Assessment of thinness based on BMI and MUAC among the adult Jaunsari: A tribal community of Uttarakhand, India

Koel Mukherjee; Pulamaghatta N. Venugopal; Kaustav Das

doi:10.52905/hbph2022.3.46

Authors

Koel Mukherjee Anthropological Survey of India, North East Regional Center, Shillong, Meghalaya, India
Pulamaghatta N. Venugopal Anthropological Survey of India, Southern Regional Center, Mysore, Karnataka, India https://orcid.org/0000-0001-9727-5278
Kaustav Das Bangabasi College https://orcid.org/0000-0003-2824-0711

DOI:

https://doi.org/10.52905/hbph2022.3.46

Keywords:

Thinness, mid-upper arm circumference, Jaunsari, India, Body Mass Index, BMI, Mid-upper arm circumference, MUAC

Abstract

Background: Researchers worldwide have tried to develop alternative measures to assess the nutritional status, especially among adults in developing countries. Body mass index (BMI) is a commonly used technique but sometimes difficult to obtain in large-scale surveys. Mid-upper arm circumference (MUAC) has been used as an alternative, but data are limited, especially in the Indian context.

Objectives: The objective of the present study was to evaluate the BMI and MUAC of the Jaunsari tribal community of Uttarakhand and to assess whether MUAC is an acceptable proxy for BMI.

Sample and Methods: A total of 303 (male 134, female 169) healthy adult Jaunsari individuals aged 18-60 years from Lakhamandal village of Dehradun district of Uttarakhand, India have been selected. Anthropometric measurements of height (cm), weight (kg), and MUAC (cm) were taken following the standard protocol. Globally accepted cut-off values for thinness were used (BMI<18.5kg/m2 and MUAC<24.0cm). Descriptive statistics, Student’s t-test and Chi-square test were performed. The statistically significant level was set at p<0.05.

Results: The Jaunsari people of Lakhamandal village of Dehradun district are very thin when following the categories developed by WHO (30.4%). Females are on average thinner than males when assessed by BMI and MUAC. Overweight was found in 12.2% of the village’s people. Individuals are two times more likely to be considered thin when classified by MUAC, than if classified by BMI.

Conclusions: Healthy Jaunsari people are on average very thin, but there is already some evidence of overnutrition in a few cases. Thinness when assessed by MUAC is twice as prevalent, than if assessed by BMI.

Author Biographies

Pulamaghatta N. Venugopal, Anthropological Survey of India, Southern Regional Center, Mysore, Karnataka, India

Assistant Anthropologist (Physical)

Kaustav Das, Bangabasi College

Faculty Member, Department of Anthropology

References

Agrawal, P./Gupta, K./Mishra, V./Agrawal, S. (2013). Effects of sedentary lifestyle and dietary habits on body mass index change among adult women in India: findings from a follow-up study. Ecology of Food and Nutrition 52 (5), 387–406. https://doi.org/10.1080/03670244.2012.719346

Benítez Brito, N./Suárez Llanos, J. P./Fuentes Ferrer, M./Oliva García, J. G./Delgado Brito, I./Pereyra-García Castro, F./Caracena Castellanos, N./Acevedo Rodríguez, C. X./Palacio Abizanda, E. (2016). Relationship between mid-upper arm circumference and Body Mass Index in inpatients. PLoS One 11 (8), e0160480. https://doi.org/10.1371/journal.pone.0160480

Bharali, N./Mondal, N./Singh Kh, N. (2017). Prevalence of Undernutrition, Overweight and Obesity among Nyishi tribal women of Arunachal Pradesh, Northeast India. Human Biology Review 6 (1), 63–78.

Bhutta, Z. A./Gupta, I./de’Silva, H./Manandhar, D./Awasthi, S./Hossain, S. M. M./Salam, M. A. (2004). Maternal and child health: is South Asia ready for change? The BMJ Clinical Research 328 (7443), 816–819. https://doi.org/10.1136/bmj.328.7443.816

Chakraborty, R./Bose, K./Koziel, S. (2011). Use of mid-upper arm circumference in determining undernutrition and illness in rural adult Oraon men of Gumla District, Jharkhand, India. Rural and Remote Health 11 (3), 1754.

Das, K./Mukherjee, K./Chanak, M./Pal, S./Ganguli, S./Bagchi, S./Bose, K. (2020). Age trends in under-nutrition among Sabar males of Purulia, West Bengal, India. Journal of Human Ecology 70 (1-3), 110–117.

Das, S./Bose, K. (2015). Adult tribal malnutrition in India: an anthropometric and socio-demographic review. Anthropological Review 78 (1), 47–65.

