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Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | Obesity | Research

Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan

Authors: Imad R. Musa, Saeed M. Omar, Ishag Adam

Published in: BMC Public Health | Issue 1/2022

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Abstract

Background

Body mass index (BMI) remains the most used indicator of nutritional status despite the presence of a potentially credible alternative. Mid-upper arm circumference (MUAC) is an anthropometric measure that requires simple equipment and minimal training. The aim of this study was to compare MUAC with BMI and propose a MUAC cut-off point corresponding to a BMI of < 18.5 kg/m2 (underweight) and ≥ 30.0 kg/m2 (obesity) among Sudanese adults.

Methods

A cross-sectional study using multistage cluster sampling was conducted in New-Halfa, eastern Sudan. Participants’ age and sex were recorded and their MUAC, weight and height were measured using the standard procedures. The MUAC (cm) cut-offs corresponding to < 18.5 kg/m2 and ≥ 30.0 kg/m2 were calculated and determined using receiver operating characteristic (ROC) curve analysis

Results

Five hundreds and fifty-two adults were enrolled in the study. The median (interquartile range, IQR) of the participants age was 31.0 (24.0 ̶ 40.0) years and 331 (60.0%) of them were females. The medians (IQR) of BMI and MUAC were 22.4 (19.1 ̶ 26.3) kg/m2 and 25.0 (23.0 ̶ 28.0) cm, respectively.
There was a significant positive correlation between MUAC and BMI (r = 0.673, p < 0.001).
Of the 552 enrolled participants, 104 (18.8%), 282 (51.1%), 89 (16.1%) and 77 (13.9%) were normal weight, underweight, overweight and obese, respectively. Best statistically derived MUAC cut-off corresponding to a BMI < 18.5 kg/m2 (underweight) was ≤ 25.5 cm in both males and females (Youden’s Index, YI = 0.51; sensitivity = 96.0%; specificity = 54.0%), with a good predictive value (AUROCC = 0.82). Best statistically derived MUAC cut-off corresponding to a BMI ≥ 30.0 kg/m2 (obesity) was ≥ 29.5 cm in both males and females (YI = 0.62, sensitivity = 70.3%, specificity = 92.0%), with a good predictive value (AUROCC = 0.86, 95.0% CI = 0.76 – 0.95).

