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August 7, 1996, Vol 276, No. 5 >
ARTICLE | August 7, 1996

Using Middle Upper Arm Circumference to Assess Severe Adult Malnutrition During Famine FREE

Steve Collins, MB, BS
[+] Author Affiliations

Corresponding author: Steve Collins, MB, BS, Oleuffynon, Old Hall, Llanidloes, Powys SY18 6PJ, Wales (e-mail: steve@concern1.demon.co.uk).


JAMA. 1996;276(5):391-395. doi:10.1001/jama.1996.03540050051023
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Article
References

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 had 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.

REFERENCES

1 +
Collins S.  The need for adult therapeutic care in emergency feeding programs . JAMA . 1993;;270:637-638.
2 +
Centers for Disease Control.  Population based mortality assessment: Baidoa and Afgoi, Somalia 1992 . MMWR Morb Mortal Wkly Rep . 1992;;41:913-917.
3 +
Collins S.  Famine in Somalia . Lancet . 1993;;341:1478-1479.
4 +
Ville de Goyet C, Seaman J, Geijer U. The Management of Nutritional Emergencies in Large Populations. Geneva, Switzerland: World Health Organization; 1978.
5 +
Hakewell P, Moren A.  Monitoring and evaluation of relief programs . Trop Doct . 1991;;1( (suppl) ):24-28.
6 +
Ferro-Luzzi A, Setti S, Franklin M, James WPT.  A simplified approach to assessing adult chronic energy deficiency . Eur J Clin Nutr . 1992;;46:173-186.
7 +
Reddy V.  Body mass index and mortality rates . Nutr News . 1991;;12:1.
8 +
Boelaert M, Davis A, Le Lin B, et al. Nutrition Guidelines . Paris, France: Médecins Sans Frontières; 1995;.
9 +
Young H. Food Scarcity and Famine: Assessment and Response . Oxford, England: Oxfam; 1992;.
10 +
Collins S.  The limit of human adaptation to starvation . Nat Med . 1995;;1:810-814.
11 +
Burger GCE, Sandstead HR, Drummond J.  Starvation in western Holland: 1945 . Lancet . 1945;; 1:282-283.
12 +
McCance RA, Widdowson EM. Studies in Undernutrition: Wuppertal 1946-9 . London, England: Medical Research Council; 1951;.
13 +
Lipscomb FM.  Medical aspects of Belsen concentration camp . Lancet . 1945;;1:313-315.
14 +
Velzeboer MI, Selwyn BJ, Sargent S, Pollitt E, Delgado H.  Evaluation of arm circumference as a public health index of protein calorie malnutrition in early childhood . J Trop Pediatr . 1983;;29:135-144.
15 +
Shakir A.  Arm circumference in the surveillance of protein energy malnutrition in Baghdad . Am J Clin Nutr . 1975;;26:661-665.
16 +
Bairagi R.  On validity of some anthropometric indicators as predictors of mortality . Am J Clin Nutr . 1981;;34:2592-2594.
17 +
Briend A, Wojtyniak B, Rowland MGM.  Arm circumference and other factors in children at high risk of death in rural Bangladesh . Lancet . 1987;;2:725-727.
18 +
Vella V, Tomkins A, Ndiku J, Marshal T, Cortinovis I.  Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables . Eur J Clin Nutr . 1994;;48:189-197.
19 +
Velzeboer MI, Selwyn BJ, Sargent S, Pollitt E, Delgado H.  The use of arm circumference in simplified screening for acute malnutrition by minimally trained health workers . J Trop Pediatr . 1983;; 29:159-166.
20 +
Ohlson MA, Biester A, Brewer WD, Hawthorne BE, Hutchinson MB.  Anthropometry and nutritional status of adult women . Hum Biol . 1956;;28:189-202.
21 +
