Standardized Mid-Upper Arm Circumference Cutoffs for Adolescents and Adults

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Although mid-upper arm circumference (MUAC) is commonly used to determine the nutritional status of adolescents and adults, there are no global standards to classify acute malnutrition among adolescents and adults using MUAC. As a result, different countries and programs use different MUAC cutoffs to determine eligibility for program services among these population groups. To address this gap, FANTA initiated a two-phase research project with Tufts University to build the evidence base for the use of standardized MUAC cutoffs as indicators of moderate acute malnutrition and severe acute malnutrition among adolescents and adults, including pregnant women.

The first phase was a systematic review of the existing evidence on the use of MUAC as an indicator or predictor of nutrition- and health-related outcomes. While the review had limitations, it found that despite significant associations between low MUAC (as defined by various cutoffs) and several adverse health outcomes—particularly among pregnant women—there was insufficient evidence to draw firm conclusions. There were also too few diagnostic test accuracy studies to be able to recommend an optimum MUAC cutoff for any particular health outcome at the time of the review.

The second phase consists of two sets of secondary data analyses, each of several large datasets, to explore the MUAC thresholds for predicting adverse outcomes associated with poor nutritional status; the first set of analyses is for pregnant women and the second for the general adult population. The analysis found that it is difficult to recommend a single cutoff to identify pregnant women with moderate acute malnutrition that would be suitable across settings. The report recommended that countries and programs conduct a cost-benefit analysis to weigh the benefit of treatment against the benefit of a negative outcome averted before adopting a specific MUAC cutoff for pregnant women. Results from the analysis for non-pregnant adults are pending.

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