A prospective study of arm circumference and risk of death in Bangladesh.
BACKGROUND
Epidemiological studies have observed protective effects of mid-upper arm circumference (MUAC) against all-cause mortality mostly in Western populations. However, evidence on cause-specific mortality is limited.


METHODS
The sample included 19 575 adults from a population-based cohort study in rural Bangladesh, who were followed up for an average of 7.9 years for mortality. Cox proportional hazards regression was used to evaluate the effect of MUAC, as well as the joint effect of body mass index (BMI) and MUAC, on the risk of death from any cause, cancer and cardiovascular disease (CVD).


RESULTS
During 154 664 person-years of follow-up, 744 deaths including 312 deaths due to CVD and 125 deaths due to cancer were observed. There was a linear inverse relationship of MUAC with total and CVD mortality. Each 1-cm increase in MUAC was associated a reduced risk of death from any cause [hazard ratio (HR) = 0.85; 95% confidence interval (C), 0.81-0.89) and CVD (HR = 0.87; 95% CI, 0.80-0.94), after controlling for potential confounders. No apparent relationship between MUAC and the risk of death from cancer was observed. Among individuals with a low BMI (<18.5 kg/m(2)), a MUAC less than 24 cm was associated with increased risk for all-cause (HR = 1.81; 95% CI, 1.52-2.17) and CVD mortality (HR = 1.45; 95% CI, 1.11-1.91).


CONCLUSIONS
MUAC may play a critical role on all-cause and CVD mortality in lean Asians.
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA yu.chen@nyumc.org habib@uchicago.edu.
Yu
Y
Chen
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Wenzhen
W
Ge
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Faruque
F
Parvez
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Sripal
S
Bangalore
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Mahbub
M
Eunus
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Alauddin
A
Ahmed
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Tariqul
T
Islam
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Muhammad
M
Rakibuz-Zaman
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Rabiul
R
Hasan
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Maria
M
Argos
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Diane
D
Levy
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA.
Golam
G
Sarwar
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, USA, Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA, Columbia University Arsenic Research Project, Dhaka, Bangladesh, Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA and Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, USA yu.chen@nyumc.org habib@uchicago.edu.
Habibul
H
Ahsan
D000328:Adult; D001132:Arm / Q000033:anatomy & histology*; D044466:Asian People / Q000706:statistics & numerical data*; D001459:Bangladesh / Q000453:epidemiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality*; D009929:Organ Size; D050177:Overweight / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012424:Rural Population; D013851:Thinness / Q000453:epidemiology*
Mid-upper arm circumference (MUAC); cardiovascular diseases; cohort study; epidemiology; mortality