Assessment of adult malnutrition

Assessment of Adult Malnutrition was the subject of a special meeting held during the SCN's 28th session in Nairobi in April 2001¹.

The aim of the meeting was to reach a common understanding of recent recommendations² on the assessment of malnutrition in adults and to identify practical steps to improve practice. Following individual presentations, and plenary discussion with an expert panel, the working groups came up with the following interim recommendations for operational agencies in six areas.

• When to consider assessing adult malnutrition
• Pre-requisites for surveying adults
• Survey methodology
• Indices
• Selective feeding
• Research needs

When to consider assessing adult malnutrition

Assessment of adult malnutrition should be considered under the following circumstances:

• if the crude mortality rate (CMR) increases in relation to the under 5 year mortality rate;
• if many adults are present at existing supplementary feeding centres;
• where there are very high rates of under 5 malnutrition in the absence of an epidemic outbreak;
• if there is reasonable doubt that the child malnutrition rates do not reflect the nutritional status of the general population;
• if the populations are entirely reliant on food aid and if data are required as an advocacy tool to leverage resources.

Prerequisites for surveying adults

In all situations a thorough contextual assessment and analysis is required prior to carrying out an adult anthropometric survey. Adequate expertise, clear objectives and sufficient resources are all prerequisites to undertaking such surveys.

Survey Methodology

A nutritional causal analysis must always be undertaken in conjunction with adult³ anthropometric surveys. Adult surveys require adaptation of the standard sampling used in under 5 year anthropometric surveys. The choice of methodology should take into consideration potential selection bias (adults are often away). Surveys of older adults only may be appropriate in some situations

Indices

The recommended indices that should be used are Cormic adjusted BMI (population specific or Norgan correction) & MUAC. Using MUAC alone may be a useful rapid alternative in a very acute situation. Functional outcomes (e.g. step test, hand grip) should be collected in conjunction with anthropometric data.

Presentation

Currently there is no consensus on exact cut-offs of anthropometric indices for adults. Therefore it was recommended that a range of cut-offs are reported. The definition of the indicator must always be described and frequency distributions presented.

Selective feeding

Alternative strategies to selective feeding programmes should always be considered. Where selective feeding programmes are implemented, admission and discharge criteria should be based on anthropometric indices, social factors and clinical signs. Indicators for monitoring should include weight gain (minimum target 5g/kg/day) and functional ability.

Research Needs

The following research needs were prioritised:

• Investigate functional significance of proposed indices (mortality & morbidity)
• Investigate differences (changes in MUAC by sex, age, ethnic group and context
• Investigate the aetiology of adult malnutrition including adult nutritional oedema. Health and food security indicators should be considered in this investigation
• Develop anthropometric and functional methods to differentiate between acute and chronic undernutrition.
• Develop anthropometric methods for assessment of undernutrition in the 18-25 year group, in older persons and in adolescents.

For copies of the report of this special meeting on the assessment of adult malnutrition in emergencies email either: Fiona O'Reilly at fiona@ennonline.net or Brian Jones at accscn@who.ch or see http://www.ennonline.net/docs/scnreport.html

¹The session was made possible through the support provided to the Food and Nutrition Technical Assistance (FANTA) Project by the office of Health and Nutrition of the Bureau for Global Programs Field Support and Research at the US Agency for International Development.

²Collins S. et al., Woodruff B., Duffield A. Assessment of Adult Malnutrition in Emergencies. ACC/SCN July 2000.

³Adults defined as over 20 years of age.