Gassull MA, Cabre E, Vilar A, Alastrue A, Montserrat A.  Protein energy malnutrition: an integral approach and a simple new classification . Hum Nutr Clin Nutr . 1984;;38C:419-431.
22 +
Heymsfield SB, McManus CB, Seitz SB, Nixon DW, Smith Andrews J.  Anthropometric assessment of adult protein-energy malnutrition . In: Wright RA, Heymsfield SB, eds. Nutritional Assessment . Boston, Mass: Blackwell Scientific Publications Inc; 1984;:27-82.
23 +
Friedman P.  Severe arm-muscle wasting: sign of lethal malnutrition in sick elderly men . Nutrition . 1991;;7:223-226.
24 +
James WPT, Taylor-Mascie GCN, Norgan NG, et al.  The value of arm circumference in assessing chronic energy deficiency in Third World adults . Eur J Clin Nutr . 1994;;48:883-894.
25 +
Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info Version 6: A Word Processing, Database and Statistics Program for Epidemiology on Microcomputers . Stone Mountain, Ga: USD Incorporated; 1990;.
26 +
Microsoft Excel Version 5. Redmond, Wash: Microsoft Corporation; 1995.
27 +
Henry CJK.  Body mass index and the limits of human survival . Eur J Clin Nutr . 1990;;44:329-335.
28 +
James WPT, Ferro-Luzzi A, Waterlow JC.  Definition of chronic energy malnutrition in adults . Eur J Clin Nutr . 1988;;42:969-981.
29 +
Waterlow JC.  Metabolic adaptation to low intakes of energy and protein . Annu Rev Nutr . 1986;; 6:495-526.
30 +
Broom J.  Sepsis and trauma . In: Garrow JS, James WPT, eds. Human Nutrition and Dietetics . London, England: Churchill Livingstone Inc; 1993;: 456-464.
31 +
Bern C, Nathanail L.  Is mid-upper arm circumference a useful tool for screening in emergency settings? Lancet . 1995;;345:631-633.
32 +
Ross DA, Taylor N, Hayes R, Mclean M.  Measuring malnutrition in famines: are weight for height and arm circumference interchangeable? Int J Epidemiol . 1990;;19:636-645.
33 +
McLaren DS.  Measuring malnutrition in famines . Lancet . 1986;;2:152.
34 +
Euronut SENECA Investigators.  Nutritional status and anthropometry . Eur J Clin Nutr . 1991;; 45:31-42.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Collins S.  The need for adult therapeutic care in emergency feeding programs . JAMA . 1993;;270:637-638.
2 +
Centers for Disease Control.  Population based mortality assessment: Baidoa and Afgoi, Somalia 1992 . MMWR Morb Mortal Wkly Rep . 1992;;41:913-917.
3 +
Collins S.  Famine in Somalia . Lancet . 1993;;341:1478-1479.
4 +
Ville de Goyet C, Seaman J, Geijer U. The Management of Nutritional Emergencies in Large Populations. Geneva, Switzerland: World Health Organization; 1978.
5 +
Hakewell P, Moren A.  Monitoring and evaluation of relief programs . Trop Doct . 1991;;1( (suppl) ):24-28.
6 +
Ferro-Luzzi A, Setti S, Franklin M, James WPT.  A simplified approach to assessing adult chronic energy deficiency . Eur J Clin Nutr . 1992;;46:173-186.
7 +
Reddy V.  Body mass index and mortality rates . Nutr News . 1991;;12:1.
8 +
Boelaert M, Davis A, Le Lin B, et al. Nutrition Guidelines . Paris, France: Médecins Sans Frontières; 1995;.
9 +
Young H. Food Scarcity and Famine: Assessment and Response . Oxford, England: Oxfam; 1992;.
10 +
Collins S.  The limit of human adaptation to starvation . Nat Med . 1995;;1:810-814.
11 +
Burger GCE, Sandstead HR, Drummond J.  Starvation in western Holland: 1945 . Lancet . 1945;; 1:282-283.
12 +
McCance RA, Widdowson EM. Studies in Undernutrition: Wuppertal 1946-9 . London, England: Medical Research Council; 1951;.
