Table 3 - uploaded by Bernard Maire
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Source publication
To test the hypothesis that 'normal but vulnerable' adults, as defined by body mass index (BMI) in combination with mid-upper-arm-circumference (MUAC), are closer to normal than to malnourished ones. For that purpose body composition measurements were compared between normal and low BMI categories and according to MUAC value in an African context a...
Contexts in source publication
Context 1
... cut-off point of mean MUAC-1 s.d. was 23.0 cm in our sample. Table 3 gives the distribution of the subjects according to the cut- off points of BMI alone (Ferro-Luzzi et al, 1992) or of BMI and MUAC . There was a medium to high prevalence of low BMIs (18.7%) according to WHO criteria (WHO, 1995). ...
Context 2
... result was similar to that of the international sample of James et al (1994) in which 38.6% of women with a BMI`18BMI`BMI`18.5 had a MUAC below the meanÀ1 s.d. The prevalence of thinness therefore decreased from 18.7% as de®ned by BMI alone to 9.0% as de®ned by BMI and MUAC (Table 3). This difference was due to the group of subjects classi®ed as`normalas`normal but vulnerable' (9.7%), who were still not`normalnot`normal', but no longer`thinlonger`thin', in the new classi®cation. ...
Citations
... Malnutrition was classified based on MUAC measurement using the criteria: <23 cm, severely malnourished; 23-25.4 cm, moderately malnourished; ≥25.5 cm, adequately nourished [28,[31][32][33][34][35]. ...
In low-income countries there are few data on hospital malnutrition. Reduced food intake combined with nutrient-poor foods served in hospitals contribute to nutritional risk. This study investigated whether reported dietary intake and disease state of hospitalized adults in critical care units was related to malnutrition determined by mid-upper arm circumference (MUAC). Adult in-patients (n = 126) in tuberculosis, burn, oncology, and intensive care units in two public tertiary hospitals in Malawi were screened for nutritional status using MUAC and a question on current dietary intake. The hospital menu was reviewed; portion sizes were weighed. The prevalence of moderate and severe malnutrition was 62%. Patients with organ-related diseases and infectious diseases had the highest rates of reduced reported dietary intake, 71.4% and 57.9%, respectively; however, there was no association between reported dietary intake and MUAC. In those unable to eat, however, the rate of severe malnutrition was 50%. The menu consisted of porridge and thickened corn-based starch with fried cabbage; protein foods were provided twice weekly. There was a nutrient gap of 250 calories and 13 gm protein daily. The findings support the need for increasing dietetic/nutrition services to prevent and treat malnutrition in hospitals using simple screening tools.
... It can also complement the identification of cases using BMI and work as a substitute if BMI measurement would be difficult in a particular situation. Several other studies have also shown a strong correlation between MUAC and BMI in different settings (12)(13)(14)(15) . MUAC also proved to be a better predictor of mortality compared with BMI (16) . ...
Objective
To assess the strength of correlation and agreement between mid-upper arm circumference (MUAC) and BMI, and determine suitable MUAC cut-offs, to detect wasting and severe wasting among non-pregnant adult women in India.
Design
Cross-sectional studies were conducted in five high-burden pockets of four Indian states.
Setting
Prevalence of malnutrition among women and children is very high in these pockets and the government plans to implement community-based pilot projects to address malnutrition in these areas.
Participants
Anthropometric measurements were carried out on 1716 women with children <5 years of age. However, analyses were conducted on 1538 non-pregnant adult women.
Results
The results showed a strong correlation between MUAC and BMI in the non-pregnant women, with correlation coefficient of 0·860 (95 % CI 0·831, 0·883; P < 0·001). Cohen’s κ of 0·812 and 0·884 also showed good agreement between MUAC and BMI in identifying maternal wasting and severe wasting, respectively. The univariate regression model between MUAC and BMI explained 0·734 or 73 % of the variation in BMI. The MUAC cut-offs for wasting (BMI < 18·5 kg/m ² ) and severe wasting (BMI < 16·0 kg/m ² ) were calculated as 232 and 214·5 mm, respectively.
Conclusions
MUAC is a strong predictor of maternal BMI among non-pregnant women with children <5 years in high-burden pockets of four Indian states. In a resource-constrained setting where BMI may not be feasible, the MUAC cut-offs could reliably be used to screen wasting and severe wasting in non-pregnant women for providing appropriate care.
