Performance of mid-upper arm circumference as a screening tool for identifying adolescents with overweight and obesity

Burden of overweight and obesity among adolescents in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Overweight and obesity continue to escalate, despite the regulations and interventions that have been put in place. To support further policy directions, it is necessary to have pooled data that illustrate the burden of overweight and obesity among adolescents nowadays. Thus, this systematic review and meta-analysis aimed to determine the burden of overweight and obesity among Ethiopian adolescents.

METHODS

Embase, Science Direct, Medline, PubMed, Google Scholar and Web of Science were the databases used in the search for publications that ran from inception until 25 October 2023. STATA version 18 was used to analyze data on overweight and obesity in adolescents. Using the random effect model, the pooled estimates with 95% CIs were calculated. Using the Galbraith plot, I2 statistics and Cochrane Q statistics, heterogeneity was investigated.

RESULTS

In total, 20145 adolescents aged 10-19 years were included in this meta-analysis study. The pooled prevalence of overweight and obesity among adolescents in Ethiopia was 10% (95% CI 9 to 12%; I2=94.03%). There was a substantial correlation between being female (OR=1.81, 95% CI 1.47 to 2.15), attending private schools (OR=1.78, 95% CI 1.31 to 2.26), having a family size of ≥4 (OR=1.86, 95% CI 1.14 to 2.58) and being of middle economic status (OR=1.62, 95% CI 1.14 to 2.10).

CONCLUSIONS

In Ethiopia, one in 10 adolescents is overweight/obese. The study's findings clearly show that a large number of adolescents are dealing with this emerging public health issue. Moreover, characteristics related to physical activity, nutrition and sociodemographics were discovered to be associated with overweight and obesity. To lessen the burden of overweight and obesity, the government and other parties should work together to support gender-specific nutritional interventions, encourage healthy lifestyle choices among teenagers and facilitate these efforts.

Performance of mid-upper arm circumference to identify adolescents with obesity and metabolic syndrome: NHANES 2011-2018 analysis

BACKGROUND

Mid-upper arm circumference (MUAC) was recommended for screening of adolescents with obesity, although its diagnostic performance with respect to high-precision assessment of body composition remains unknown.

OBJECTIVE

To evaluate the diagnostic performance of MUAC in identifying obesity and metabolic syndrome in U.S. adolescents.

METHODS

A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) data (2011-2018) of adolescents aged 12-19. We calculated the area under the receiver operating characteristic curve, sensitivity, specificity, positive and negative predictive values and likelihood ratios of MUAC in identifying obesity and metabolic syndrome.

RESULTS

In our study, data of 5496 adolescents, including 2665 females, were analysed. The prevalence of obesity was higher in boys (14%) than girls (10%), whilst metabolic syndrome was more common in males (2.6%) than females (1.7%). The area under the curve (AUC) of MUAC in identifying obesity was 0.69 in boys and 0.86 in girls, whilst the AUC of MUAC in identifying metabolic syndrome was 0.91 in boys and 0.87 in girls. The optimal MUAC cut-off for identifying adolescents with obesity was 28.3 cm in boys (sensitivity: 64.8%, specificity: 85.5%) and 30.8 cm in girls (sensitivity: 67.9%, specificity: 90.1%).

CONCLUSIONS

MUAC was a good indicator of both obesity and metabolic syndrome, with higher accuracy in girls.

The Association between Mid-Upper Arm Circumference and Blood Pressure in an Italian Population of School-Aged Children and Adolescents with Lipid Disorders

