1. bookVolume 84 (2021): Issue 3 (September 2021)
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Journal
First Published
24 Jan 2008
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4 times per year
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English
access type Open Access

Validating mid-upper arm circumference (MUAC) cut off points as an indicator of nutritional status among nine tribal populations of India

Published Online: 01 Oct 2021
Page range: 301 - 315
Received: 04 May 2021
Accepted: 13 Aug 2021
Journal Details
License
Format
Journal
First Published
24 Jan 2008
Publication timeframe
4 times per year
Languages
English
Abstract

Mid-upper arm circumference (MUAC) is an alternative anthropometric measurement to assess undernutrition but a universally accepted cut-off is yet to be established. The objectives of the present study are to determine whether the proposed sex-specific global cut-offs are suitable across several tribes in India. This cross-sectional study was conducted among nine tribal populations in India (1046 males, 1087 females). Weight, height and MUAC values were obtained, and body mass index (BMI) was calculated. The BMI cut-off (<18.5 kg/m2) was used to determine chronic energy deficiency (CED). The ROC Curve analyses of binomial logistic regression for MUAC versus CED revealed optimal cut-off point of MUAC as 23.8 cm (in males) and 21.8 cm (in females). MUAC cut-offs were similar in females, relative to males, in all tribes. Males with MUAC<24cm and females with MUAC<22 encompassed significantly higher numbers of CED than those with MUAC≥24 and ≥22 cm, respectively (χ2-value males: 254.9, p<0.001; females: 493.60, p<0.01). A single cut off point of MUAC may not be universally applicable for diverse populations and both sexes as well. It seemed that there is no alternative than to undertake further validation studies in various populations before using the MUAC cut off to identify undernourished or CED condition.

Keywords

Bahwere P, Deconinck H, Banda T, Mtimuni A, Collins S. 2011. Impact of household food insecurity on the nutritional status and the response to therapeutic feeding of people living with human immunodeficiency virus. Patient Prefer Adherence 5:619–27. Search in Google Scholar

Basu A, Sarkar-Roy N, Majumder PP. 2016. Genomic reconstruction of the history of extant populations of India reveals five distinct ancestral components and a complex structure. Proc Natl Acad Sci USA 113:1594–9. Search in Google Scholar

Bisai S, Bose K. 2009. Undernutrition in the Kora Mudi tribal population, West Bengal, India: a comparison of body mass index and mid-upper-arm circumference. Food Nutr Bull 30:63–7. Search in Google Scholar

Bose K, Bisai S, Das P, Dikshit S, Pradhan S. 2007. Relationship of income with anthropometric indicators of chronic energy deficiency among adult female slum dwellers of Midnapore town. J Hum Ecol 22:171–6. Search in Google Scholar

Chakraborty R, Bose K, Bisai S. 2009a. 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 67:129–37. Search in Google Scholar

Chakraborty R, Bose K, Bisai S.2009b. Relationship of family income and house type to body mass index and chronic energy deficiency among urban Bengalee male slum dwellers of Kolkata, India. HOMO 60:45–57. Search in Google Scholar

Chakraborty R, Bose K, Bisai S. 2009c. Use of mid-upper arm circumference as a measure of nutritional status and its relationship with self-reported morbidity among adult Bengalee male slum dwellers of Kolkata, India. In: Appetite and Nutritional Assessment, ed. SJ Ellsworth and RC Schuster, 377–85. New York: NOVA Science Publishers, Inc. Search in Google Scholar

Chakraborty R, Bose K, Koziel S. 2011. Use of mid-upper arm circumference in determining undernutrition and illness in rural adult Oraon men of Gumla District, Jharkhand, India. Rural Remote Health 11:1754. Search in Google Scholar

Chakraborty R, Bose K. 2014. Defining malnutrition in India: how much is too little, how much is too much? Curr Sci 106:670–2. Search in Google Scholar

Chen Y, Ge W, Parvez F, Bangalore S, Eunus M, Ahmed A, Islam T, Rakibuz-Zaman M, Hasan R, Argos M et al. 2014. A prospective study of arm circumference and risk of death in Bangladesh. Int J Epidemiol 43:1187–96. Search in Google Scholar

Das A, Saimala G, Reddy N, Mishra P, Giri R, Kumar A, Raj A, Kumar G, Chaturvedi S, Babu S et al. 2020. Mid-upper arm circumference as a substitute of the body mass index for assessment of nutritional status among adult and adolescent females: learning from an impoverished Indian state. Public Health 179:68–75. Search in Google Scholar

Das MB, Mehta SK. 2012. Issue Brief, Poverty and Social Exclusion in India: Adivasis. Washington DC, USA, World Bank Group. Search in Google Scholar

Das P, Khatun A, Bose K, Chakraborty R. 2018. The validity of MUAC as indicator of low BMI in population screening for undernutrition: A study among adult slum dwellers in Eastern India. Public Health Nutr 21:2575–83. Search in Google Scholar

Das S, Bose K. 2012. Nutritional deprivation among Indian tribals: A cause for concern. Anthropol Notebooks 18:5–16. Search in Google Scholar

Debnath S, Mondal N, Sen J. 2017.Use of upper arm anthropometry, upper arm muscle area-by-height (UAMAH) and mid upper-arm-circumference (MUAC)-for-height as indicators of body composition and nutritional status among children. Anthropol Rev 80:85–102. Search in Google Scholar