Dutta, M./Selvamani, Y./Singh, P./Prashad, L. (2019). The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16). Epidemiology and Health 41, e2019050. https://doi.org/10.4178/epih.e2019050

Ezeh, A./Oyebode, O./Satterthwaite, D./Chen, Y.-F./Ndugwa, R./Sartori, J./Mberu, B./Melendez-Torres, G. J./Haregu, T./Watson, S. I./Caiaffa, W./Capon, A./Lilford, R. J. (2017). The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet 389 (10068), 547–558. https://doi.org/10.1016/S0140-6736(16)31650-6

Flegal, K. M./Shepherd, J. A./Looker, A. C./Graubard, B. I./Borrud, L. G./Ogden, C. L./Harris, T. B./Everhart, J. E./Schenker, N. (2009). Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. The American Journal of Clinical Nutrition 89 (2), 500–8.

Gouda, J./Prusty, R. K. (2014). Overweight and obesity among women by economic stratum in urban India. Journal of Health, Population and Nutrition 32 (1), 79–88.

IIPS, Mumbai (2021). National family health survey (NFHS-5) 2019-21 Compendium of fact sheets: Key indicators – India and 14 States/UTs (Phase-II). Ministry of Health and Family Welfare, Government of India, New Delhi, New Delhi.

James, W. P./Ferro-Luzzi, A./Waterlow, J. C. (1988). Definition of chronic energy deficiency in adults. Report of a working party of the International Dietary Energy Consultative Group. European Journal of Clinical Nutrition 42 (12), 969–981.

Kshatriya, G. K./Acharya, S. K. (2019). Prevalence and risks of hypertension among Indian tribes and its status among the lean and underweight individuals. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2), 1105–1115. https://doi.org/10.1016/j.dsx.2019.01.028

Kshatriya, G. K./Acharya, S. K. (2016a). Triple burden of obesity, undernutrition, and cardiovascular disease risk among Indian tribes. PLoS One 11 (1), e0147934. https://doi.org/10.1371/journal.pone.0147934

Kshatriya, G. K./Acharya, S. K. (2016b). Gender Disparities in the Prevalence of Undernutrition and the Higher Risk among the Young Women of Indian Tribes. PLoS One 11 (7), e0158308. https://doi.org/10.1371/journal.pone.0158308

Laxmaiah, A./Mallikharjuna Rao, K./Hari Kumar, R./Arlappa, N./Venkaiah, K./Brahmam, G. N. V. (2007). Diet and nutritional status of tribal population in ITDA oroject areas of Khammam district, Andhra Pradesh. Journal of Human Ecology 21 (2), 79–86. https://doi.org/10.1080/09709274.2007.11905954

Lee, R./Nieman, D. (2003). Nutritional assessment, 7th ed. McGrawHill, New York.

Lohman, T. G./Roche, A. F./Martorell, R. (1988). Anthropometric standardization reference manual. Human Kinetics Books, Champaign, IL.

Lönnroth, K./Williams, B. G./Cegielski, P./Dye, C. (2010). A consistent log-linear relationship between tuberculosis incidence and body mass index. International Journal of Epidemiology 39 (1), 149–155. https://doi.org/10.1093/ije/dyp308

Majumdar, D. (1955). Family and marriage in a polyandrous society. Eastern Anthropologist 8, 85–110.

Mukherjee, K./Das, K. (2014). Polyandry practiced among Jaunsari of Uttarakhand: scope for futuristic study. International Journal of Interdisciplinary and Multidisciplinary Studies 2, 139–143.

Mukherjee, K./Harihar, H./Pulamaghatta/V. N./Alam, A./Rawat, B. (2015). Body mass index and chronic energy deficiency among adults of Tharu population, Uttarakhand, India. International Journal of Biomedical Research 6 (7), 475–478. https://doi.org/10.7439/ijbr.v6i7.2218

Mungreiphy, N. K./Kapoor, S. (2010). Socioeconomic changes as covariates of overweight and obesity among Tangkhul Naga tribal women of Manipur, north-east India. Journal of Biosocial Science 42 (3), 289–305. https://doi.org/10.1017/S0021932009990587

NNMB (2017). Diet and nutritional status of urban population in India and prevalence of obesity, hypertension, diabetes and hyperlipidaemia in urban men and women - A brief NNMB urban nutrition report. (Technical Report No. 27). National Institute of Nutrition. Hyderabad.

NNMB (2009). Diet and nutritional status of tribal population and prevalence of hypertension among adults—Report on second repeat survey (Technical Report No. 25). National Institute of Nutrition-Indian Council of Medical Research. Hyderabad.

Nuttall, F. Q. (2015). Body Mass Index: Obesity, BMI, and health: A critical review. Nutrition Today 50 (3), 117–128. https://doi.org/10.1097/NT.0000000000000092

Pant, B. (2016). Demographic profile and nutrition status of women in Uttarakhand. ENVIS Bulletin Himalayan Ecology 24, 101–108.

Pawar, S./Chakraborty, M./Mukherjee, K./Das, K. (2017). Is Rh Factor is behind the moderate life expectancy of Uttarakhand tribals? A brief review. Anthropology 5, 191.

