Could mid-upper arm circumference be a valid proxy to the body mass index for elderly persons?

Introduction: In elderly persons, due to physiological, anatomical, and functional changes, body mass index (BMI) may not be suitable for the assessment of nutritional status. Mid-upper arm circumference (MUAC) can be a proxy indicator to identify underweight and overweight/obesity among elderly persons. This study aimed to estimate the correlation between MUAC and BMI, and the cutoffs for MUAC using receiver operating characteristic (ROC) analysis. Material and Methods: This survey was carried out in a resettlement colony of Delhi. The participants were residents of the area who were aged 60 years or older, and selected by a simple random sampling technique. The arm span, weight, and MUAC of the participants were measured. The correlation between MUAC and BMI for gender and age group was calculated. The ROC curve was also constructed. Results: A total of 946 eligible participants were enrolled. The correlation between MUAC and BMI was 0.67 (P < 0.001) and 0.76 (P < 0.001) among men and women, respectively. The MUAC cutoff for underweight was <25 cm with a sensitivity of 68.8% and specificity of 84.9%. The area under the curve (AUC) was 0.84 (0.80–0.88). The MUAC cutoff for overweight/obesity was ?27 cm with a sensitivity of 83.9% and specificity of 64.9%, and AUC was 0.78 (0.75–0.82). Conclusion: The MUAC of the participants increased as the BMI of the participants increased. MUAC cutoff was determined using the ROC curve for underweight and overweight/obesity among elderly persons.

Neonatal mid upper arm circumference as surrogate of birth weight

Background: Recording an accurate birth weight by primary health worker has been a problem in rural areas, leading to search for an alternative, inexpensive, age independent and noninvasive method to predict newborn birth weight and wellbeing. With this background I aimed to found out whether the neonatal-MUAC is associated with birth weight or not?Methods: This hospital based prospective observational study was conducted in SNCU and postnatal ward, Kamla Raja Hospital, G.R. Medical College, and Gwalior (M.P). A total of 1303 newborns were included in the study. The Mid upper arm circumference (MUAC) of newborns were taken and Birth weight recorded were filled in a proforma.Results: Total 1303 neonates were evaluated. The mean MUAC and birth weight in preterm was found to be 1854.80'387.3 and 7.47'0.9 as compared to full term newborn having mean birth weight(2818.95'328.1) and mean MUAC (9.58+0.7).The Pearson coefficient of correlation between neonatal MUAC (N-MUAC) and birth weight was found to be r= 0.987 and p<0.01. Birth weight can be predicted from regression equation: Birth weight (gms)=422.99 (N-MUAC) + (-1272.66). Cut-off value of neonatal mid upper arm circumference (N-MUAC) was found to be 8.85cm to predict low birth weight newborn.Conclusions: Birth weight of newborn can be predicted from neonatal mid upper arm circumference (N-MUAC) in areas where the conventional scale are not easily available for measuring the birth weight of newborn.

Impact of effective counselling on management of moderate acute malnutrition in a community

Background: Moderate Acute Malnutrition (MAM) is defined as Weight for Height between -2SD to -3SD, and/or Mid Upper Arm Circumference (MUAC) 11.5 cm to 12.5 cm. Effect of not treating MAM has a significant impact on Severe Acute Malnutrition (SAM) burden. Management of MAM is possible through supplementary feeding or Community centre counselling.Methods: Present study was a prospective case control study done in 2013-14 in 200 children in adjacent communities. Community in which intervention (dietary counselling) was planned, it was labelled as case group. For dietary counselling 'structured group counselling' method was selected in which at a time parents of six MAM children were involved. Counselling was done by a trained counsellor using all techniques proposed by IYCF. Counselling sessions were scheduled at 0, 1, 3 and 6 months.Results: 60% children of case group moved to improved or well- nourished nutritional status (p-value 0.00001). Amongst improved group, weight for height improvement is statistically significant (p-value 0.001), average weight attained is 2-3 kg in 6 months with average weight gain of 1.5-3 grams/kg/day. MUAC improvement was also found to be statistically significant (p-value 0.003), there was 47% improvement in case group with average MUAC gain is 0.6 cm to 1 cm in 6 months (0.13 cm/month). Also, there is early rise in weight for height then MUAC. Average duration to achieve target weight for height is 4.3 months in case group as compare to 5.3 months in control group.Conclusions: Structured and integrated group counselling using all counselling skills by a trained counsellor should be an integral part of managing MAM in community. Weight for height should be primary indicator in early phase of response as compare to MUAC in measuring impact of counselling.

