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Potential of mid-upper arm circumference to replace body mass index as a screening tool for assessment of nutritional status: A study among a rural elderly population in eastern India

Shobhit Garg, Bijit Biswas, Swanya P Maharana, Aparajita Dasgupta.

Abstract
Background: Malnutrition in the form of undernutrition or overnutrition has reached epidemic proportions globally in all age groups assessment of which often becomes very difficult among the elderly since many of them cannot even stand for accurate measurement of their height and weight.

Aims and Objectives: The aim of this study is to assess and to find the optimum cutoff of mid-upper arm circumference (MUAC) to predict overweight/obesity using receiver operating characteristic (ROC) curves.

Materials and Methods: A community-based cross-sectional study was conducted in May 2017–August 2017 among 335 elderly, in two villages, West Bengal. Height, weight, and MUAC were measured for each subject. ROC curve analysis was used to estimate the cutoff values of MUAC.

Results: Mean (standard deviation) age of the participants was 67.40 (6.19) years. More than half were overweight and 14 (4.2%) were obese. MUAC and body mass index (BMI) had strong significant positive correlation (r = 0.79). On ROC for MUAC to have overweight/obesity (BMI ≥25 kg/m2), area under curve was 0.9133 which signifies MUAC as a excellent screening and predictive tool. With Youden’s method as well with closest to top-left method, optimum cutoff of MUAC was found to be 21.75 cm. At this cutoff, an elderly individual will have BMI ≥25 kg/m2 with a sensitivity of 87.30% and specificity of 78.49%.

Conclusion: Our study suggests that MUAC has potential for surveillance of overweight/obesity and has a predictive tool to identify elderly who will need further assessment of obesity and its associated comorbidities.

Key words: Mid-upper Arm Circumference; Elderly, Obesity, Receiver Operating Characteristic Curve, Youden’s Index



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