Mid-Upper Arm Circumference as a Surrogate for Nutritional Assessment in Surgical Patients: Insights from Global Leadership Initiative on Malnutrition Criteria Screening.

Abstract

Background: Undernutrition significantly affects surgical patient outcomes, prompting the Global Leadership Initiative on Malnutrition (GLIM) to establish a set of diagnostic criteria. This study assessed the prevalence of undernutrition using the GLIM criteria and determined a mid-upper arm circumference (MUAC) cutoff for malnutrition.

Methods: This cross-sectional study was conducted from December 2021 to May 2023. Biodata, information necessary for GLIM criteria, and anthropometric measurements including height, body weight, MUAC, fat mass (FM), and fat-free mass (FFM), were collected. Correlations among indicators analysed using Pearson's correlation. The MUAC cutoff points for underweight, obesity, and undernourishment were derived using receiver operating characteristics (ROC) and area under the curve (AUC), and the sensitivity, specificity, and positive and negative predictive values were calculated.

Results: Despite a mean body mass index (BMI) of 25.8 (6.0) kg/m², 30.0% of the patients met the GLIM undernutrition criteria. Overall, 13.4% of the patients were overweight, and 54.2% were obese. ROC analysis showed MUAC measures with an AUC ranging from 0.66-0.97. A MUAC cutoff of 28.9 cm identified undernourished patients with 66.7% sensitivity, 67.1% specificity, and 46.6% positive predictive value (PPV). Notably, the PPV increased to 75.4% in patients with cancer. The optimal MUAC cutoffs derived from the fat-free mass index (FFMI) for undernourished males and females were 26.8 cm and 26.1 cm, respectively.

Conclusion: Malnutrition is prevalent among surgical patients. The MUAC is a promising surrogate for assessing BMI and FFMI and serves as a valuable screening tool for nutritional status. These findings emphasise the importance of nutritional assessment in surgical care.