Association between mid-upper arm circumference and non-alcoholic fatty liver disease or insulin resistance in middle-aged and elderly Chinese community population / 上海交通大学学报（医学版）

Objective·To investigate the association between mid-upper arm circumference (MUAC) and non-alcoholic fatty liver disease (NAFLD) or insulin resistance in middle-aged and elderly Chinese community population. Methods·A cross-sectional study was conducted in 6570 residents aged 40 years or older in Jiading District of Shanghai in 2014. All participants received standard questionnaire, anthropometric measurements, biochemical evaluation and ultrasonic examination. NAFLD was defined by hepatic ultrasonography, after excluding subjects with excess alcohol consumption and medical history of liver diseases. Participants were divided into 4 groups according to the quartiles of MUAC, then association between MUAC and NAFLD or insulin resistance was analyzed. Results·With the increase of MUAC level, body mass index (BMI), waist circumference, systolic blood pressure, diastolic blood pressure, triacylglycerol, fasting insulin, HOMA-IR levels, low-density lipoprotein-cholesterol, alanine aminotransferase,γ-glutamyl transpeptidase, and aspartic transaminase levels were increased significantly (all P<0.01), as well as the prevalence of NAFLD, hypertension,dyslipidemia, and insulin resistance (all P<0.01). A fully adjusted multivariate Logistic regression analysis revealed that with the increase of MUAC level, the risk of having NAFLD and insulin resistance were increased among women. However, among men, there was no correlation between MUAC and NAFLD or insulin resistance. Conclusion·MUAC is significantly associated with NAFLD and insulin resistance in middle-aged and elderly female Chinese community population.

Association between mid-upper arm circumference and non-alcoholic fatty liver disease or insulin resistance in middle-aged and elderly Chinese community population / 上海交通大学学报（医学版）

Objective·To investigate the association between mid-upper arm circumference (MUAC) and non-alcoholic fatty liver disease (NAFLD) or insulin resistance in middle-aged and elderly Chinese community population. Methods·A cross-sectional study was conducted in 6570 residents aged 40 years or older in Jiading District of Shanghai in 2014. All participants received standard questionnaire, anthropometric measurements, biochemical evaluation and ultrasonic examination. NAFLD was defined by hepatic ultrasonography, after excluding subjects with excess alcohol consumption and medical history of liver diseases. Participants were divided into 4 groups according to the quartiles of MUAC, then association between MUAC and NAFLD or insulin resistance was analyzed. Results·With the increase of MUAC level, body mass index (BMI), waist circumference, systolic blood pressure, diastolic blood pressure, triacylglycerol, fasting insulin, HOMA-IR levels, low-density lipoprotein-cholesterol, alanine aminotransferase,γ-glutamyl transpeptidase, and aspartic transaminase levels were increased significantly (all P<0.01), as well as the prevalence of NAFLD, hypertension,dyslipidemia, and insulin resistance (all P<0.01). A fully adjusted multivariate Logistic regression analysis revealed that with the increase of MUAC level, the risk of having NAFLD and insulin resistance were increased among women. However, among men, there was no correlation between MUAC and NAFLD or insulin resistance. Conclusion·MUAC is significantly associated with NAFLD and insulin resistance in middle-aged and elderly female Chinese community population.

