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Miele MJ, Souza RT, Vieira MC, Pacagnella RC, Cecatti JG. Maternal diet and interactions with nutritional evaluation during pregnancy. Int J Gynaecol Obstet 2023; 163:782-789. [PMID: 37401116 DOI: 10.1002/ijgo.14974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
This narrative review aims to describe the knowledge regarding nutritional evaluation and monitoring in pregnant women. We discuss care provided by non-specialists in nutrition, regarding dietary information and risks during pregnancy, from a theoretical or conceptual viewpoint. A narrative review was conducted following a literature search when scientific databases were investigated, including SciELO, LILACS, Medline, PubMed, theses, government reports, books, and chapters in books. Finally, the material was fully read, categorized, and critically analyzed. National and international protocols of prenatal nutritional care were included and discussed. Different protocols describe the complexity of evaluating and monitoring nutrition among pregnant women during the prenatal period according to each country. The understanding of social conditions and eating habits has an important role in providing nutritional advice during pregnancy. The lack of dietitians in care overwhelms the healthcare workers and characterizes a missed opportunity. Therefore, it is important to consider rapid support tools that can track adverse nutritional status, and ways to recommend a diet that meets eating habit dynamics, according to the reality of each public health system.
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Affiliation(s)
- Maria J Miele
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Matias C Vieira
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
- Division of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - José G Cecatti
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
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Khan KI, Gaidhane SA, Kumar S, Acharya S. Correlation of FIRE-MADE (Frailty Index in Rural Elderly - Mental Status, Activities of Daily Living, Depression, and Events) With Sarcopenia in Elderly Population of Central Rural India. Cureus 2023; 15:e44942. [PMID: 37818502 PMCID: PMC10561536 DOI: 10.7759/cureus.44942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Ageing results in the deprivation of various physiological reserves and resources resulting in the development of frailty. Frailty in turn brings various morbidities and dependence on others for the survival of an individual making him weak and vulnerable to various infective and non-infective insults leading to death. The present study assessed frailty in rural older adults of central India by using the Frailty Index in Rural Elderly - Mental Status, Activities of Daily Living, Depression, and Events (FIRE-MADE) and correlated it with sarcopenia assessed by the Asian Working Group for Sarcopenia (AWGS) and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Materials This study was a prospective cross-sectional study, involving 250 older adults (i.e. age >60 years) with good functional status (i.e. able to perform basic activities of daily living or more), visiting the Medicine Department of Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, from December 2019 to May 2020. Frailty was assessed and estimated by FIRE-MADE frailty index (FI) and then correlated it with sarcopenia assessed by AWGS and EWGSOP2 criteria. And effects of various parameters of FIRE-MADE (like mental status, functional status, depression, polypharmacy, diabetes mellitus, chronic obstructive airway disease, ischemic heart disease, stroke and cancer) and sarcopenia on frailty were studied. Results The mean age of the present study group was 68.08±4.46 years. Out of 250, 204 (91.07%) were frail and 178 (71.2%) were sarcopenic, and among the whole study population, 72 (28.8%) were severely frail, whereas 89 (35.6%) were severely sarcopenic. Frailty and sarcopenia increase with an increase in age. Females were more sarcopenic than males in all age groups. All the components of FIRE-MADE were significant contributors to frailty, but sarcopenia was the most important factor, with an odds ratio of 295.00. Conclusion In the rural regions of India, there is an elevated probability of frailty, with sarcopenia being the main reason behind it.
