Adult undernutrition is increasingly being recognized as an important cause of mortality during famine. However, no international consensus exists on the anthropometric indicator, or criteria that should be used to assess acute adult undernutrition. The World Health Organization has proposed the body mass index (BMI) as the anthropometric indicator to assess adult undernutrition. However, the proposed BMI criteria were derived from data collected in nonfamine situations. These cutoffs are too sensitive for use in most famine situations. In addition, many pastoral groups in the horn of Africa have a tall, thin body shape, and BMI should be adjusted to account for body shape before comparisons with international references are made. Furthermore, the measurement of BMI is affected by famine edema. The limitations of BMI for assessing acute adult undernutrition will be highlighted using results from a 30-cluster survey conducted in Ethiopia during the famine in 2000. Adjustments for body shape were made using the sitting height/standing height ratio. The prevalence of undernutrition, defined as a BMI < 18.5 kg/m,2 was 49% using unadjusted BMI; the prevalence decreased to 23% when adjusted BMI was used. In parts of the world frequently affected by famine, a high proportion of normally nourished individuals are likely to be classified as undernourished unless adjustments for body shape are made. Further validation of adjusted BMI against mortality and health outcomes is required. Other research needs and alternative anthropometric indicators, such as the middle upper-arm circumference, will be discussed.
Learning Objectives: At the end of this session participants will be able to do the following: 1. Describe the use and limitations of body mass index as an anthropometric indicator to assess acute adult undernutrition during famine. 2. Understand the importance of adjusting for body shape when interpreting body mass index.
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