Associações entre pressão arterial, circunferências braquial e abdominal de pessoas com hipertensão arterial / Associations between blood pressure, and mid-upper arm and waist circumferences in individuals with high blood pressure / Asociaciones entre presión arterial y circunferencias braquial y abdominal de personas con hipertensión

Objetivo: analisar as associações entre a pressão arterial, a medida da circunferência braquial e a circunferência abdominal em pessoas com Hipertensão Arterial Sistêmica (HAS). Método: estudo descritivo, transversal, de abordagem quantitativa realizado com 397 pessoas de Estratégia de Saúde da Família de Minas Gerais. Dados coletados em 2013 e 2014 em visita domiciliária com instrumentos validados, obtendo-se, inclusive, medidas antropométricas e de pressão arterial (PA). Aplicados os testes quiquadrado e exato Fisher. Projeto aprovado pelo Comitê de Ética. Resultados: em 41,1% dos participantes com circunferência braquial igual ou superior a 27cm, os valores da PA encontravam-se iguais ou superiores a 140/90 mmHg e em 38,6% daqueles com circunferência abdominal com risco aumentado e muito aumentado, a PA encontrava-se igual ou superior a 140/90 mmHg. Conclusão: embora as associações não tenham significância estatística, devem constituir critérios importantes para avaliação não apenas da HAS, mas como fatores de risco para outras condições cardiovasculares.

Objective: to analyze the associations between blood pressure, and mid-upper arm and waist circumferences in adults with systemic arterial hypertension (SAH). Method: this quantitative, descriptive, cross-sectional study examined 397 individuals in the Family Health Strategy in Minas Gerais. Data was collected using validated instruments during home visits in 2013 and 2014, when anthropometric and blood pressure measurements were taken. Chi-square and Fisher's exact tests were applied. Results: 41.1% of participants with mid-upper arm circumference equal to or greater than 27 cm had blood pressure values equal to or greater than 140/90 mmHg, and 38.6% of those with increased-risk or much-increased-risk waist circumference had blood pressure equal to or greater than 140/90 mmHg. Conclusion: although the associations showed no statistical significance, they do constitute important criteria for assessing not only SAH, but also risk factors for other cardiovascular conditions.

Objetivo: analizar las asociaciones entre la presión arterial, la medición de la circunferencia braquial y la circunferencia abdominal en adultos con hipertensión arterial sistémica. Método: estudio descriptivo, transversal, con enfoque cuantitativo, realizado junto a 397 personas de la Estrategia de salud de la familia de Minas Gerais. Datos recolectados en 2013 y 2014 en visita a domicilio con instrumentos validados, obteniéndose, incluso, mediciones antropométricas y de presión arterial. Se han aplicado las pruebas de Chi cuadrado y exacto Fisher. Proyecto aprobado por el Comité de Ética. Resultados: en un 41.1% de los participantes con circunferencia braquial igual o superior a 27 cm, los valores de la presión arterial fueron iguales o superiores a 140/90mmHg y en 38.6% de aquéllos con circunferencia abdominal con riesgo aumentado y muy aumentado, la presión arterial estaba igual o superior a 140/90mmHg.Conclusión: aunque las asociaciones no posean significancia estadística, deben constituir criterios importantes para evaluar no sólo la hipertensión arterial sistémica, sino también factores de riesgo para otras enfermedades cardiovasculares.

Nutritional Assessment of Children Aged Twelve to Fifty Nine Months with Diarrhoea, Using Mid-upper-arm Circumference (MUAC).