Conclusion

The results suggest that the cut-offs based on MUAC can be used for community-based screening of underweight and obesity
Literature
1.
go back to reference 1.Abdu AO, Yimamu ID, Kahsay AA. Predictors of malnutrition among older adults aged above 65 years in eastern Ethiopia: neglected public health concern. BMC Geriatr. 2020;20:497.CrossRefPubMedPubMedCentral 1.Abdu AO, Yimamu ID, Kahsay AA. Predictors of malnutrition among older adults aged above 65 years in eastern Ethiopia: neglected public health concern. BMC Geriatr. 2020;20:497.CrossRefPubMedPubMedCentral
3.
5.
go back to reference Saunders J, Smith T. Malnutrition: causes and consequences. Clin Med (Northfield Il). 2010;10:624.CrossRef Saunders J, Smith T. Malnutrition: causes and consequences. Clin Med (Northfield Il). 2010;10:624.CrossRef
6.
go back to reference Bhattacharya A, Pal B, Mukherjee S, Roy SK. Assessment of nutritional status using anthropometric variables by multivariate analysis. BMC Public Health. 2019;19:1045.CrossRefPubMedPubMedCentral Bhattacharya A, Pal B, Mukherjee S, Roy SK. Assessment of nutritional status using anthropometric variables by multivariate analysis. BMC Public Health. 2019;19:1045.CrossRefPubMedPubMedCentral
8.
go back to reference Kimokoti RW, Hamer DH. Nutrition, health, and aging in sub-Saharan Africa. Nutr Rev. 2008;66:611–23.CrossRefPubMed Kimokoti RW, Hamer DH. Nutrition, health, and aging in sub-Saharan Africa. Nutr Rev. 2008;66:611–23.CrossRefPubMed
9.
go back to reference Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes (Lond). 2008;32:959–66.CrossRef Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes (Lond). 2008;32:959–66.CrossRef
10.
go back to reference Vanderwall C, Randall Clark R, Eickhoff J, Carrel AL. BMI is a poor predictor of adiposity in young overweight and obese children. BMC Pediatr. 2017;17:135.CrossRefPubMedPubMedCentral Vanderwall C, Randall Clark R, Eickhoff J, Carrel AL. BMI is a poor predictor of adiposity in young overweight and obese children. BMC Pediatr. 2017;17:135.CrossRefPubMedPubMedCentral
11.
go back to reference Sultana T, Karim MN, Ahmed T, Hossain MI. Assessment of under nutrition of Bangladeshi adults using anthropometry: Can body mass index be replaced by mid-upper-arm-circumference? PLoS One. 2015;10:e0121456.CrossRefPubMedPubMedCentral Sultana T, Karim MN, Ahmed T, Hossain MI. Assessment of under nutrition of Bangladeshi adults using anthropometry: Can body mass index be replaced by mid-upper-arm-circumference? PLoS One. 2015;10:e0121456.CrossRefPubMedPubMedCentral
12.
go back to reference Van Tonder E, Mace L, Steenkamp L, Tydeman-Edwards R, Gerber K, Friskin D. Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition. South African J Clin Nutr. 2019;32:93–8.CrossRef Van Tonder E, Mace L, Steenkamp L, Tydeman-Edwards R, Gerber K, Friskin D. Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition. South African J Clin Nutr. 2019;32:93–8.CrossRef
13.
go back to reference Eleraky L, Issa R, Maciel S, Mbwana H, Rybak C, Frank J, et al. High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique. Int J Environ Res Public Health. 2021;18:9128.CrossRefPubMedPubMedCentral Eleraky L, Issa R, Maciel S, Mbwana H, Rybak C, Frank J, et al. High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique. Int J Environ Res Public Health. 2021;18:9128.CrossRefPubMedPubMedCentral
14.
go back to reference Thorup L, Hamann SA, Kallestrup P, Hjortdal VE, Tripathee A, Neupane D, et al. Mid-upper arm circumference as an indicator of underweight in adults: a cross-sectional study from Nepal. BMC Public Health. 2020;20:1187.CrossRefPubMedPubMedCentral Thorup L, Hamann SA, Kallestrup P, Hjortdal VE, Tripathee A, Neupane D, et al. Mid-upper arm circumference as an indicator of underweight in adults: a cross-sectional study from Nepal. BMC Public Health. 2020;20:1187.CrossRefPubMedPubMedCentral
15.
go back to reference Tang AM, Chung M, Dong KR, Bahwere P, Bose K, Chakraborty R, et al. Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women). Public Health Nutr. 2020;23:3104–13.CrossRefPubMed Tang AM, Chung M, Dong KR, Bahwere P, Bose K, Chakraborty R, et al. Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women). Public Health Nutr. 2020;23:3104–13.CrossRefPubMed
16.
