.88; 95% confidence interval, 0.82-0.92 P<.001). The proportions of the population and the actual individuals identified as malnourished by the 2 indicators were similar.

Conclusions: The MUAC measurement reflects adult nutritional status as defined by BMI. During famine, MUAC may be better suited to screening admissions to adult feeding centers than BMI. Studies to assess the capacity of MUAC cutoffs to predict mortality in severe adult malnutrition are needed.