Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan

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/m(2) (underweight) and >= 30.0 kg/m(2) (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/m(2) and >= 30.0 kg/m(2) 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/m(2) 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/ m(2) (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/m(2) (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

Automated summary

This study compared mid-upper arm circumference (MUAC) with body mass index (BMI) and proposed MUAC cut-off points for underweight and obesity among Sudanese adults. The results suggest that MUAC cut-offs can be used for community-based screening of underweight and obesity.