Defining functional cut-offs - Longitudinal studies should be undertaken to determine whether individuals falling below specific cut-off points for BMI, and MUAC have elevated morbidity or mortality, poor pregnancy outcome, decreased work ability or physical performance measures. Such studies must be conducted in a variety of situations with different levels of undernutrition among adults. During emergencies, such studies are problematic. Ideally studies relating indicators to the risk of mortality in a general population are required to establish functional cut-off points that could be used for the screening of adult admissions to feeding centres. However, famines always involve massive social upheaval and large numbers of afflicted people. These factors, combined with the armed conflict that has characterised almost all famines during the last ten years, make such broad-based population studies unfeasible. Consequently, no such studies have yet been performed for any nutritional indicator in either adults or children during the height of a famine. Given these difficulties, relating indicators to mortality in a selected feeding centre population may be all that is reasonably possible. The selection bias involved in such studies must be acknowledged and results interpreted with caution.
Patterns and prevalence of adult undernutrition during famine - Data on the prevalence and patterns of adult undernutrition during famines may be useful in defining cut-offs. Data on different ethnic groups and settings would be useful.
Practicality of measurements and calculations - The practicality of obtaining various measures should be explored in field situations. Survey organisers should assess the ease of training survey workers in measuring MUAC, weight, and height, as well as assessing inter- and intra-observer variability in these measurements when measuring adults.
Adjusting for differences in body shape - Surveys undertaken in a variety of populations should explore the utility of adjusting indices using weight and height for differences in body shape by using the SH/S Index or other indicators of body shape.
The use of MUAC to monitor recovery from undernutrition. The changes in MUAC and weight during recovery from undernutrition should be compared with a view to establishing whether MUAC is useful in this role and if it is, establishing relevant MUAC discharge criteria.
More data on differentiating between secondary and primary undernutrition - Examination of adult failure-to-thrive in centres should include attempts to identify measurements or signs that predict failure-to-thrive in feeding centres.
The aetiology, significance and treatment of famine oedema and ascites - More information on the significance and prevalence of famine oedema and ascites is required. It is recommended that surveys assess subjects for these symptoms.
