This article describes simple techniques suitable for the assessment of the nutritional status of adults aged 20-60 years in emergency-affected populations. The BMI (Body Mass Index), MUAC (Mid-upper Arm Circumference), and clinical models are assessed for their usefulness in determining the prevalence of chronic undernutrition in adults at the population level, and also for screening severely undernourished adults for entrance to feeding clinics.
No consensus on a definitive method to assess adult undernutrition has been reached; more research is required to do this. This article makes only preliminary recommendations.
SURVEYS AND POPULATION LEVEL ASSESSMENTS OF CHRONIC UNDERNUTRITION
The BMI may be used to estimate the prevalence of chronic undernutrition in a population survey, using the classification system shown below.
The classification of categories of chronic undernutrition using the BMI
|
Classification of chronic underweight
categories |
BMI (kg m-2) |
|
Normal |
>=18.5 |
|
Grade I |
17.0-18.4 |
|
Grade II |
16.0-16.9 |
|
Grade III |
<=15.9 |
MUAC may also be used to assess the prevalence of chronic undernutrition at the population level.
SCREENING SEVERELY UNDERNOURISHED ADULTS
No single definition or classification of acute adult undernutrition has been universally accepted, but interim techniques may be recommended until further research clarifies criteria. We suggest that the MUAC in combination with clinical signs should be used to screen adult entrance into feeding centres, using the classification shown below. The BMI is inappropriate for this purpose as it is affected by oedema and body shape and difficult to measure. In any particular situation, workers should only use these suggested criteria as a starting point and adapt them to situation-specific factors.
Admission criteria into adult therapeutic feeding centres should be based upon the following cutoffs:
Additional social factors can be included in the model. The relative weighting of these must be determined locally; for example whether you need one, two or three additional social factors to tip the balance in favour of therapeutic rather than supplementary care. Relevant social factors could include the following:MUAC < 160 mm irrespective of clinical signs
- Bilateral pitting oedema (Beattie grade 3 or worse)
- Inability to stand
- Apparent dehydration
Admission to adult supplementary feeding centres should be based upon the following cut off:
MUAC 161-185 mm and no relevant signs or few relevant social criteria.
In any particular situation, workers should take these suggested standards as the starting point and adapt them according to situation-specific factors.
