Role of Mid Arm Muscular Area (MAMA) in identification of Severe Acute Malnutrition

Abstract

Background: Mid arm muscular area (MAMA) and triceps skin fold thickness (TSFT) were introduced for the body composition and nutritional
status assessment. Currently these parameters in the identification of Severe Acute Malnutrition (SAM) are unutilized. This study compared age
specific upper arm composition and nutritional status among children with normal nutrition and Severe Acute Malnutrition (SAM). Method: This
case control study was conducted in Special Malnutrition Treatment Unit (S.M.T.U.) and children medical wards of a medical college hospital in
Madhya Pradesh. In the age group of 6-to-59 month, 100 children with SAM and 100 normal nutritional status children as control were taken.
Mid upper arm circumference (MUAC) was measured by nonflexible colour coded tape and TSFT by Harpenden skin fold calliper to calculate
MAMA by formula, MAMA = (MuAC – ×TSFT)2/4. Result: Mean MAMA, mean MUAC and mean TSFT are more among controls as
compared to case (p<0.001). In normal nutritional status children MUAC, MAMA and TSFT increases as the age advances, unlike in SAM
children where MUAC, TSFT and MAMA were almost stationary. MAMA and MUAC are significantly correlated (p<0.001). TSFT was
significantly correlated with MAMA and MUAC. Each unit change in TSFT i.e., with 1 cm increase in TSFT, severity of malnutrition (z score
decreased by 10.3) decreased significantly [ z score = 7.47 – 10.31 (TSFT)]. Similarly, with each cm2 increase in MAMA, the severity of
malnutrition decreased i.e., z score decreased by 0.52 which was statistically significant [ z score = 8.81 – 0.52 (MAMA)]Conclusion: The
upper-arm composition can be a useful measure for the nutritional status assessment in SAM children. The MAMA is a valuable parameter that
can be used to measure specifically the muscle-mass. The use of MAMA can improve the accuracy of assessment in oedematous SAM and hence
seems to be a more appropriate tool in a health care setting