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.
More like this
FEX: Postscript on older people, nutrition in emergencies in Ethiopia
Bradley A.Woodruff, MD MPH, Medical Epidemiologist International Emergency and Refugee Health Branch U.S. Centers for Disease Control and Prevention This field article from...
FEX: Taking forward research on adult malnutrition
Summary of ongoing research By Laura Wyness, Researcher, University of Aberdeen, UK Adult malnutrition was initially put on the agenda of the United Nations Standing Committee...
FEX: Improved surveillance prevents excess mortality: the Gode experience
Summary of published paper1 A study on the epidemiology of the famine in Gode district of Ethiopia has just been published. The primary objectives of the study (which was...
FEX: Summary of the Meeting of the Working Group on Nutrition in Emergencies
by Annalies Borrel The 26th ACC/SCN meeting was held from the 8th to 15th of April in Geneva. The Working Group on Nutrition in Emergencies, made up of NGO, bilateral and UN...
FEX: Adults and adolescents: assessment of nutritional status in emergency-affected populations
New publications1,2 In July last year the ACC/Sub-committee on nutrition published two reports on the assessment of nutritional status in emergencies. One report deals with...
FEX: ACC/SCN Working Group on Nutrition in Emergencies
Excerpts from Working Group Report The ACC/SCN held its 27th Session at the World Bank in Washington DC last April. About 60 participants from NGOs, bilateral and UN agency...
FEX: An Ongoing Omission: Adolescent and Adult Malnutrition in Famine Situations
By Peter Salama and Steve Collins. (December '98) A boy sits under a tree awaiting a distribution by the UN World Food Programme in the southern village Acum Cum. The food is...
FEX: Nutrition in emergencies: SCN conference 2003
Between 3-7 March, 2003 the annual United Nations SCN (Standing Committee on Nutrition) conference was held in Chennai, India. Key achievements and plans to emerge from the...
en-net: Nutritional status and vulnerability of older adults/older people (aged 50 +)
Happy New Year to En-net colleagues, I have recently been contracted by HelpAge International (in partnership with NutritionWorks) to write a module on nutrition in older...
FEX: Somali Region Ethiopia
Summary of situation report Two consultants from UNICEF and WHO carried out an assessment of the emergency response in the Somali region of Ethiopia in August this year1. The...
FEX: Interagency meeting looks at Emergency Selective Feeding Programmes
The Minister of State for Foreign affairs, Joan Burton, recently opened a meeting on 'Emergency Selective Feeding Programmes' in Dublin. The three day event (April 18th-2Oth)...
FEX: MSF Holland
Name MSF Holland Year formed Staff (2003) 1984 Address Plantage Middenlaan 14 PO Box 10014 1001 EA Amsterdam The Netherlands Overseas 795 Telephone 00 31 20 520...
FEX: Issue 06 Editorial
Dear Readers, This issue of field exchange heralds the second phase of the ENN. Our first two years appear to have been sufficiently successful to prompt continued support...
FEX: Anthropometric cut-off points for older children and adolescents in Syria
By Paluku Bahwere View this article as a pdf Paluku Bahwere is a paediatrician with over 25 years of experience in operational research and programming in the fields of...
en-net: Nutrition Survey Co-ordinator Tanzania
TERMS OF REFERENCE CONSULTANT, NUTRITION SURVEY COORDINATOR EXPERIENCED IN NUTRITION SURVEYS AND SMART METHODOLOGY TANZANIA – NYAGARUSU, NDUTA AND NTENDELE REFUGEE...
en-net: Nutrition Survey Co-ordinator Sudan
TERMS OF REFERENCE CONSULTANT, NUTRITION SURVEY COORDINATOR EXPERIENCED IN NUTRITION SURVEYS AND SMART METHODOLOGY SUDAN - WHITE NILE STATE BACKGROUND UNHCR is seeking an...
FEX: A Review of the advances and challenges in nutrition in conflicts and crises over the last 20 years
Abbreviated version of unpublished paper Food distribution at the ICRC kitchen in Tonj. By Frances Mason and Anna Taylor This paper is a shortened version of the complete...
en-net: Assessing levels of maternal malnutrition
In Niger the 2006 MICS estimated 19.2% of women of reproductive age to be malnourished (with a BMI-18.5) and 1.9% severely malnourished (BMI-16). In Zinder the rate was 29.6%...
FEX: Can height-adjusted cut-offs improve MUAC’s utility as an assessment tool?
By Michel Van Herp, An Verwulgen, Bérengère Leurquin, and Pascale Delchevalerie Michael Ven Herp, Bérengère Leurquin, An Verwulgen & Pascale Delchevalerie Michael Ven Herp is...
en-net: Treatment of malnourished adults and the elderly
Could anyone provide references on treatment of severely malnourished adults and/or the elderly? I'm particularly looking for evidence of the impact of programmes on a large...
Reference this page
Assessment of adult malnutrition. Field Exchange 13, August 2001. p10. www.ennonline.net/fex/13/malnutrition
(ENN_3521)