General summary - suggested indicators for assessing adult undernutrition in the field

Earlier in this report we defined the criteria of an ideal index of nutritional status. Table 6 shows how BMI, MUAC, and CHANCES meet these criteria.

Table 6 How BMI, MUAC, and CHANCES meet the criteria of an ideal index of nutritional status in famines

Criteria	BMI	MUAC	CHANCES
Independent of height	Yes	Yes	Yes
Correlated with body energy stores	Yes	Yes	Yes
	Upwardly biased by oedema.
Correlated with health/ functional outcomes	Yes in chronic	?	Yes
	? acute	Insufficient data.
Simple to obtain and interpret	No	Yes	Yes
	Measurements difficult in patients unable to stand and those with musculo-skeletal problems.		Proposes clinical signs are easy to elicit.
Accurate	?	Yes	Yes
	Needs correction for body shape using extra measurement of SH/S and further arithmetic.
Valid	?	Yes	Yes
	Not in the presence of oedema.
Precise	Yes	?	?
		measurement errors in children. Insufficient data in adults.	See MUAC.

In table 7 we present some interim recommendations for techniques that may be used, under different circumstances for the assessment of adult nutritional status. These recommendations are preliminary and there is a need for further research to clarify the criteria. It must also be noted that, in emergency relief programmes, the appropriate indicator cut-off point (screening level) is that which selects the number of individuals that can be treated with the resources at hand ⁹⁴. In reality, such cut-off point values often cannot be determined universally but must be tailored to suit the resources available in each particular situation⁹⁴. The choice of underlying body measurement may also be determined by available equipment (e.g. scales may not be available to measure weight).

Table 7 The applicability of BMI, MUAC, Weight, and CHANCES in different situations

	BMI	MUAC	Weight	CHANCES
Chronic undernutrition	+	+
Acute undernutrition		+		+
Monitoring nutritional rehabilitation
(& progressive illness / post operative recovery)	+		+