Background: Many anthropometric measurements have been investigated concerning their association with blood pressure (BP) in paediatric age groups. This study aims to find a relationship between mid-upper arm circumference (MUAC) and BP in a population of children and adolescents aged 1-18 years. Methods: 5853 subjects (2977 females and 2876 males) were studied. MUAC, body mass index (BMI), and BP were measured. The individuals in the study were subdivided and grouped by gender and type of school attended in Italy: 1-5 years (pre-school), 6-10 years (primary school), 11-13 years (secondary school), 14-18 years (high school). Results: In the age range of 6-13 years, all the subjects with MUAC > 50th percentile had systolic and diastolic BP significantly higher than children with MUAC below 50th percentile (p < 0.0001). In the age range 14-18 years, the relationship persisted only in females (p < 0.001 and p < 0.05 for diastolic and systolic BP, respectively). A linear relationship was found between MUAC and BMI. Conclusions: In Italian children of both genders aged 6-13, arm distribution of body fat is strongly associated with increased systolic and diastolic BP. As such, a simple anthropometric measurement like MUAC might represent a tool to identify young subjects who are at risk for HTN.

Establishment of prediction equations for subcutaneous tissue thickness in two representative intramuscular deltoid injections

This study clarifies the predicted subcutaneous shoulder depth and investigates the safety of the conventional (three-finger breadth method) and new (axillary method) intramuscular injection methods. The anatomical features of 245 volunteers who received the COVID-19 vaccination via the conventional method were investigated at the injection site (T point) and the hypothetical injection site using the new method (A point) via ultrasonography. The body mass index (BMI) and subcutaneous thickness at the T point (men: r = 0.75; women: r = 0.45) and the A point (men: r = 0.81; women: r = 0.55) were positively correlated. The upper arm circumference and subcutaneous thickness at the T point (r = 0.51) and the A point (r = 0.58) were correlated in women. Formulas to predict subcutaneous thickness using BMI and upper arm circumference were established: predicted subcutaneous thickness at the A point = 0.62 × BMI - 7.7 mm (R² = 0.66) in men and 0.658 × BMI - 5.5 mm (R² = 0.31) in women. This study demonstrates safe intramuscular injection sites and their depth.

Mid upper arm circumference as screening tool of overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia

Background

Overweight or obesity is an excessive fat accumulation that impairs the health and wellbeing of the adult population throughout the world. Recently Mid upper arm circumference (MUAC) was suggested as a screening index for overweight or obesity among adolescents, but its utilization for the assessment of overweight or obesity in the adult population is not clear yet. In addition, little is known about the screening ability of MUAC for overweight or obesity in the adult population of Ethiopia. Therefore, this study aimed to evaluate the utility of MUAC for screening overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia.

Method

A Facility -based cross-sectional study was carried out from February 21 to March 20, 2020, at Mizan Tepi University. About 585 study participants were selected by gender-based stratified sampling technique. Anthropometric data like weight, height, and MUAC were collected. Pearson's correlation between MUAC, body mass index (BMI), and age was calculated to see a relationship between them. The Receiver operating characteristics (ROC) curve was calculated to identify the screening ability of MUAC for overweight or obesity. The appropriate MUAC cutoff point for both men and women established using the Youden index. Additionally, sensitivity, specificity, positive, and negative predictive values were calculated.

Result

The prevalence of overweight and obesity among the study participants was 18.1% and 4.8%, respectively. MUAC had a strong positive correlation with BMI, r = 0.65 (95% CI; 0.56–0.69). According to ROC analysis, MUAC is an excellent screening tool for male and female employees with excellent accuracy (AUC = 0.9 with 91.4% sensitivity and 76.4% specificity) and good accuracy (AUC = 0.83 with 67.2% sensitivity and 83.5% specificity), respectively. Based on the youden index, the cutoff point of MUAC to screen overweight or obesity among male and female employees was 26.91cm.

Conclusion

Mid-upper arm circumference (MUAC) has an equal ability with BMI to screen overweight or obesity among adults. Therefore, MUAC can be utilized as an alternative index to screen overweight and obesity in resource-limited setups.

The relationship of body mass index and mid-upper arm circumference with anemia in non-pregnant women aged 19-49 years in Indonesia: Analysis of 2018 Basic Health Research data

Background and objectives

Anemia remains a major public health problem worldwide. This study examined the relationship between anemia and the nutritional status of non-pregnant women aged 19–49 years in Indonesia.