Background: Protein energy malnutrition is a significant cause of morbidity and mortality in children between the ages of 12 and 59 months and diarrhoea has been shown to have a bi-directional relationship with malnutrition. Mid upper arm circumference (MUAC) has been shown to be a useful indicator of malnutrition in children aged 12 to 59 months. Objective: To determine the nutritional status of children aged 12 to 59 months with diarrhoea using mid upper arm circumference (MUAC). Method: Over a 6 month period, all children aged 12 to 59 months who presented to the Niger Delta University Teaching Hospital (NDUTH) with diarrhoea were consecutively recruited into the study. Information on their ages, diarrhoeal type, duration and frequency as well as parental educational level and occupation were obtained and recorded into a proforma. MUACs were measured and recorded to the nearest 0.1cm. Results: There were 144 children with a male to female ratio of 1.3:1. The mean MUAC was 14.25 ± 2.46cm with a steady increase with age from13.45 ± 1.99cm at 12 to 23 months to 16.50 ± 0.58cm at 48 to 59 months. Using MUAC measurements, 19 (13.2%) of the children were malnourished, with 7 (4.9%) having severe acute malnutrition and 12 (8.3%) having moderate acute malnutrition (MAM). Seventeen (11.8%) of the children were at risk of malnutrition. Children with chronic diarrhoea and ages ranging from 12 to 23 months had significantly lower MUACs with χ2 and p values of 19.58 (0.000) and 7.99 (0.005) respectively. Conclusion: Under nutrition is an important problem in children aged 12 to 59 months with diarrhoea. There is need to pay extra attention to nutritional status of this age group especially during episodes of diarrhoea.

Relação circunferência braquial e tamanho de manguitos utilizados nas Unidades Básicas de Saúde de uma cidade do interior paulista / Relation arm circumference and the cuffs size used in Basic Health Units in São Paulo countryside

Verificar se o tamanho dos manguitos utilizados nas Unidades Básicas de Saúde (UBS) para aferição da pressão arterial estão adequados à circunferência braquial dos pacientes. Métodos - Realizou-se pesquisa quantitativa, não experimental, descritiva, transversal, e de campo, onde foram medidas circunferências braquiais, de 80 pacientes, em 8 UBS. Resultados - As circunferências braquiais variaram de 22 a 52 cm, e os manguitos correspondentes, de 10 a 42 cm. O manguito padrão, 13x30cm (adulto), único disponível nas UBS, foi apropriado apenas para 50% dos sujeitos da amostra, cujas circunferências braquiais variaram entre 27 e 34 cm. A análise dos resultados deste estudo, indicam que os manguitos padrão disponíveis nas UBS, não estão adequadas aos outros 50% das circunferências braquiais encontradas, resultando em registros superestimados ou subestimados da pressão arterial, sendo provável que muitos pacientes hipertensos erroneamente avaliados, estejam seguindo tratamento incorreto. Conclusão - Conclui-se que, 50% dos pacientes da amostra, o tamanho dos manguitos utilizados nas UBS para aferição de sua pressão arterial, estavam adequados com a circunferência braquial, ou seja, tamanho adulto. A falta de disponibilidade de diferentes tamanhos de manguitos continua sendo um desafiante problema a ser encarado na rede pública de saúde, sendo necessária uma revisão nas práticas adotadas...

To check if the cuffs size used at Basic Health Units (BHUs) to blood pressure measurement are adequate to patient's arm circumference. Methods - It was conducted a quantitative research, non-experimental, descriptive, transversal, and , where it were measured arm circumferences, of 80 patients, at 8 BHUs. Results - The arm circumferences varied from 22 to 52 cm, and the correspondent cuffs, 10 to 42 cm. The standard cuff, 13x30 cm (adult), the only one available at BHUs, it was just appropriate to 50% of the sample subjects, whose arm circumferences varied between 27 and 34 cm. The results' analysis of this study, indicate that the standard cuff available at BHUs do not meet the other 50% of arm circumferences identified, resulting in overestimated or underestimated records of blood pressure, being likely that many hypertensive patients erroneously evaluated are following incorrect treatment. Conclusion - It was concluded that, 50% of the sample patients, the cuffs size used at BHUs to its blood pressure measurement, were adequate for the arm circumference, or, adult size.The lack of availability of different cuff size continue being a challenging problem to be faced in the public health being necessary a review in practices adopted...