Arm circumference as a marker of muscle mass: cutoff values from NHANES 1999-2006

Authors

• Jarson P. Costa-Pereira, Federal University of Pernambuco, Recife, PE, Brazil
• Carla M. Prado, University of Alberta, Edmonton, AB, Canada
• Steven B. Heymsfield, Pennington Biomedical Research Center, Baton Rouge, LA
• Ana Pt Fayh, Federal University of Rio Grande do Norte, Natal, RN, Brazil
• Luiz Aa Menezes-Júnior, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
• Poliana C. Cabral, Federal University of Pernambuco, Recife, PE, Brazil
• Alcides S. Diniz, Federal University of Pernambuco, Recife, PE, Brazil
• M Cristina Gonzalez, Federal University of Pelotas, Pelotas, RS, Brazil

Document Type

Article

Publication Date

9-25-2025

Publication Title

The American Journal of Clinical Nutrition

Abstract

Background: Although mid-upper arm circumference (MUAC) is a potential marker of skeletal muscle (SM), no study has proposed MUAC cutoff points using a large young reference population. Additionally, growing evidence highlights the impact of excess adiposity on anthropometric markers, which can mask their value in evaluating SM. Objectives: This study aimed to propose cutoff points for MUAC as a marker of muscle mass, along with BMI-adjustment factors for individuals outside the normal BMI range (18.5-24.9 kg/m2), using data from the NHANES 1999-2006 sample. Methods: Anthropometric and appendicular lean soft tissue (ALST; by dual-energy X-ray absorptiometry) data from the adult NHANES sample (aged ≥18 y) were divided into sex, age, ethnicity, and self-reported race subgroups. Adults aged 18-39 y with a BMI of 18.5-24.9 kg/m2 were used as the reference population, and MUAC cutoff points were derived at 1 and 2 SDs below the mean. Pearson's correlation (r) was used to assess the correlation between MUAC and ALST. Survey-weighted linear regression analysis was used to derive BMI-adjustment factors for MUAC. Results: A total of 18,195 individuals were included (weighted proportion: 49.4% male; mean age: 43.9 y, 95% confidence interval: 43.4, 44.4 y). MUAC showed a strong positive correlation with ALST index (ALST/height2) (r = 0.83 for males, r = 0.79 for females). Rounded cutoff points for low MUAC were 28 cm (male) and 25 cm (female) and for very low MUAC were 26 cm (male) and 23 cm (female). Overall BMI-adjustment factors were: -3 cm (male), -2 cm (female) (BMI: 25-29.9 kg/m2); -7 cm (male), -6 cm (female) (BMI: 30-39.9 kg/m2); -10 cm (male), -9 cm (female) (BMI: ≥40 kg/m2). Conclusions: This study proposes practical MUAC cutoff points, a potential marker of SM, along with BMI adjustment factors for individuals with excess weight, aiming to reduce errors in using MUAC for this purpose. Our results have the potential to enhance clinical routine assessments.

First Page

1809

Last Page

1818

DOI

10.1016/j.ajcnut.2025.09.034

Rights

© 2025 American Society for Nutrition. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Recommended Citation

Costa-Pereira, Jarson P.; Prado, Carla M.; Heymsfield, Steven B.; Fayh, Ana Pt; Menezes-Júnior, Luiz Aa; Cabral, Poliana C.; Diniz, Alcides S.; and Gonzalez, M Cristina, "Arm circumference as a marker of muscle mass: cutoff values from NHANES 1999-2006" (2025). LSU-LCMC Cancer Center Faculty Publications. 122.
https://digitalscholar.lsuhsc.edu/llcc_facpubs/122
10.1016/j.ajcnut.2025.09.034