Methods and study design

The data were derived from the 2018 Basic Health Research Data of Indonesia. We used information from 11,471 non-pregnant women aged 19–49 years. The dependent variable was anemia (hemoglobin level <12 g/dL). The independent variable was women’s nutritional status, a combined indicator of body mass index (BMI) and mid-upper arm circumference (MUAC). Our analysis controlled for women’s age, education, physical activity, fruit and vegetable consumption, and the presence of communicable or non-communicable diseases. We performed logistic regression analyses.

Results

The prevalence of anemia in non-pregnant women aged 19–49 years was 22.3% (95% confidence interval [CI]: 21.4–23.3). Women with overweight and obesity were less likely to develop anemia than those with a normal BMI, regardless of their MUAC score. The highest odds for developing anemia were observed in underweight women with low MUAC scores (adjusted odds ratio [aOR] = 2.83, 95%CI: 2.19–3.68). Higher odds ratios were also observed in women with insufficient physical activity, despite their sufficient consumption of fruits or vegetables (aOR = 1.87, 95%CI: 1.06–3.28). However, women who had been diagnosed with a non-communicable disease had a reduced likelihood of developing anemia (aOR = 0.75, 95%CI: 0.67–0.83).

Conclusions

Strengthening health promotion activities to improve nutritional status and healthy behaviors, particularly a healthy diet, remains important for women in Indonesia to reduce the prevalence of anemia and improve their overall health status.

The performance of mid-upper arm circumference for identifying children and adolescents with overweight and obesity: a systematic review and meta-analysis

OBJECTIVE

This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity.

DESIGN

Systematic review and meta-analysis.

SETTING

We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2-19 years were included.

PARTICIPANTS

A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses.

RESULTS

In boys, MUAC showed a pooled AUC of 0·92 (95 % CI 0·89, 0·94), sensitivity of 84·4 (95 % CI 84·6, 90·8) and a specificity of 86·0 (95 % CI 79·2, 90·8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0·93 (95 % CI 0·90, 0·95), sensitivity of 86·4 (95 % CI 79·8, 91·0), specificity of 86·6 (95 % CI 82·2, 90·1) when compared against overweight and obesity defined using BMI z-scores.

CONCLUSION

In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the 'golden standard' measure of excess adiposity.

Large mid-upper arm circumference is associated with reduced insulin resistance independent of BMI and waist circumference: A cross-sectional study in the Chinese population

BACKGROUND

Body mass index (BMI) is a common indicator in clinical practice, but it is not sufficient to predict insulin resistance (IR). Other anthropometric methods supplement BMI in the assessment of body composition, which can be predicted more accurately. This cross-sectional study aimed to evaluate the association between mid-upper arm circumference (MUAC), triceps skinfold (TSF) thickness, mid-arm muscle circumference (MAMC) and IR in Chinese adults.

METHODS

This cross-sectional study analyzed data from the 2009 China Health and Nutrition Survey database. The study population was divided into four groups according to the MUAC quartiles, and the homeostasis mode assessment was used to evaluate the degree of IR. Logistic regression analysis was performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs), with adjustments for multiple covariates. Subgroup analyses stratified by age, sex, BMI, waist circumference (WC), smoking status, and alcohol consumption were performed.

RESULTS

In total, 8,070 participants were included in the analysis. As MUAC increased, BMI, TSF thickness, MAMC, and the proportion of IR tended to increase. However, we found that there was a significant negative association between MUAC and MAMC and IR in the logistic regression analysis, independent of BMI and WC, the ORs for the highest quartiles compared with the lowest quartiles were 0.662 (95%CI: 0.540-0.811) and 0.723 (95%CI: 0.609-0.860), respectively. There was no significant association was observed between the TSF thickness and IR (OR=1.035 [95%CI: 0.870-1.231]). The inverse associations were more pronounced among participants with lower BMI and WC. No significant age-specific differences were observed (P-heterogeneity > 0.05).