go back to reference Amegovu AK, Chewere T, Mawadri M. Mid-upper arm circumference ( MUAC ) cut-offs to diagnose overweight and obesity among adults. J Clin Community Med. 2020:184–90. Amegovu AK, Chewere T, Mawadri M. Mid-upper arm circumference ( MUAC ) cut-offs to diagnose overweight and obesity among adults. J Clin Community Med. 2020:184–90.
17.
go back to reference Nguyen P, Ramakrishnan U, Katz B, Gonzalez-Casanova I, Lowe AE, Nguyen H, et al. Mid-upper-arm and calf circumferences are useful predictors of underweight in women of reproductive age in northern Vietnam. Food Nutr Bull. 2014;35:301–11.CrossRefPubMed Nguyen P, Ramakrishnan U, Katz B, Gonzalez-Casanova I, Lowe AE, Nguyen H, et al. Mid-upper-arm and calf circumferences are useful predictors of underweight in women of reproductive age in northern Vietnam. Food Nutr Bull. 2014;35:301–11.CrossRefPubMed
19.
go back to reference Abdelbagi OM, Musa IR, Altigani SA, Osman A, Adam I. Prevalence of diabetic foot amongst adults with diabetes mellitus in northern Sudan: A cross-sectional study. Int J Clin Pract. 2021;75:e14892.CrossRefPubMed Abdelbagi OM, Musa IR, Altigani SA, Osman A, Adam I. Prevalence of diabetic foot amongst adults with diabetes mellitus in northern Sudan: A cross-sectional study. Int J Clin Pract. 2021;75:e14892.CrossRefPubMed
21.
go back to reference Bujang MA, Baharum N. Sample Size Guideline for Correlation Analysis. World J Soc Sci Res. 2016;3:37.CrossRef Bujang MA, Baharum N. Sample Size Guideline for Correlation Analysis. World J Soc Sci Res. 2016;3:37.CrossRef
23.
go back to reference Collins S. Using middle upper arm circumference to assess severe adult malnutrition during famine. JAMA. 1996;276:391–5.CrossRefPubMed Collins S. Using middle upper arm circumference to assess severe adult malnutrition during famine. JAMA. 1996;276:391–5.CrossRefPubMed
24.
go back to reference Benítez Brito N, Suárez Llanos JP, Fuentes Ferrer M, Oliva García JG, Delgado Brito I, Pereyra-García Castro F, et al. Relationship between Mid-Upper Arm Circumference and Body Mass Index in Inpatients. PLoS One. 2016;11:e0160480.CrossRefPubMedPubMedCentral Benítez Brito N, Suárez Llanos JP, Fuentes Ferrer M, Oliva García JG, Delgado Brito I, Pereyra-García Castro F, et al. Relationship between Mid-Upper Arm Circumference and Body Mass Index in Inpatients. PLoS One. 2016;11:e0160480.CrossRefPubMedPubMedCentral
26.
go back to reference Philpott DCE, Belchior-Bellino V, Ververs M. Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees. Public Health Nutr. 2021;24:4777–85.CrossRefPubMed Philpott DCE, Belchior-Bellino V, Ververs M. Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees. Public Health Nutr. 2021;24:4777–85.CrossRefPubMed
27.
go back to reference Ha L, Hauge T, Iversen PO. Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital. BMC Geriatr. 2010;10:75.CrossRefPubMedPubMedCentral Ha L, Hauge T, Iversen PO. Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital. BMC Geriatr. 2010;10:75.CrossRefPubMedPubMedCentral
28.
go back to reference Chakraborty R, Bose K, Bisai S. Mid-upper arm circumference as a measure of nutritional status among adult Bengalee male slum dwellers of Kolkata, India: relationship with self reported morbidity. Anthropol Anz. 2009;67:129–37.CrossRefPubMed Chakraborty R, Bose K, Bisai S. Mid-upper arm circumference as a measure of nutritional status among adult Bengalee male slum dwellers of Kolkata, India: relationship with self reported morbidity. Anthropol Anz. 2009;67:129–37.CrossRefPubMed
29.
go back to reference Chakraborty R, Bose K, Koziel S. Use of mid-upper arm circumference in determining undernutrition and illness in rural adult Oraon men of Gumla District, Jharkhand, India. Rural Remote Health. 2011;11:1754.PubMed Chakraborty R, Bose K, Koziel S. Use of mid-upper arm circumference in determining undernutrition and illness in rural adult Oraon men of Gumla District, Jharkhand, India. Rural Remote Health. 2011;11:1754.PubMed
30.
go back to reference Das P, Khatun A, Bose K, Chakraborty R. The validity of mid-upper arm circumference as an indicator of low BMI in population screening for undernutrition: a study among adult slum dwellers in eastern India. Public Health Nutr. 2018;21:2575–83.CrossRefPubMed Das P, Khatun A, Bose K, Chakraborty R. The validity of mid-upper arm circumference as an indicator of low BMI in population screening for undernutrition: a study among adult slum dwellers in eastern India. Public Health Nutr. 2018;21:2575–83.CrossRefPubMed