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Affiliation(s)
- Khalid I Khan
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shilpa A Gaidhane
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Musa IR, Omar SM, Adam I. Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan. BMC Public Health 2022; 22:2056. [PMID: 36357916 PMCID: PMC9650816 DOI: 10.1186/s12889-022-14536-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Body mass index (BMI) remains the most used indicator of nutritional status despite the presence of a potentially credible alternative. Mid-upper arm circumference (MUAC) is an anthropometric measure that requires simple equipment and minimal training. The aim of this study was to compare MUAC with BMI and propose a MUAC cut-off point corresponding to a BMI of < 18.5 kg/m2 (underweight) and ≥ 30.0 kg/m2 (obesity) among Sudanese adults. Methods A cross-sectional study using multistage cluster sampling was conducted in New-Halfa, eastern Sudan. Participants’ age and sex were recorded and their MUAC, weight and height were measured using the standard procedures. The MUAC (cm) cut-offs corresponding to < 18.5 kg/m2 and ≥ 30.0 kg/m2 were calculated and determined using receiver operating characteristic (ROC) curve analysis Results Five hundreds and fifty-two adults were enrolled in the study. The median (interquartile range, IQR) of the participants age was 31.0 (24.0 – 40.0) years and 331 (60.0%) of them were females. The medians (IQR) of BMI and MUAC were 22.4 (19.1 – 26.3) kg/m2 and 25.0 (23.0 – 28.0) cm, respectively. There was a significant positive correlation between MUAC and BMI (r = 0.673, p < 0.001). Of the 552 enrolled participants, 104 (18.8%), 282 (51.1%), 89 (16.1%) and 77 (13.9%) were normal weight, underweight, overweight and obese, respectively. Best statistically derived MUAC cut-off corresponding to a BMI < 18.5 kg/m2 (underweight) was ≤ 25.5 cm in both males and females (Youden’s Index, YI = 0.51; sensitivity = 96.0%; specificity = 54.0%), with a good predictive value (AUROCC = 0.82). Best statistically derived MUAC cut-off corresponding to a BMI ≥ 30.0 kg/m2 (obesity) was ≥ 29.5 cm in both males and females (YI = 0.62, sensitivity = 70.3%, specificity = 92.0%), with a good predictive value (AUROCC = 0.86, 95.0% CI = 0.76 – 0.95). Conclusion The results suggest that the cut-offs based on MUAC can be used for community-based screening of underweight and obesity
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Northuis CA, Murray TA, Lutsey PL, Butler KR, Nguyen S, Palta P, Lakshminarayan K. Body mass index prediction rule for mid-upper arm circumference: the atherosclerosis risk in communities study. Blood Press Monit 2022; 27:50-54. [PMID: 34534134 PMCID: PMC8734618 DOI: 10.1097/mbp.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Electronic health records (EHR) are a convenient data source for clinical trial recruitment and allow for inexpensive participant screening. However, EHR may lack pertinent screening variables. One strategy is to identify surrogate EHR variables which can predict the screening variable of interest. In this article, we use BMI to develop a prediction rule for arm circumference using data from the Atherosclerosis Risk in Communities (ARIC) Study. This work applies to EHR patient screening for clinical trials of hypertension. METHODS We included 11 585 participants aged 52-75 years with BMI and arm circumference measured at ARIC follow-up visit 4 (1996-1998). We selected the following arm circumference cutpoints based on the American Heart Association recommendations for blood pressure (BP) cuffs: small adult (≤26 cm), adult (≤34 cm) and large adult (≤44 cm). We calculated the sensitivity and specificity of BMI values for predicting arm circumference using receiver operating characteristic curves. We report the BMI threshold that maximized Youden's Index for each arm circumference upper limit of a BP cuff. RESULTS Participants' mean BMI and arm circumference were 28.8 ± 5.6 kg/m2 and 33.4 ± 4.3 cm, respectively. The BMI-arm circumference Pearson's correlation coefficient was 0.86. The BMI threshold for arm circumference≤26 cm was 23.0 kg/m2, arm circumference≤34 cm was 29.2 kg/m2 and arm circumference≤44 cm was 37.4 kg/m2. Only the BMI threshold for arm circumference≤34 cm varied significantly by sex. CONCLUSIONS BMI predicts arm circumference with high sensitivity and specificity and can be an accurate surrogate variable for arm circumference. These findings are useful for participant screening for hypertension trials. Providers can use this information to counsel patients on appropriate cuff size for BP self-monitoring.