13 +
Lipscomb FM.  Medical aspects of Belsen concentration camp . Lancet . 1945;;1:313-315.
14 +
Velzeboer MI, Selwyn BJ, Sargent S, Pollitt E, Delgado H.  Evaluation of arm circumference as a public health index of protein calorie malnutrition in early childhood . J Trop Pediatr . 1983;;29:135-144.
15 +
Shakir A.  Arm circumference in the surveillance of protein energy malnutrition in Baghdad . Am J Clin Nutr . 1975;;26:661-665.
16 +
Bairagi R.  On validity of some anthropometric indicators as predictors of mortality . Am J Clin Nutr . 1981;;34:2592-2594.
17 +
Briend A, Wojtyniak B, Rowland MGM.  Arm circumference and other factors in children at high risk of death in rural Bangladesh . Lancet . 1987;;2:725-727.
18 +
Vella V, Tomkins A, Ndiku J, Marshal T, Cortinovis I.  Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables . Eur J Clin Nutr . 1994;;48:189-197.
19 +
Velzeboer MI, Selwyn BJ, Sargent S, Pollitt E, Delgado H.  The use of arm circumference in simplified screening for acute malnutrition by minimally trained health workers . J Trop Pediatr . 1983;; 29:159-166.
20 +
Ohlson MA, Biester A, Brewer WD, Hawthorne BE, Hutchinson MB.  Anthropometry and nutritional status of adult women . Hum Biol . 1956;;28:189-202.
21 +
Gassull MA, Cabre E, Vilar A, Alastrue A, Montserrat A.  Protein energy malnutrition: an integral approach and a simple new classification . Hum Nutr Clin Nutr . 1984;;38C:419-431.
22 +
Heymsfield SB, McManus CB, Seitz SB, Nixon DW, Smith Andrews J.  Anthropometric assessment of adult protein-energy malnutrition . In: Wright RA, Heymsfield SB, eds. Nutritional Assessment . Boston, Mass: Blackwell Scientific Publications Inc; 1984;:27-82.
23 +
Friedman P.  Severe arm-muscle wasting: sign of lethal malnutrition in sick elderly men . Nutrition . 1991;;7:223-226.
24 +
James WPT, Taylor-Mascie GCN, Norgan NG, et al.  The value of arm circumference in assessing chronic energy deficiency in Third World adults . Eur J Clin Nutr . 1994;;48:883-894.
25 +
Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info Version 6: A Word Processing, Database and Statistics Program for Epidemiology on Microcomputers . Stone Mountain, Ga: USD Incorporated; 1990;.
26 +
Microsoft Excel Version 5. Redmond, Wash: Microsoft Corporation; 1995.
27 +
Henry CJK.  Body mass index and the limits of human survival . Eur J Clin Nutr . 1990;;44:329-335.
28 +
James WPT, Ferro-Luzzi A, Waterlow JC.  Definition of chronic energy malnutrition in adults . Eur J Clin Nutr . 1988;;42:969-981.
29 +
Waterlow JC.  Metabolic adaptation to low intakes of energy and protein . Annu Rev Nutr . 1986;; 6:495-526.
30 +
Broom J.  Sepsis and trauma . In: Garrow JS, James WPT, eds. Human Nutrition and Dietetics . London, England: Churchill Livingstone Inc; 1993;: 456-464.
31 +
Bern C, Nathanail L.  Is mid-upper arm circumference a useful tool for screening in emergency settings? Lancet . 1995;;345:631-633.
32 +
Ross DA, Taylor N, Hayes R, Mclean M.  Measuring malnutrition in famines: are weight for height and arm circumference interchangeable? Int J Epidemiol . 1990;;19:636-645.
33 +
McLaren DS.  Measuring malnutrition in famines . Lancet . 1986;;2:152.
34 +
Euronut SENECA Investigators.  Nutritional status and anthropometry . Eur J Clin Nutr . 1991;; 45:31-42.

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