Philpott, D. C./Belchior-Bellino, V./Ververs, M. (2021). Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees. Public Health Nutrition 24 (15), 4777–4785. https://doi.org/10.1017/S1368980021002913

Popkin, B. M./Corvalan, C./Grummer-Strawn, L. M. (2020). Dynamics of the double burden of malnutrition and the changing nutrition reality. Lancet 395 (10217), 65–74. https://doi.org/10.1016/S0140-6736(19)32497-3

Ravi, K./Singla, M./Ansari, M. (2019). Body mass index in adult Jaunsari tribe population of Dehradun district of Uttarakhand. Journal of The Anatomical Society of India 68, 138–142.

Ruel, M./Garrett, J./Yosef, S./Olivier, M. (2017). Urbanization, food security and nutrition. Humana Press, New York.

Segal, K. R./Dunaif, A./Gutin, B./Albu, J./Nyman, A./Pi-Sunyer, F. X. (1987). Body composition, not body weight, is related to cardiovascular disease risk factors and sex hormone levels in men. The Journal of Clinical Investigation 80, 1050–1055.

Selvamani, Y./Singh, P. (2018). Socioeconomic patterns of underweight and its association with self-rated health, cognition and quality of life among older adults in India. PLoS One 13 (3), e0193979. https://doi.org/10.1371/journal.pone.0193979

Selvaraj, K./Jayalakshmy, R./Yousuf, A./Singh, A.K./Ramaswamy, G./Palanivel, C. (2017). Can mid-upper arm circumference and calf circumference be the proxy measures to detect undernutrition among elderly? Findings of a community-based survey in rural Puducherry, India. Journal of Family Medicine and Primary Care 6 (2), 356–359.https://doi.org/10.4103/jfmpc.jfmpc_357_16

Singh, K./Ahmed, M. (2018). Study on the contribution of women of Jaunsari tribe to the protection of cultural heritage. International Journal of Creative Research Thoughts 6, 304–308.

Singh, K. K. (1997). Studies on native medicine of Jaunsari tribe of Dehradun District, Uttar Pradesh, India. International Journal of Pharmacognosy 35 (2), 105–110. https://doi.org/10.1076/phbi.35.2.105.13289

Sultana, T./Karim, M. N./Ahmed, T./Hossain, M. I. (2015). Assessment of under nutrition of Bangladeshi adults using anthropometry: can body mass index be replaced by mid-upper-arm-circumference? PLoS One 10 (4).

Tang, A. M./Chung, M., Dong/K. R., Bahwere/P., Bose, K./Chakraborty, R./Charlton, K./Das, P./Ghosh, M./Hossain, M. I./Nguyen, P./Patsche, C. B./Sultana, T./Deitchler, M./Maalouf-Manasseh, Z. (2020). Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women). Public Health Nutrition 23 (17), 3104–3113. https://doi.org/10.1017/S1368980020000397

Touitou, Y./Portaluppi, F./Smolensky, M. H./Rensing, L. (2004). Ethical principles and standards for the conduct of human and animal biological rhythm research. Chronobiology International 21, 161–70. https://doi.org/10.1081/cbi-120030045

Tripathi, P. (2020). The dilemma in defining tribe in India: An example of Jaunsari tribe of Uttarakhand. Kalākalpa, Journal of the Indira Gandhi National Centre for the Arts 5, 189–200.

Ulijaszek, S. J./Kerr, D. A. (1999). Anthropometric measurement error and the assessment of nutritional status. British Journal of Nutrition 2, 165–77. https://doi.org/10.1017/s0007114599001348

Van Tonder, E./Mace, L./Steenkamp, L./Tydeman-Edwards, R./Gerber, K./Friskin, D. (2019). Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition. South African Journal of Clinical Nutrition 32 (4), 93–98. https://doi.org/10.1080/16070658.2018.1484622

Venkatrao, M./Nagarathna, R./Majumdar, V./Patil, S. S./Rathi, S./Nagendra, H. (2020). Prevalence of obesity in India and its neurological implications: A multifactor analysis of a nationwide cross-sectional study. Annals of Neurosciences 27 (3-4), 153–161. https://doi.org/10.1177/0972753120987465

Wellens, R. I./Roche, A. F./Khamis, H. J./Jackson, A. S./Pollock, M. L./Siervogel, R. M. (1996). Relationships between the Body Mass Index and body composition. Obesity Research 4 (1), 35–44. https://doi.org/10.1002/j.1550-8528.1996.tb00510.x

WHO (2021). Obesity and overweight. Available online at https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed 10/15/22).

WHO (2017). The double burden of malnutrition: policy brief. Available online at https://www.who.int/publications-detail-redirect/WHO-NMH-NHD-17.3 (accessed 10/15/22).

WHO (1995). Physical status : the use of and interpretation of anthropometry, report of a WHO expert committee. Available online at https://apps.who.int/iris/handle/10665/37003 (accessed 10/15/22).