... Other studies which examined the association between low MUAC and low BMI (<18·5 kg/m 2 ) among non-pregnant adults also found strong associations between these two measures, with statistically significant OR ranging from 13·9 to 28·8. All these studies used an MUAC cut-off of 23 cm (25,57,58) . Moreover, Ferro-Luzzi and James (54) also suggested a cut-off of MUAC < 22 cm for women and found a strong association with BMI < 18·5 kg/m 2 , with a high OR of 21·2. ...
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 χ² 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.
... 23 Several studies have shown a strong association between a MUAC < 23 cm and a BMI of < 18.5. [24][25][26][27] In this study BMI (< 18.5) and MUAC (< 23 cm) were used to determine malnutrition prevalence and MUST to determine malnutrition risk prevalence. Demi-span or ulna length was used to determine height for non-ambulatory patients, using validated formulae. ...
Objectives: The aim of this study was to describe the prevalence of malnutrition among adult hospitalised patients in three South African public hospitals and to determine the availability of nutrition-related quality indicators at ward and institutional level.
Method: A descriptive, cross-sectional, multi-centre study was used to determine the prevalence of malnutrition, whilst a descriptive exploratory design was used to determine the use of nutrition-related quality indicators for the identification and treatment of malnutrition. A total of 141 adult hospitalised patients in three public hospitals in an urban setting participated. Mid-upper arm circumference (MUAC), body mass index (BMI), and malnutrition universal screening tool (MUST) were used to determine the prevalence of malnutrition or malnutrition risk. A Hospital Nutrition Review Tool (HNRT) determined the use of nutrition-related quality indicators.
Results: The overall malnutrition risk according to MUST was 72.3% (48.2% high risk and 24.1% medium risk), whilst 45.4% were malnourished based on MUAC. No routine nutritional screening was conducted in any of the wards to identify patients at nutritional risk. The majority of nurses reported inadequate training or knowledge to calculate patients’ BMI or percentage weight loss, or to perform nutritional screening.
Conclusion: Both malnutrition prevalence and malnutrition risk among adult hospitalised patients are high in the public sector. Inadequate resources may lead to delays in malnutrition identification and appropriate nutritional intervention, which may adversely affect both the patient and the institution. This study contributes to baseline data on adult malnutrition in the South African public hospital setting.
... Constitutional thinness (CT) ) is a non-undernutrition but underweight state in the same age range of anorexia nervosa. This is a relatively poorly described and explored condition (Norgan, 1994) (Gartner et al., 2001). Prevalence of CT is therefore unknown. ...
Introduction
Constitutional thinness (CT) is an underweight state characterized by normal menstruations and no change in feeding behaviour. Thinness is the only resemblance between Anorexia Nervosa (AN) and CT. Removal of amenorrhea from the new DSM 5 definition of AN might result in misdiagnosis between these two populations.
The objective of this study was to compare CT, AN and Control subjects in terms of biological, anthropometric, and psychological markers in order to better distinguish AN from CT subjects.
Materials and methods
Body composition, nutritional markers, pituitary hormones, bone markers and psychological scores were evaluated in three groups of young women: fifty-six CT, forty restrictive-type AN and fifty-four Control subjects. For every marker, a receiver Operator Characteristics (ROC) curve was calculated to evaluate the accuracy of differentiation between AN and CT groups.
Results
For most studied parameters, CT subjects were similar to Controls but dramatically different from AN subjects. DEBQ Restrained Eating subscale score was identified by ROC data analysis as the only psychological parameter tested to successfully differentiate AN from CT. Free-T3 and Leptin were shown to be powerful markers to differentiate AN and CT populations as they were highly specific and sensitive ones.
Conclusion
The exclusive use of psychological testing criteria is not always sufficient to differentiate AN and CT patients. Minimally, additional testing of Free T3 levels, which is cheap and widely accessible for general practitioners, should be completed to avoid misdiagnosis which could result in the implementation of ineffective treatment plans and social stigmatization for CT women.
