Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition

E Van Tonder; L Mace; L Steenkamp; R Tydeman-Edwards; K Gerber; D Friskin

E Van Tonder Nelson Mandela University
L Mace Tayler Bequest Hospital
L Steenkamp Settlers Hospital
R Tydeman-Edwards Port Elizabeth Provincial Hospital
K Gerber Nelson Mandela University
D Friskin Nelson Mandela University

Keywords: adults, hospitalised, malnutrition, mid-upper arm circumference, MUAC, referral rates, screening

Abstract

Objectives: This study aimed to expand on the limited South African malnutrition prevalence data and investigate the feasibility of mid-upper-arm circumference (MUAC) as a malnutrition screening tool.

Design: A cross-sectional, multi-centre, descriptive design was adopted.

Setting: The study was undertaken in three tertiary public hospitals in the same urban area within the Eastern Cape of South Africa.

Subjects: Adult hospitalised patients volunteered to participate (n = 266).

Methods: Data were collected using interviewer-administered questionnaires; obtaining anthropometric measurements; and consulting medical files. For maximum accuracy of various MUAC cut-off points, receiver operating characteristic curves were generated and area under the curve determined.

Results: Both body mass index (BMI) and MUAC identified 21% of participants as underweight or malnourished, and 39% as overweight or obese. The Malnutrition Universal Screening Tool (MUST) found 23% at increased malnutrition risk. Nurses or doctors detected and referred only 19% of underweight patients (BMI < 18.5 kg/m^2), to dietetics services. Direct measurements of BMI and MUST were unobtainable in 38% and 43% of patients respectively, whilst MUAC was obtainable in 100%. A statistically significant relationship (p < 0.001) exists between MUAC, BMI and MUST to detect malnutrition or malnutrition risk. MUAC cut-offs for undernutrition were determined at < 23 cm (BMI < 16 kg/m²) and < 24 cm (BMI < 18.5 kg/m²), respectively, for the study’s population groups.

Conclusion: Malnutrition prevalence was high in this study, but often unidentified, with only a fifth referred to dietetic services. MUAC is a feasible method to identify adult malnutrition and should be considered as a malnutrition screening tool and key nutritional status indicator in South African public hospitals.

The full article is available at https://doi.org/10.1080/16070658.2018.1484622

Author Biographies

E Van Tonder, Nelson Mandela University

Department of Dietetics, Nelson Mandela University, Port Elizabeth, South Africa

L Mace, Tayler Bequest Hospital

Dietetics Department, Department of Health, Tayler Bequest Hospital, Matatiele, South Africa

L Steenkamp, Settlers Hospital

Dietetics Department, Department of Health, Settlers Hospital, Grahamstown, South Africa

R Tydeman-Edwards, Port Elizabeth Provincial Hospital

Dietetics Department, Department of Health, Port Elizabeth Provincial Hospital, Port Elizabeth, South Africa

K Gerber, Nelson Mandela University

Nursing Department, Nelson Mandela University, Port Elizabeth, South Africa

D Friskin, Nelson Mandela University

Department of Statistics, Nelson Mandela University, Port Elizabeth, South Africa