Dey U, Bisai S. 2019. The prevalence of under-nutrition among the tribal children in India: a systematic review. Anthropol Rev 82:203–17. Search in Google Scholar

Fakier A, Petro G, Fawcus S. 2017. Mid-upper arm circumference: A surrogate for body mass index in pregnant women. South Africa Med J 107:606–10. Search in Google Scholar

Ferro-Luzzi A, Sette S, Franklin M, James WP. 1992. A simplified approach of assessing adult chronic energy deficiency. Eur J Clin Nutr 46:173–86. Search in Google Scholar

International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai, IIPS. Search in Google Scholar

James WP, Mascie-Taylor CGN, Norgan NG, Bistrian BR, Shetty PS, Ferro-Luzzi A. 1994. The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. Eur J Clin Nutr 48:883–94. Search in Google Scholar

Khongsdier R. 2002. Body mass index and morbidity in adult males of the War Khasi in Northeast India. Eur J Clin Nutr 56:484–9. Search in Google Scholar

Kshatriya GK,Acharya SK.2016a. Triple Burden of Obesity, Undernutrition, and Cardiovascular Disease Risk among Indian Tribes. PLoS One11:e0147934. doi: 10.1371/journal.pone.0147934. Search in Google Scholar

Kshatriya GK, Acharya SK.2016b. Gender Disparities in the Prevalence of Under-nutrition and the Higher Risk among the Young Women of Indian Tribes. PLoS One11:e0158308. doi: 10.1371/journal. pone.0158308. Search in Google Scholar

Kumar V, Basu D, Reddy BM. 2004. Genetic heterogeneity in northeastern India: reflection of Tribe-Caste continuum in the genetic structure. Am J Hum Biol 16:334–45. Search in Google Scholar

Maalouf-Manasseh Z, Remancus S, Milner E, Fenlason L, Quick T, Patsche CB, Bose K, Collins S, Ververs M, Walia S et al. 2020. Global mid-upper arm circumference cutoffs for adults: a call to action. Public Health Nutr 23:3114–5. Search in Google Scholar

Majumder PP, Basu A. 2014. A genomic view of the peopling and population structure of India. Cold Spring Harb Perspec Biol 7:a008540. doi: 10.1101/cshperspect. a008540. Search in Google Scholar

Menon S, Peñalvo JL. 2019. Actions Targeting the Double Burden of Malnutrition: A Scoping Review. Nutrients12:81. doi: 10.3390/nu12010081. Search in Google Scholar

Oliveira I, Andersen A, Furtado A. 2012. Assessment of simple risk markers for early mortality among HIV-infected patients in Guinea-Bissau: a cohort study. BMJ Open 2:e001587. doi: 10.1136/bmjopen-2012-001587. Search in Google Scholar

Olukoya AA. 1990. Identification of under-weight women by measurement of the arm circumference. Int J Gynecol Obstet 31:231–5. Search in Google Scholar

Portaluppi F, Smolensky MH, Touitou Y. 2010. Ethics and methods for biological rhythm research on animals and human beings. Chronobiol Int 27:1911–29. Search in Google Scholar

Powell-Tuck J, Hennessy EM. 2003. A comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients. Clin Nutr 22:307–12. Search in Google Scholar

Razak F, Corsi DJ, Slutsky AS, Kurpad A, Berkman L, Laupacis A, Subramanian SV. 2015. Prevalence of body mass index lower than 16 among women in low-and middle-income countries. JAMA 314:2164–71. Search in Google Scholar

Rodrigues VC, Rao RS, Lena A. 1994. Utility of arm circumference as a screening instrument to identify women at nutritional risk. Trop Doct 24:164–6. Search in Google Scholar

Sachdeva S, Dewan P, Shah D, Malhotra RK, Gupta P. 2016. Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age. Public Health Nutr 19:2513–20. Search in Google Scholar

Schaap LA, Quirke T, Wijnhoven, HAH, Visser M. 2018. Changes in body mass index and mid-upper arm circumference in relation to all-cause mortality in older adults. Clin Nutr 37:2252–9. Search in Google Scholar

Sen J, Mondal N, Dey S. 2011. Assessment of the nutritional status of children aged 5-12 years using upper arm composition. Ann Hum Biol 38:752–9. Search in Google Scholar

Sun H, Ren X, Chen Z. 2016. Association between body mass index and mortality in a prospective cohort of Chinese adults. Medicine 95:e4327. doi: 10.1371/journal. pone.0180818. Search in Google Scholar

Tang AM, Chung M, Dong KR, Bahwere P, Bose K, Chakraborty R, Charlton K, Das P, Ghosh M, Hossain MI et al. 2020. Determining a global mid-upper arm circumference cutoff to assess underweight in adults (men and non-pregnant women). Public Health Nutr 23:3104–13. Search in Google Scholar

Thorup L, Hamann SA, Kallestrup P, Hjortdal VE, Tripathee A, Neupane D, Patsche CB. 2020. Mid-upper arm circumference as an indicator of underweight in adults: a cross-sectional study from Nepal. BMC Public Health 20:1187. doi: 10.1186/s12889-020-09294-0. Search in Google Scholar

WHO Expert Consultation. 2004. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–63. Search in Google Scholar

WHO, UNICEF. 2019. WHO child growth standards and the identification of severe acute malnutrition in infants and children. A joint statement by the World Health Organization and the United Nations Children’s Fund. New York, Geneva. Search in Google Scholar

World Health Organization. 2004. Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series no. 854. Geneva, World Health Organization. Search in Google Scholar

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