CONCLUSIONS

After adjusting for BMI and WC, MUAC was negatively associated with IR in Chinese adults, and the association between MUAC and IR was derived from arm muscle instead of subcutaneous fat. MUAC could be an additional predictor of IR besides BMI and WC in clinical practice.

Mid-upper arm circumference for identifying adult overweight in large-scale population-based surveys: empirical evaluation using data of the EAT Addis study, Ethiopia

OBJECTIVES

The present study evaluates body circumferences as a nutrition screening tool for women of reproductive age with children less than 5 years of age to improve the detection of overweight and obesity in a community setting.

DESIGN

This study draws data from a community-based cross-sectional study conducted between July-August 2017 and January-February 2018 to account for seasonality in Addis Ababa, Ethiopia.

SETTING

One hundred and sixteen districts were included in Addis Ababa, Ethiopia.

PARTICIPANTS

A total of 4914 women of reproductive age with children less than 5 years of age were participated in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures included anthropometric indices. There were no secondary outcomes.

RESULTS

The optimal cut-off points to identify overweight women of reproductive age were >87.5 cm for waist circumference (WC), >31.7 cm for neck circumference (NC) and >28.0 cm for mid-upper arm circumference (MUAC) based on the highest corresponding Youden index. The area under the receiver operating characteristics curve was 0.92 (95% CI: 0.91 to 0.93) for WC, 0.83 (95% CI: 0.82 to 0.84) for NC and 0.91 (95% CI: 0.89 to 0.92) for MUAC.

CONCLUSIONS

Our result shows that WC and MUAC are alternative tools to body mass index. Both WC and MUAC are effective in identifying overweight women. We recommend using MUAC in large-scale population-based assessments to identify overweight and obesity in low-income settings as it is logistically simpler and operationally feasible.

High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique

The increasing prevalence of overweight/obesity may already have reached the farmers in Tanzania and Mozambique. Here, the measurement of the mid-upper-arm-circumference (MUAC) could become a simple and sensitive tool for early detection of at-risk groups of overweight as well as underweight. Body Mass Index (BMI) and MUAC of female and male farmers (n = 2106) from different regions of Tanzania and the Zambézia province, Mozambique, were analyzed by region, sex, age, and correlates. MUAC cut-offs, calculated via BMI cut-offs (<18.5, ≥25, and ≥30 kg/m²), and multiple linear regression (MLR), compared to those selected by highest Youden’s index (YI) value, were assessed. The study showed an overall higher prevalence of overweight (19%) than underweight (10%) due to the high number of overweight female farmers (up to 35%) in southern Tanzania. BMI, which was mainly and positively predicted by MUAC, was higher in Tanzania and among female farmers, and decreased significantly from the age of ≥65 years. MUAC cut-offs of <24 cm and ≥30.5 cm, calculated by MLR, detected 55% of farmers being underweight and 74% being overweight, with a specificity of 96%; the higher cut-off <25 cm and lower cut-off ≥29 cm, each selected according to YI, consequently detected more underweight (80%) and overweight farmers (91%), but on the basis of a lower specificity (87–88%). Overweight was evident among female farmers in East Africa. MUAC cut-offs, whether defined via linear regression or Youden’s Index, could prove to be easy-to-use tools for large-scale screenings of both underweight and overweight.

Discriminatory performance of mid-upper arm circumference for identifying thin and severely thin adolescents: a secondary data analysis using Comprehensive National Nutrition Survey

Background

Timely identification of adolescents with undernutrition is of utmost importance, and recently, mid-upper circumference (MUAC) had been considered as an alternative to body mass index (BMI) and BMI for age z-score (BAZ) for its screening. However, little is known about the MUAC cut-offs, specific to age and sex. The study was planned to assess the discriminatory performance of MUAC in identifying thin and severely thin adolescents and estimating age specific MUAC cut-offs, separately for males and females, against BAZ as the gold standard.

Methods

The Comprehensive National Nutrition Survey (CNNS), India data was used for this analysis. The Receiver Operating Characteristic curve (ROC), area under curve (AUC), and Youden Index were used to estimate MUAC cut-off values for thin (BAZ < -2) and severely thin (BAZ < -3) adolescents. The current analysis was done on 31471 adolescents.