... Increased fat mass, for example, is associated with an increased risk of coronary artery disease (CAD), hypertension, stroke, type 2 diabetes, various cancers, osteoarthritis, degenerative joint disease, and abnormal blood lipid profiles (Howley & Franks, 2003). Low levels of FFM have been shown to contribute to osteoporosis, impaired functional capacity and reduced physical activity levels (Gartner, Maire, Kameli, Traissac, & Delpeuch, 2001; American College of Sports Medicine, 2006). Regional body composition has been linked to heart disease, stroke, diabetes mellitus, hypertension, endometrial cancer, peptic ulcers, non-alcoholic hepatitis, gall bladder disease, Cushing's syndrome, polycystic ovaries, menstrual disorders, Werner's syndrome, psychosocial problems, and other health risks (Lean, 2003; Janssen, Heymsfield, Allison, Kotler, & Ross, 2002). ...
Knowing one's waist circumference (WC) is a primary step in assessing risk of disease and health disorders. One concern, however, is the accuracy with which WC measurements are taken. This study attempted to determine the effectiveness of a computer-based tutorial (CBT) in teaching previously untrained individuals to properly self-measure WC. Eighty-three subjects used the CBT to learn and perform WC self-measurement. Validity of the subjects' measurements was determined by comparing their measurements to a traditionally trained and experienced tester's. Bland-Altman and Box-Whisker comparisons revealed an average 1.57cm bias in the subjects' WC measurements. Bland-Altman bias plots illustrated agreement between the subjects' and experienced tester's measurements. Pearson correlation (r=0.97) showed no significant (p<0.0001) difference between the two groups. The results of this experiment suggest that the tested CBT is efficacious in teaching WC self-measurement. The tutorial could be used in the areas of health assessment, standardization, biomedical education and research.
... The nonpathological state of constitutional thinness is supported by the absence of Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for AN, normal menstruation (27), normal hormonal profile (13), normal levels of sc adipose tissue (28) and, as we have recently described, a normal energy metabolism (14). This entity was initially described in African and Australian aboriginal populations (28,29), whereas no estimate of prevalence has been performed in Western populations. No bone quality data have previously been published on young women with constitutional thinness. ...
... The low bone mass and overall bone size reduction in constitutional thinness associated with normal hormonal parameters led us to hypothesize a genetic causality. We have previously reported that the families of the constitutionally thin subjects frequently have low BMI (14), in line with previous studies (28,29,40,42). Therefore, the genetic determinism of severe underweight was postulated. ...
Low fat mass and hormonal or nutritional deficiencies are often incriminated in bone loss related to thinness. Constitutional thinness has been described in young women with low body mass index (BMI) but close-to-normal body composition, physiological menstruation, no hormonal abnormalities, and no anorexia nervosa (AN) psychological profile.
Our objective was to determine whether constitutional thinness is associated with impaired bone quality.
This was an observational, cross-sectional study on 25 constitutionally thin and 44 AN young women with similar low BMI (<16.5 kg/m2) and 28 age-matched controls.
Femoral and lumbar spine bone mineral density by dual-energy x-ray absorptiometry, distal tibia and radius bone architecture and breaking strength by three-dimensional peripheral quantitative computed tomography, and bone turnover markers were determined.
Constitutionally thin subjects displayed a higher percentage of fat mass than AN subjects but had similar lumbar and femoral bone mineral density, which were significantly lower than in controls (P < 0.001). Constitutionally thin subjects displayed more markedly impaired trabecular and cortical bone parameters in the distal tibia than in the radius. AN bone structure was impaired only in subjects with a long history of disease. Calculated breaking strength was decreased in constitutional thinness and long-standing AN in both the radius and the tibia. Bone markers in constitutionally thin subjects were similar to those of controls. Osteoprotegerin to receptor activator of nuclear factor kappa B ligand ratio was higher in constitutionally thin subjects than in controls or AN women.
Young women with constitutional thinness present an unexpectedly high prevalence of low bone mass (44%) associated with small bone size, overall diminished breaking strength, but normal bone turnover. Mechanisms related to insufficient skeletal load and/or genetics are proposed to explain this new phenotype of impaired bone quality.
... São escassos os estudos que já utilizaram a medida da circunferência do braço para caracterizar o estado nutricional em adultos 29,30 . Na presente pesquisa, a alta correlação entre a circunferência do braço e o IMC em mulheres adultas sugere que o uso da circunferência do braço como medida de rastreamento da adiposidade global em mulheres pode ser uma alternativa factível. ...
