A comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients

doi:10.1016/S0261-5614(03)00009-8

Clinical Nutrition

Volume 22, Issue 3, June 2003, Pages 307-312

https://doi.org/10.1016/S0261-5614(03)00009-8 Get rights and content

Abstract

A nutritional supplementation trial (Vlaming et al., Clin Nutr 2001; 20: 517) enabled us to assess the nutrition of 1561 patients on emergency admission to hospital. Patients acutely admitted to the 15 relevant medical, surgical and orthopaedic wards were identified. Mid upper arm circumference (MUAC) measurements were obtained in 95% (848 m, 635f) patients. For clinical reasons, Body mass index (BMI) was assessable in only 44% patients (408 m, 285f). Data on three month weight loss were obtainable in 509 patients. These measurements combined to demonstrate that 18.3% of patients were undernourished (At least one of : BMI<20 kg/m² or MUAC<25 cm or loss of weight ≥10%). There was a close relationship between BMI and MUAC. Regression equations (excluding age)were for men : BMI=1.01×MUAC—4.7, (R²=0.76), and for women BMI=1.10×MUAC−6.7, (R²=0.76). After adjustment for age, weight loss ≥10% was the most significant of the three as a predictor of mortality. Among patients in whom weight loss was not recorded MUAC was a significant predictor of mortality either alone (P=0.002) or after adjustment for BMI (P=0.007), but BMI was not significant. All three measures, even when adjusted for age and sex, were poor predictors of hospital stay although MUAC was significant in the larger group with a MUAC measure (R²=0.7% P<0.001). MUAC correlates closely with BMI, is easier to measure and predicts poor outcome better.

Introduction

Body mass index (BMI) and percentage weight loss are recommended and widely used to assess the nutrition of patients entering hospital. However it is not always possible to measure weight or height in the acutely ill because patients may not be able to stand or leave their bed. A nutritional supplementation trial (1) gave us the opportunity to assess the nutrition of 1561 patients on emergency admission to medical (1097), surgical (335) and orthopaedic (129) services of the Royal London Hospital, a teaching hospital in London's socially deprived East End. We sought to compare measurements of the mid upper arm circumference with the BMI and the percentage weight loss.

The purpose of such screening measures is to identify patients likely to benefit from enhanced nutritional care by improved outcome. They will thus be of most use in the acutely hospitalized patient if they can be shown to relate to outcome. Because the benefit of the nutritional interventions in the trial were small or non-existent, and the confidence intervals for difference in mean length of stay for supplements vs placebo were narrow, (−2 to 1.2 days) we used all the available data to assess the measurements’ validity as predictors for hospital length of stay and mortality.

Section snippets

Methods

Two research dietitians employed for the purposes of a nutritional supplementation trial (1), tried to include all consenting patients admitted as an emergency to General Medicine, Surgery or Orthopaedics on Sundays to Thursdays, from June 1997–January 1999. Patients admitted to the 15 relevant wards were identified by lists generated by the admissions department. Patients electively admitted to medical or orthopaedic wards were excluded. Patients were, whenever clinically possible, weighed and

The sample analysed

For the statistical analysis of 1561 study members 1559 had an outcome measure. Of these 1559, 78 had no MUAC, 867 had no BMI, and 11 had neither measurement. Those missing both were not considered in the analysis. In practice because of the clinical state of the patient weight and/or height could often not be measured. Thus MUAC measurements (Table 1) were obtained in 95% (848 m, 635f ) patients and BMI (Table 2) could be assessed in 44% (408 m, 285f). Weight loss data were successfully obtained

Discussion

Undernutrition in hospital patients is often unrecognized and there is a need for a simple means of screening to facilitate targeted nutritional intervention. BMI has been emphasized as an objective anthropometric criterion (4). The British Association for Parenteral and Enteral Nutrition (BAPEN) recommends that the measurements used for screening are based upon the patients weight for height (BMI) and their percentage weight loss (5). This study confirms the high prevalence of undernutrition

Acknowledgements

Ms Shona Vlaming, Ms Anzonette Biehler, Dr Crawford PJamieson, Dr Santanu Chattophadhyay, Ms Claire Archer, and Ms Katie Durman were all active investigators in the original study from which the data for this analysis are derived. Drs O.A. Obeid and Sandra Warrington and Ms A. Farrell also contributed to that study.

The study was supported by grants from the Responsive Funding Group of the North Thames Regional Health Authority NHS R&D and Abbott Laboratories Ltd. We thank the medical, surgical

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ORIGINAL ARTICLEA comparison of mid upper arm circumference, body mass index and weight loss as indices of undernutrition in acutely hospitalized patients