31.
go back to reference James WPT, Mascie-Taylor GCN, Norgan NG, Bistrian BR, Shetty PS, Ferro-Luzzi A. The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. Eur J Clin Nutr. 1994;48:883–94.PubMed James WPT, Mascie-Taylor GCN, Norgan NG, Bistrian BR, Shetty PS, Ferro-Luzzi A. The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. Eur J Clin Nutr. 1994;48:883–94.PubMed
32.
go back to reference Shifraw T, Selling K, Worku A, Berhane HY, Ekström EC, Berhane Y. Mid-upper arm circumference for identifying adult overweight in large-scale population-based surveys: Empirical evaluation using data of the EAT Addis study, Ethiopia. BMJ Open. 2021;11:e049602.CrossRefPubMedPubMedCentral Shifraw T, Selling K, Worku A, Berhane HY, Ekström EC, Berhane Y. Mid-upper arm circumference for identifying adult overweight in large-scale population-based surveys: Empirical evaluation using data of the EAT Addis study, Ethiopia. BMJ Open. 2021;11:e049602.CrossRefPubMedPubMedCentral
33.
go back to reference Zhu Y, Lin Q, Zhang Y, Deng H, Hu X, Yang X, et al. Mid-upper arm circumference as a simple tool for identifying central obesity and insulin resistance in type 2 diabetes. PLoS One. 2020;15:e0231308.CrossRefPubMedPubMedCentral Zhu Y, Lin Q, Zhang Y, Deng H, Hu X, Yang X, et al. Mid-upper arm circumference as a simple tool for identifying central obesity and insulin resistance in type 2 diabetes. PLoS One. 2020;15:e0231308.CrossRefPubMedPubMedCentral
34.
go back to reference Kok P, Seidell JC, Meinders AE. The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity. Ned Tijdschr Geneeskd. 2004;148:2379–82.PubMed Kok P, Seidell JC, Meinders AE. The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity. Ned Tijdschr Geneeskd. 2004;148:2379–82.PubMed
35.
go back to reference Deurenberg P, Yap M, Van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord. 1998;22:1164–71.CrossRefPubMed Deurenberg P, Yap M, Van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord. 1998;22:1164–71.CrossRefPubMed
36.
go back to reference Zheng HY, Zhang M, Yang CX, Zhang N, Wang XC, Yang XP, et al. Elevated exhaustion levels and reduced functional diversity of T cells in peripheral blood may predict severe progression in COVID-19 patients. Cell Mol Immunol. 2020;17:541–3.CrossRefPubMedPubMedCentral Zheng HY, Zhang M, Yang CX, Zhang N, Wang XC, Yang XP, et al. Elevated exhaustion levels and reduced functional diversity of T cells in peripheral blood may predict severe progression in COVID-19 patients. Cell Mol Immunol. 2020;17:541–3.CrossRefPubMedPubMedCentral
37.
38.
go back to reference Bose K, Ganguly S, Mamtaz H, Mukhopadhyay A, Bhadra M. High prevalence of undernutrition among adult Kora Mudi tribals of Bankura District, West Bengal, India. Anthropol Sci. 2006;114:65–8.CrossRef Bose K, Ganguly S, Mamtaz H, Mukhopadhyay A, Bhadra M. High prevalence of undernutrition among adult Kora Mudi tribals of Bankura District, West Bengal, India. Anthropol Sci. 2006;114:65–8.CrossRef
39.
go back to reference Leiter LA, Marliss EB. Survival During Fasting May Depend on Fat as Well as Protein Stores. JAMA. 1982;248:2306–7.CrossRefPubMed Leiter LA, Marliss EB. Survival During Fasting May Depend on Fat as Well as Protein Stores. JAMA. 1982;248:2306–7.CrossRefPubMed
40.
go back to reference Powell-Tuck J, Hennessy EM. A comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients. Clin Nutr. 2003;22:307–12.CrossRefPubMed Powell-Tuck J, Hennessy EM. A comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients. Clin Nutr. 2003;22:307–12.CrossRefPubMed
41.
go back to reference Fakier A, ChB M, Petro G, Fawcus S. Mid-upper arm circumference: A surrogate for body mass index in pregnant women. S Afr Med J. 2017;107:606–10.CrossRefPubMed Fakier A, ChB M, Petro G, Fawcus S. Mid-upper arm circumference: A surrogate for body mass index in pregnant women. S Afr Med J. 2017;107:606–10.CrossRefPubMed
Metadata
Title
Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan
Authors
Imad R. Musa
Saeed M. Omar
Ishag Adam
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-14536-4

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