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Affiliation(s)
- Carin A. Northuis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Thomas A. Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Kenneth R. Butler
- Department of Medicine, University of Mississippi Medical Center, University of Mississippi, Jackson, Mississippi
| | - Steve Nguyen
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Priya Palta
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, Columbia University, New York, USA
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
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The Cutoff Point of Mid–Upper Arm Circumference in the Supine Position to Detect Malnutrition in Patients with Cancer. TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bhurchandi S, Kumar S, Agrawal S, Acharya S, Jain S, Talwar D, Lomte S. Correlation of Sarcopenia With Modified Frailty Index as a Predictor of Outcome in Critically Ill Elderly Patients: A Cross-Sectional Study. Cureus 2021; 13:e19065. [PMID: 34849305 PMCID: PMC8616666 DOI: 10.7759/cureus.19065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Frailty phenotype represents weight loss, decreased functional and physical capacity and activity, falls, slow gait, and memory impairment. Sarcopenia is a generalized and progressive loss of skeletal muscle mass, strength, and function, which occurs due to primary effects of aging and secondary effects of other causes including diseases, malnutrition, and inactivity. MATERIALS AND METHODS This prospective cross-sectional study was performed on 70 critically ill geriatric patients (of age > 60 years) admitted in Medicine ICU (MICU) from December 2020 to May 2021 at a rural medical school at Wardha in central rural India. We assessed sarcopenia in all the patients by the European Working Group on Sarcopenia in Older People (EWGSOP) criteria and compared it with the modified frailty index. All the patients were divided in sarcopenic and non-sarcopenic groups; frailty index was applied, and outcomes were measured in terms of mortality, the need for ventilation, and length of ICU stay. RESULTS In this study, the mean age of the patients was 68.61 ± 5.88 years in the sarcopenic group and 69.10 ± 6.31 years in the non-sarcopenic group. Eighteen (42.86%) patients in the sarcopenic group were severely frail, whereas eight (28.57%) patients in the non-sarcopenic group (p = 0.532) were not. In the sarcopenic severely frail group, mortality was six (14.29%), and eight (19.05%) required ventilation (p = 0.001), whereas in the non-sarcopenic severely frail group, mortality as well as the need for ventilation were four (14.29%) (p = 0.0001). Total duration of ICU stays was 4.30 ± 1.07 days in the sarcopenic group (n = 42), whereas it was 3.85 ± 1.23 days in the non-sarcopenic group (n = 28) (p = 0.10). CONCLUSION Our study found that critically ill patients with sarcopenia had more tendency to become frail, thereby increased risk of mortality. A timely routine assessment for sarcopenia upon ICU admission may provide an important prognostic factor in patient outcomes.
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Affiliation(s)
- Shreerang Bhurchandi
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sachin Agrawal
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shraddha Jain
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Dhruv Talwar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sunayana Lomte
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Gainey M, Qu K, Garbern SC, Barry MA, Lee JA, Nasrin S, Monjory M, Nelson EJ, Rosen R, Alam NH, Schmid CH, Levine AC. Assessing the performance of clinical diagnostic models for dehydration among patients with cholera and undernutrition in Bangladesh. Trop Med Int Health 2021; 26:1512-1525. [PMID: 34469615 PMCID: PMC9118139 DOI: 10.1111/tmi.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Accurately assessing dehydration severity is a critical step in reducing mortality from diarrhoea, but is complicated by cholera and undernutrition. This study seeks to assess the accuracy of two clinical diagnostic models for dehydration among patients over five years with cholera and undernutrition and compare their respective performance to the World Health Organization (WHO) algorithm. METHODS In this secondary analysis of data collected from the NIRUDAK study, accuracy of the full and simplified NIRUDAK models for predicting severe and any dehydration was measured using the area under the Receiver Operator Characteristic curve (AUC) among patients over five with/without cholera and with/without wasting. Bootstrap with 1000 iterations was used to compare the m-index for each NIRUDAK model to that of the WHO algorithm. RESULTS A total of 2,139 and 2,108 patients were included in the nutrition and cholera subgroups respectively with an overall median age of 35 years (IQR = 42) and 49.6% female. All subgroups had acceptable discrimination in diagnosing severe or any dehydration (AUC > 0.60); though the full NIRUDAK model performed best among patients without cholera, with an AUC of 0.82 (95%CI:0.79, 0.85) and among patients without wasting, with an AUC of 0.79 (95%CI:0.76, 0.81). Compared with the WHO's algorithm, both the full and simplified NIRUDAK models performed significantly better in terms of their m-index (p < 0.001) for all comparisons, except for the simplified NIRUDAK model in the wasting group. CONCLUSIONS Both the full and simplified NIRUDAK models performed less well in patients over five years with cholera and/or wasting; however, both performed better than the WHO algorithm.