O objetivo do estudo consiste em definir padrões de adiposidade em mulheres. O estudo foi realizado em um Centro Municipal de Saúde de Belo Horizonte, Minas Gerais, com 827 mulheres entre 12 e 65 anos. As participantes realizaram diversas medidas antropométricas e responderam a um questionário sobre condições socioeconômicas, demográficas, história obstétrica, estilo de vida. A técnica de análise fatorial de componentes principais (ACP) foi utilizada para identificar conglomerados e independência de variáveis antropométricas na definição de padrões de adiposidade em mulheres. Os três primeiros componentes principais independentes explicaram 85,97% da variância. O primeiro foi representado pelas pregas cutâneas, o segundo pelo Índice de Massa Corporal (IMC) e pela circunferência do braço (CB) e o terceiro pela razão cintura/quadril (RCQ). Os fatores explicaram 38,42%, 29,03% e 18,52% da inércia, respectivamente. Evidenciou-se associação positiva entre todas as variáveis. Observou-se associação de maior intensidade, justificado pela alta correlação, entre as pregas da coxa, peitoral, bicipital, subescapular e supra-ilíaca (Fator 1) e a CB e o IMC (Fator 2). A variável RCQ foi identificada como principal representante do terceiro fator. Conclui-se que a análise fatorial de componentes principais identificou adequadamente três padrões de adiposidade em mulheres: periférica, global e central. A forte associação entre o IMC e CB demonstra que essa última medida poderia substituir com vantagens o IMC no rastreamento populacional da obesidade. Os critérios diagnósticos para a obesidade em mulheres seriam mais precisos se considerassem simultaneamente a CB, a RCQ e a prega da coxa.
... The length 2 /R 5 is assumed to reflect the ECW volume, and the length 2 /R 100 is assumed to reflect the TBW volume. Their ratio was used as a simple index of the ECW/TBW ratio, as we had done in previous studies in African subjects (23,24). ...
Little information is available on the validity of simple and indirect body-composition methods in non-Western populations. Equations for predicting body composition are population-specific, and body composition differs between blacks and whites.
We tested the hypothesis that the validity of equations for predicting total body water (TBW) from bioelectrical impedance analysis measurements is likely to depend on the racial background of the group from which the equations were derived.
The hypothesis was tested by comparing, in 36 African women, TBW values measured by deuterium dilution with those predicted by 23 equations developed in white, African American, or African subjects. These cross-validations in our African sample were also compared, whenever possible, with results from other studies in black subjects.
Errors in predicting TBW showed acceptable values (1.3-1.9 kg) in all cases, whereas a large range of bias (0.2-6.1 kg) was observed independently of the ethnic origin of the sample from which the equations were derived. Three equations (2 from whites and 1 from blacks) showed nonsignificant bias and could be used in Africans. In all other cases, we observed either an overestimation or underestimation of TBW with variable bias values, regardless of racial background, yielding no clear trend for validity as a function of ethnic origin.
The findings of this cross-validation study emphasize the need for further fundamental research to explore the causes of the poor validity of TBW prediction equations across populations rather than the need to develop new prediction equations for use in Africa.
Résumé
La maigreur constitutionnelle (MC) est un état physiologique de maigreur ne présentant aucun trouble du comportement alimentaire, ni aucune des anomalies hormonales classiquement retrouvées dans l’anorexie mentale, et secondaires - entre autres - à la dénutrition, avec préservation de l’axe gonadotrope, et donc des règles physiologiques. La question de la résistance à la prise de poids s’est posée, d’autant plus qu’il existe des modèles monogéniques animaux de maigreurs/résistance à la prise de poids.
Afin de tester l’hypothèse d’une résistance à la prise de poids dans la maigreur constitutionnelle, nous avons soumis à une surnutrition lipidique de 630 kcal/jour, huit femmes ayant une MC (indice de masse corporelle [IMC] : < 17,5 kg/m²) et huit femmes témoins (IMC : 18,5-25,0 kg/m²) pendant 4 semaines.
Les quatre semaines de surnutrition lipidique bien suivie n’ont pas permis de faire grossir les MC en comparaison des témoins, faisant de la MC le premier modèle humain de résistance à la prise de poids. Cette étude a aussi montré que la MC présentait une balance énergétique positive paradoxale, le « gap », en miroir d’un gap négatif paradoxal retrouvé chez les obèses, et qui suggère que la MC utilise des voies énergétiques spécifiques pour résister à la prise de poids. La découverte de ce « gap » nous force à repenser nos méthodes de mesures et nos équations de balance énergétique.
