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MUAC cut off to identify overweight pregnant women

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Anonymous 1722

Normal user

27 Nov 2012, 12:07

Hi There,

Just wondering, is there a MUAC cut off to determine overweight and obesity in pregnant women? We have recently received data sets from a rapid assessment, and by observation it looks as though the population measured may have an issue/past issue with overweight/obesity as the MUAC scores are quite high. I feel like we could be missing something importnat if we only analyse the low MUAC scores. Its a difficult context as the population group are refugees living with the host population and also in camps.

Thank you!

Mark Myatt

Consultant Epideomiologist

Frequent user

27 Nov 2012, 12:51

What do you mean by "quite high"? We can have our perceptions skewed by working a lot with very poor people or with people with extreme body shapes.

High MUAC (on its own) does not mean "overweight" or "obesity". It may means high peripheral muscle mass which is healthy. If you had some measure of adiposity (e.g.TSF) then you might be able to address the issue of "overweight" and "obesity".

I must admit to being a little confused about the question. Why would you care about "chubby" mothers? You would not select them for (e.g.) supplementary feeding - you "would do no harm" WRT adiposity. These mums tend to have healthy babies and the diet and energy reserves needed for production of breast milk. I suppose that there is an increased risk of pre-eclampsia (but checking for hypertension or proteinuria might have better prognostic value). Am I missing something?

Anonymous 1722

Normal user

27 Nov 2012, 13:03

Hi Mark,

Thanks for your response.

Is there a range which we could consider as healthy/chubby? This must have its limits, yeah? We identify those with low MUACs, though what if the population has a high prevalence of obesity or overweight? Can we potentially identify overweight/obesity during pregnancy by analysing MUACs? We see in a number of transition countries a high prevalence of childhood stunting, with a high prevalence of overweight and obesity. If we could somehow use the data that we have to identify if there is an issue with overweight/obesity, then we could design complementary interventions to that of SFP, such as nutrition education etc.

Thanks for your help.

Mark Myatt

Consultant Epideomiologist

Frequent user

27 Nov 2012, 14:36

Thinking out loud ...

I suppose a limit could be used. The limit could be taken from a reference (e.g. NHANES). I'd guess that the 75th percentile (e.g. c. 365 mm in NHANES) would be sensitive enough. Above this limit we would do another test. This would be a two-stage screen for adiposity. The second stage would need to be some measure of adiposity such as TSF to differentiate between high muscle and high fat. Since we will have selected out most low TSF mothers a simple and cheap (i.e. < US$10) TSF tool such as those used in "fitness centres" should suffice.

There are other measures of adiposity such as waist to hip ratio and BAI:

   BAI = (hip circumference / height^1.5) – 18

See this article for more information.

I am not sure how practicable these are in pregnant women.

This looks like a nice topic for an MSc project for ENN to fund (and an NGO to facilitate).

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