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Mid-upper arm circumference, calf circumference and mortality in Chinese long-term care facility residents: a prospective cohort study
  1. Chien-Hsiang Weng1,2,3,
  2. Chia-Ping Tien4,
  3. Chia-Ing Li5,
  4. Abby L’Heureux6,
  5. Chiu-Shong Liu4,7,8,
  6. Chih-Hsueh Lin4,8,
  7. Cheng-Chieh Lin4,7,8,
  8. Shih-Wei Lai4,8,
  9. Ming-May Lai4,
  10. Wen-Yuan Lin4,7,8
  1. 1 Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2 NH Dartmouth Family Medicine Residency, Concord Hospital, Concord, New Hampshire, USA
  3. 3 Department of Family Medicine, Providence Community Health Centers, Providence, Rhode Island, USA
  4. 4 Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
  5. 5 Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
  6. 6 Department of Family Medicine, Rural Medical Partners, Grand Forks, North Dakota, USA
  7. 7 Department of Social Medicine, College of Medicine, China Medical University, Taichung, Taiwan
  8. 8 Department of Family Medicine, College of Medicine, China Medical University, Taichung, Taiwan
  1. Correspondence to Prof. Wen-Yuan Lin; wylin{at}


Objective To investigate the association between mid-upper arm circumference (MUAC), calf circumference (CC) and all-cause mortality in a Chinese population.

Design Prospective cohort study.

Setting Eight long-term care facilities in central Taiwan.

Participants A total of 329 residents age 60 years and older (median 79.0 years, range 60–101; 139 men, 190 women) were enrolled.

Methods Anthropometrics and metabolic parameters were measured at the time of enrolment to the study. Mean MUAC and CC were 24.2±3.4 cm and 27.5±4.3 cm, respectively. Mortality data were obtained from the Department of Health in Taiwan.

Main outcome measure To identify the association between all-cause mortality and MUAC or CC.

Results There were 255 deaths during the 7-year follow-up period. After adjusting for age, sex, cigarette smoking, betel nut chewing, alcohol use, Karnofsky Performance Status Scale score, serum albumin level, hypertension and diabetes mellitus, subjects in the highest tertile of MUAC (27.8±2.2 cm) and CC (32.1±2.6 cm) had a significantly lower mortality rate than did subjects in the lowest tertile (MUAC 20.6±1.7 cm; CC 22.8±1.9 cm). The adjusted HR for all-cause mortality in the highest versus lowest MUAC tertile was 0.64 (95% CI 0.45 to 0.90). The adjusted HR for all-cause mortality in the highest versus lowest CC tertile was 0.51 (95% CI 0.35 to 0.74).

Conclusions MUAC and CC are negative predictors for all-cause mortality in older Chinese adults living in long-term care facilities. Participants with higher MUAC and CC had lower all-cause mortality.

  • mid-upper arm circumference
  • calf circumference
  • body mass index
  • elderly
  • mortality
  • long-term care facility

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  • C-HW and C-PT share first authorship.

  • Contributors C-HW and AL’H wrote the manuscript. W-YL had full access to all the data in the study and keeps the integrity of the data. C-IL, C-PT and W-YL did the statistical analysis and took responsibility for the accuracy of the data analysis. C-HW, AL’H, C-IL, C-PT and W-YL interpreted the findings. All authors contributed to the study design, provided inputs, expertise and critical review of the manuscript and read and approved the manuscript.

  • Funding This study was financially supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-121-123004), Department of Health, Executive Yuan, Taiwan (DOH92-TD-1024), National Science Council of Taiwan (NSC 93-2314-B-039-031), China Medical University Hospital (DMR-93-021, DMR-93-078, and DMR-96-061).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Institutional Review Board of China Medical University Hospital (IRB # DMR91-IRB-071).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data is available by emailing the Corresponding author (

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