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Eur J Clin Nutr. 2018 Apr;72(4):613-617. doi: 10.1038/s41430-018-0106-1. Epub 2018 Feb 26.

Upper arm anthropometrics versus DXA scan in survivors of acute respiratory distress syndrome.

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Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
Outcomes After Critical Illness and Surgery (OACIS) Group, Baltimore, MD, USA.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
Division of Pulmonary, Critical Care & Sleep Medicine, University of Kentucky, Lexington, KY, USA.
Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT, USA.
Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA.
Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.


Survivors of acute respiratory distress syndrome (ARDS) experience severe muscle wasting. Upper arm anthropometrics can provide a quick, non-invasive estimate of muscle status, but its accuracy is unknown. This study examines the accuracy of upper arm percent muscle area (UAMA) with reference measures of lean mass from dual energy X-ray absorptiometry (DXA). Data are from 120 ARDS survivors participating in a multicenter national study. Receiver operating characteristic (ROC) curves, by patient sex, demonstrated that UAMA did no better than chance in discriminating low appendicular skeletal muscle mass identified using DXA findings (c-statistics, 6 months: 0.50-0.59, 12 months: 0.54-0.57). Modest correlations of UAMA with DXA measures (whole-body: r = 0.46-0.49, arm-specific: r = 0.50-0.51, p < 0.001) and Bland-Altman plots indicate poor precision. UAMA is not an appropriate screening measure for estimating muscle mass when compared to a DXA reference standard. Alternate screening measures should be evaluated in ARDS survivors.

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