Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees

David C.E. Philpott, Valérie Belchior-Bellino, Mija Ververs

Research output: Contribution to journalArticlepeer-review


Abstract Objective: BMI is a time-intensive measurement to assess nutritional status. Mid-upper arm circumference (MUAC) has been studied as a proxy for BMI in adults, but there is no consensus on its optimal use. Design: We calculated sensitivity, specificity and area under receiver operating characteristic curve (AUROCC) of MUAC for BMI < 18·5, <17 and <16 kg/m2. We designed a system using two MUAC cut-offs, with a healthy (non-thin) 'green' group, a 'yellow' group requiring BMI measurement and a 'red' group who could proceed directly to treatment for thinness. Setting: We retrospectively analysed monitoring data collected by the International Committee of the Red Cross in places of detention. Participants: 11 917 male detainees in eight African countries. Results: MUAC had excellent discriminatory ability with AUROCC: 0·87, 0·90 and 0·92 for BMI < 18·5, BMI < 17 and BMI < 16 kg/m2, respectively. An upper cut-off of MUAC 25·5 cm to exclude healthy detainees would result in 64 % fewer detainees requiring BMI screening and had sensitivity 77 % (95 % CI 69·4, 84·7) and specificity 79·6 % (95 % CI 72·6, 86·5) for BMI < 18·5 kg/m2. A lower cut-off of MUAC < 21·0 cm had sensitivity 25·4 % (95 % CI 11·7, 39·1) and specificity 99·0 % (95 % CI 97·9, 100·0) for BMI < 16 kg/m2. An additional 50 kg weight requirement improved specificity to 99·6 % (95 % CI 99·0, 100·0) with similar sensitivity. Conclusions: A MUAC cut-off of 25·5 cm, above which detainees are classified as healthy and below receive further screening, would result in significant time savings. A cut-off of <21·0 cm and weight <50 kg can identify some detainees with BMI < 16 kg/mwho require immediate treatment.

Original languageEnglish (US)
Pages (from-to)4777-4785
Number of pages9
JournalPublic health nutrition
Issue number15
StatePublished - Oct 12 2021
Externally publishedYes


  • BMI
  • Male detainees in sub-Saharan Africa
  • Malnutrition
  • Mid-upper arm circumference
  • Sensitivity and specificity
  • Thinness

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nutrition and Dietetics
  • Medicine (miscellaneous)


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