Poster Topical Area: Global Nutrition

Location: Hall D

Poster Board Number: 598

P12-114 - Determining a Global Mid-Upper Arm Circumference (MUAC) Cutoff to Assess Underweight in Adults (Men and Non-pregnant Women)

Sunday, Jun 10
8:00 AM – 6:00 PM

Objectives: Mid-upper arm circumference (MUAC) is increasingly being used to assess nutritional status and determine eligibility for clinical and nutrition services among adults; yet globally recognized MUAC cutoffs have not been established for undernutrition among adults. Many countries and programs have established their own MUAC cutoffs, but there is limited evidence supporting these cutoffs and it is not known whether they are optimal. This study aimed to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cutoffs for identifying undernutrition among adults, as defined by low BMI (<18.5 kg/m2).

We undertook an individual participant data meta-analysis (IPDMA) using data from 17 studies across 4 continents. Measures of diagnostic accuracy were determined for every 0.5 cm across a range of MUAC values from 19.0 cm to 26.5 cm. A bivariate random effects model was fit to jointly estimate SENS and SPEC while accounting for the heterogeneity between studies. Various subgroup analyses were performed to determine how MUAC cutoffs might differ by setting or subpopulations.

The number of participants per study ranged from 182 to 4,926. Mean age was 32.4±12.0 years (range: 18 to 91 years) for all studies combined. 69% were female. Mean MUAC varied between studies, ranging from 19.7 to 32.7 cm. Overall, 27% had low BMI. MUAC was highly discriminatory in its ability to distinguish between adults with BMI <18.5 vs. BMI ≥18.5 kg/m2. The area under the ROC curve (AUC) for the combined dataset was 0.92, which is considered to be in the "excellent" range. Results of the meta-analysis showed that MUAC cutoffs in the range of ≤23.0 cm to ≤25.5 cm could serve as appropriate indicators of undernutrition. We propose that a MUAC cutoff ≤24.0 cm meets the criteria for optimizing SENS and SPEC across various subpopulations when assessed against low BMI.

The recommendation for a MUAC cutoff based on this IPDMA is the first step towards determining a standardized global MUAC cutoff for men and non-pregnant women. The use of MUAC in place of BMI in communities and clinics could reduce the amount of time and technical skill required for nutrition screening, resulting in a higher yield of individuals who would benefit from further nutrition assessment and intervention.

Funding Source: Funding was provided by the United States Agency for International Development (USAID) through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360

CoAuthors: Mei Chung – Tufts University School of Medicine; Kimberly Dong – Tufts University School of Medicine; Christine Wanke – Tufts University School of Medicine; Paluku Bahwere – Valid International; Kaushik Bose – Vidyasagar University; Raja Chakraborty – Dinabandhu Mahavidyalaya; Karen Charlton – University of Wollongong; Steven Hong – Tufts Medical Center; Phuong Nguyen – International Food and Policy Research Institute; Cecilie Patsche – Aarhus University; Megan Deitchler – Intake - Center for Dietary Assessment, FHI360; Zeina Maalouf-Manasseh – FANTA/FHI360

Alice Tang

Tufts University School of Medicine
Boston, Massachusetts