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Affiliation(s)
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Meagan A. Barry
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - John Austin Lee
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahmuda Monjory
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Eric J. Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Rochelle Rosen
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Nur H. Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Christopher H. Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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Validating mid-upper arm circumference (MUAC) cut off points as an indicator of nutritional status among nine tribal populations of India. ANTHROPOLOGICAL REVIEW 2021. [DOI: 10.2478/anre-2021-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Guzmán-Mercado E, Vásquez-Garibay EM, Sánchez Ramírez CA, Muñoz-Esparza NC, Larrosa-Haro A, Meza Arreola PL. Full Breastfeeding Modifies Anthropometric and Body Composition Indicators in Nursing Mothers. Breastfeed Med 2021; 16:264-271. [PMID: 33179962 DOI: 10.1089/bfm.2020.0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: It has been observed that breastfeeding mobilizes the deposits of fat that accumulate during pregnancy and promotes weight loss through energy expenditure. The purpose of this study was to demonstrate that full breastfeeding (FBF) reduces anthropometric and body composition indicators in women between the 8th and the 16th week postpartum. Methods: In a nonrandom cohort study, 170 mothers at the Hospital Civil de Guadalajara, Guadalajara, México, were enrolled: FBF 74, partial breastfeeding (PBF) 57, and human milk substitutes (HMS) 39. Anthropometric indicators and body composition were measured at the 8th and 16th week postpartum. We performed analysis of variance to compare body composition according to the type of feeding and paired Student's t-test to compare the changes from the 8th to 16th week postpartum. Results: We found that FBF mothers had a trend to lower arm fat area and triceps skinfold than PBF and HMS mothers at 8 and 16 weeks postpartum. We observed a decrease in weight (p = 0.004), weight/age index (p = 0.003), body mass index (p = 0.003), hip circumference (p = 0.037), and lean mass (p = 0.003) from 8 to 16 weeks postpartum in mothers who offered FBF. The mid-upper arm circumference, the arm total area, and their z-score increased in the three feeding groups. Conclusions: Our results show that FBF mothers had some lower adiposity from 8 to 16 weeks postpartum compared with the result observed among PBF mothers and those who utilized HMS.