Results

The MUAC cut-offs for identifying thin adolescents were: for 10-14 years - 19.2/19.4 cm, for 15-19 years - 22.9/21.7 cm for males and females respectively; and for severe thinness were: for 10-14 years - 18.4/18.3 cm, for 15-19 years - 21.9/20.2 cm for males/females. For thinness, the cut-off varied between 17.4-24.5 cm (for 10-19 years) among males, and for females, it varied between 17.5-20.9 cm (for 10-19 years). For severe thinness, MUAC cut-off ranged between 16.4-23.7 cm (for 10-19 years) among males, and for females, between 17.3-20.7 cm (for 10-19 years).

Conclusion

MUAC, a easy to use measure demonstrated an equivalent diagnostic performance for the identification of thinness and severe thinness against BAZ. Thus, age- and sex-specific cut-offs could be considered for screening thin and severely thin adolescents.

Reference centile curves for mid-upper arm circumference for assessment of under- and overnutrition in school-aged Indian children and adolescents

OBJECTIVES

Malnutrition is common in developing countries and is not restricted to young children. It has been suggested that measuring mid-upper arm circumference (MUAC) is an easy, accurate, and low-cost method of identifying malnutrition in the early stages. The aims of this study were to construct age- and sex-specific MUAC reference centiles, and to define and validate cutoffs for assessment of under- and overnutrition in Indian children 5 to 17 y of age.

METHODS

This was a cross-sectional, multicentric, observational study conducted in seven schools in seven states from June 2018 to November 2019. The study included 6680 healthy 5- to17-y-old children. MUAC was measured using non-stretch tapes (UNICEF). Sex-specific MUAC percentiles were computed for age and height. Cutoffs for MUAC z-scores for thinness and overnutrition were defined and validated for healthy school children (n = 726) and children with cancer (n = 500).

RESULTS

Reference centiles for MUAC for age (and height) for boys and girls are presented. Cutoffs defined for thinness and for obesity were -0.7 and +1.5 z-score, respectively (corresponding to 25th and 95th percentiles of the MUAC for age/height). For ease of use, rounded cutoffs for thinness were 16 and 18.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both sexes, and a cutoff of 22 cm in boys and 20 cm in girl from 15 to 17 y of age. For obesity, 20 and 25.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both girls and boys and a rounded cutoff of 29 cm in boys and 27 cm in girls from 15 to17 y are proposed.

CONCLUSIONS

We presented MUAC percentiles and cutoffs for screening for thinness and overnutrition in Indian children from 5 to 17 y of age. These data may also be used in children with cancer and other chronic disorders with growth failure.

Obesity and Metabolic Care of Children of South Asian Ethnicity in Western Society

South Asians constitute one-fourth of the world’s population and are distributed significantly in western countries. With exponentially growing numbers, childhood obesity is of global concern. Children of South Asian ancestry have a higher likelihood of developing obesity and associated metabolic risks. The validity of commonly used measures for quantifying adiposity and its impact on metabolic outcomes differ by race and ethnicity. In this review we aim to discuss the validity of body mass index (BMI) and other tools in screening for adiposity in South Asian children. We also discuss the prevalence of overweight and obesity amongst South Asian children in western countries and the differences in body fat percentage, adiposity distribution, and metabolic risks specific to these children compared to Caucasian children. South Asian children have a characteristic phenotype: lower lean mass and higher body fat percentage favoring central fat accumulation. Hence, BMI is a less reliable predictor of metabolic status in these children than it is for Caucasian children. Furthermore, the relatively lower birth weight and rapid growth acceleration in early childhood of South Asian children increase the risk of their developing cardiometabolic disorders at a younger age than that of Caucasians. We emphasize the need to use modified tools for assessment of adiposity, which take into consideration the ethnic differences and provide early and appropriate intervention to prevent obesity and its complications.