The validity of mid-upper arm circumference as an indicator of low BMI in population screening for undernutrition: a study among adult slum dwellers in eastern India

Objective: To explore the possibility for a statistically appropriate value of mid-upper arm circumference (MUAC) to identify the state of severe undernutrition, based on very low BMI, among adult Indian slum dwellers. Design: Cross-sectional study on adults. Height and MUAC were recorded and BMI was computed. Chronic energy deficiency (CED) was determined using the WHO international guidelines as BMI < 18.5 kg/m(2) and normal as BMI >= 18.5 kg/m(2). Besides calculating mean, SD and 25th, 50th and 75th percentile values, multiple linear regression analysis was undertaken to assess the associations between age, MUAC and BMI. Receiver-operating characteristic curve analysis was performed to determine the best MUAC cut-off to identify CED status. The chi(2) test was used to assess significance of the difference in CED prevalence across MUAC categories. Setting: An urban slum in Midnapore town, West Bengal State, India. Subjects: Male (n 467) and female (n 488) Indian slum dwellers. Results: MUAC of 22.7 and 21.9 cm, respectively, in males and females were the best cut-off points to differentiate CED from non-CED. Conclusions: Results supported the validity of the WHO-recommended MUAC cut-offs for adults. There is still a need to establish statistically appropriate MUAC cut-offs to predict undernutrition and morbidity.