Assessing Nutritional Status Using Oedema and Mid-Upper Arm Circumference (MUAC)

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Mid-Upper Arm Circumference (MUAC) is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow (olecranon process and the acromium).

MUAC is used for the assessment of nutritional status. It is a good predictor of mortality and in many studies, MUAC predicted death in children better than any other anthropometric indicator. This advantage of MUAC was greatest when the period of follow-up was short.

The MUAC measurement requires little equipment and is easy to perform even on the most debilitated individuals. Although it is important to give workers training in how to take the measurement, the correct technique can be readily taught to minimally trained health workers and community-based volunteers. It is thus suited to screening admissions to feeding programs during emergencies.

MUAC is recommended for use with children between six and fifty-nine months of age and for assessing acute energy deficiency in adults during famine.

The major determinants of MUAC, arm muscle and sub-cutaneous fat, are both important determinants of survival in starvation. MUAC is less affected than weight and height based indices (e.g. WHZ, WHM, BMI) by the localised accumulation of fluid (i.e. bipedal or nutritional oedema, periorbital oedema, and ascites) common in famine and is a more sensitive index of tissue atrophy than low body weight. It is also relatively independent of height and body-shape.


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