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Affiliation(s)
- Elizabeth Guzmán-Mercado
- Instituto de Nutrición Humana, Universidad de Guadalajara, Guadalajara, Mexico.,Doctorado en Ciencias Médicas, Universidad de Colima, Colima, Mexico
| | - Edgar M Vásquez-Garibay
- Instituto de Nutrición Humana, Universidad de Guadalajara, Guadalajara, Mexico.,División de Pediatría, Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, Mexico
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Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women). Public Health Nutr 2020; 23:3104-3113. [PMID: 32799964 DOI: 10.1017/s1368980020000397] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine if a global mid-upper arm circumference (MUAC) cut-off can be established to classify underweight in adults (men and non-pregnant women). DESIGN We conducted an individual participant data meta-analysis (IPDMA) to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cut-offs for identifying underweight among adults (defined as BMI < 18·5 kg/m2). Measures of diagnostic accuracy were determined every 0·5 cm across MUAC values from 19·0 to 26·5 cm. A bivariate random effects model was used to jointly estimate SENS and SPEC while accounting for heterogeneity between studies. Various subgroup analyses were performed. SETTING Twenty datasets from Africa, South Asia, Southeast Asia, North America and South America were included. PARTICIPANTS All eligible participants from the original datasets were included. RESULTS The total sample size was 13 835. Mean age was 32·6 years and 65 % of participants were female. Mean MUAC was 25·7 cm, and 28 % of all participants had low BMI (<18·5 kg/m2). The area under the receiver operating characteristic curve for the pooled dataset was 0·91 (range across studies 0·61-0·98). Results showed that MUAC cut-offs in the range of ≤23·5 to ≤25·0 cm could serve as an appropriate screening indicator for underweight. CONCLUSIONS MUAC is highly discriminatory in its ability to distinguish adults with BMI above and below 18·5 kg/m2. This IPDMA is the first step towards determining a global MUAC cut-off for adults. Validation studies are needed to determine whether the proposed MUAC cut-off of 24 cm is associated with poor functional outcomes.
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Thorup L, Hamann SA, Kallestrup P, Hjortdal VE, Tripathee A, Neupane D, Patsche CB. Mid-upper arm circumference as an indicator of underweight in adults: a cross-sectional study from Nepal. BMC Public Health 2020; 20:1187. [PMID: 32727437 PMCID: PMC7391598 DOI: 10.1186/s12889-020-09294-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background Undernourished people have an increased risk of premature mortality from both infectious and non-communicable diseases. Aside from screening purposes, assessment of nutritional status is a useful tool in management and evaluation of various chronic diseases. Body-Mass-Index (BMI) is today the most commonly used marker of nutritional status however, this method presents a challenge in many low resource settings and immobile patients. Mid-upper arm circumference (MUAC) is another anthropometric measure that requires minimal equipment and little training. So far, MUAC cutoffs for undernutrition are well established in children < 5 years but there is still no consensus for a specific cutoff in adults. The objective of this study was to compare MUAC with BMI and suggest a MUAC cut-off corresponding to a BMI of 18.5 kg/m2 to identify underweight in adults. Methods A cross-sectional study was conducted at two urban public hospitals in Nepal. The following variables where collected: MUAC, weight, height, sex, age and self-reported medical history. Exclusion criteria: < 19 years of age, pregnancy and oedema. Sensitivity and specificity for a MUAC value corresponding to BMI < 18.5 was calculated. ROC analysis was performed for male and female as well as Pearson’s correlation of MUAC and BMI. Results A total of 302 people between 18 and 86 years of age, 197 women and 105 men, were included. Of these, 90 people suffered from rheumatic heart disease. MUAC was highly correlated with BMI in both women r = 0.889 and men r = 0.846. Best statistically derived MUAC cutoff corresponding to a BMI < 18.5 kg/m2 was 24.5 cm (Youdens Index = 0.75; sensitivity 92.86; specificity 82.48), with high predictive value (AUROCC> 0.9). The setting based optimal MUAC cutoff was also 24.5 cm. No considerable variation was found in sex- and disease specific subgroups. Conclusion MUAC is strongly correlated with BMI in adults in Nepal. For simplicity, a MUAC of 24.5 cm is the optimal statistically and setting based cutoff in both women and men to identify underweight (BMI < 18.5 kg/m2).
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Affiliation(s)
- Lene Thorup
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Aarhus N, Denmark. .,Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Sophie Amalie Hamann
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Per Kallestrup
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ashish Tripathee
- Western Regional Hospital, Pokhara Academy of Health Sciences, Pokhara, Nepal
| | - Dinesh Neupane
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Nepal Development Society, Bharatpur, Chitwan, Nepal
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