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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 26-29

Evaluation of the nutritional status of oral submucous fibrosis patients using body mass index and mid-upper arm circumference (anthropometric assessment): A cross-sectional, observational study


1 Postgraduate Student, Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
2 Professor and Head, Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
3 Postgraduate Student, Department of Public Health Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
4 Postgraduate Student, Department of Pediatric and Preventive Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
5 Dental Graduate, Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India

Date of Submission09-May-2020
Date of Acceptance31-May-2020
Date of Web Publication27-Jun-2020

Correspondence Address:
Dr. Pritam Yadav
Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_15_20

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  Abstract 


Background: For a rapid nutritional status of oral submucous fibrosis (OSMF), body mass index (BMI) and mid-upper arm circumference (MUAC) are used in the study.Materials and Methods: The cross-sectional, observational study was conducted among 150 OSMF patients and categorized into four groups according to the functional stages of OSMF. The measurements of BMI and MUAC among all groups were noted, compared, and statistically analyzed.Results: Among 150 patients, BMI and MUAC scores showed a statistically significant difference and highly correlated in all stages of OSMF.Conclusion: In OSMF patients, BMI and MUAC scores were decreased with an increase in severity and stages of OSMF.

Keywords: Body mass index, mid-upper arm circumference, nutrition, oral submucous fibrosis


How to cite this article:
Yadav P, Singh MP, Tickoo D, Todkar M, Panwar M, Agarwal P. Evaluation of the nutritional status of oral submucous fibrosis patients using body mass index and mid-upper arm circumference (anthropometric assessment): A cross-sectional, observational study. Int J Prev Clin Dent Res 2020;7:26-9

How to cite this URL:
Yadav P, Singh MP, Tickoo D, Todkar M, Panwar M, Agarwal P. Evaluation of the nutritional status of oral submucous fibrosis patients using body mass index and mid-upper arm circumference (anthropometric assessment): A cross-sectional, observational study. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Nov 30];7:26-9. Available from: https://www.ijpcdr.org/text.asp?2020/7/2/26/288186




  Introduction Top


Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa.[1] OSMF is a well-recognized potentially malignant disorder of the oral mucosa, and the malignant potential had been estimated around 7%–13% in the last few years.[2] OSMF is commonly seen in those from the Indian subcontinent and from many parts of South-East Asia.[3],[4] Nutrition and oral health are interrelated; perhaps, nutrition is a major factor in infection, inflammation, and prognosis of a disease.[5] Body mass index (BMI) is a simple, inexpensive, and noninvasive surrogate measure of body fat. In contrast to other methods, BMI relies solely on height and weight and can be routinely measured and calculated with reasonable accuracy.[6] Furthermore, mid-upper arm circumference (MUAC) is a useful, easy, and inexpensive tool for a quick assessment of the nutritional status. It is used in developing countries for rapid and extensive nutrition surveillance and screening programs.[7] MUAC is the circumference of the right upper arm measured at the midpoint between the tip of the shoulder and tip of the elbow (olecranon process and acromion). The other anthropometric parameters include skin-fold thickness at defined sites, muscle circumference, and waist: hip ratio.[8] However, MUAC is a useful indicator of malnutrition that can be used in ill patients.[9] Therefore, the purpose of the study was to evaluate the nutritional status of OSMF patients by measuring their BMI and MUAC.


  Materials and Methods Top


A cross-sectional, observational study was conducted among OSMF patients, which were selected from outpatients visited during the period October 2016–October 2018 in the dental hospital at Udaipur, Rajasthan, India. The study was approved by the College Ethical Committee (Ref no. PDCH/17/EC-87). Informed consent was obtained from all of the patients. Clinically diagnosed with OSMF patients were selected for the study. Patients who are <16 years of age, have a history of systemic diseases, during pregnancy, and mentally or physically disabled were excluded from the study. A total of 150 sample sizes was calculated for the study using G power - version 3.1.9.2 software developed by Faul, F, Erdfelder, E, Buchner A, and Lang A-G, Germany. with input parameters as α = 0.05, 80% power of study, and medium (0.3) effect size. The patients were categorized into four groups according to the functional stages of OSMF based on the classification given by More et al.[10] BMI was calculated by measuring and applying weight and height to the BMI formula; then the nutritional status was evaluated using BMI guidelines given by the World Health Organization.[11] MUAC will be measured using color-coded MUAC measuring tape. Patients with MUAC <23 cm will be considered undernourished described by Chakraborty et al.[12] Data were collected and analyzed using IBM SPSS statistics - version 26 software, IBM Corporation, Armonk, New York, United States of America. The P value was set at 0.05. The Chi-square test, one-way ANOVA test, and Pearson's correlation test were used for statistical analysis.


  Results Top


Among 150 OSMF patients, 136 were male and 14 were female, and the majority of (around 49) patients are in the age group of 26–35 years. In [Table 1], 43 (28.7%) undernourished and 107 (71.3%) normal patients were recorded by calculating their MUAC. In [Table 2], a total of 46 underweight, 93 normal, 9 overweight, and only 2 obese patients were recorded by calculating their BMI. In [Table 3], from the MUAC and BMI mean scores within and between the groups, a statistically significant difference was found to be P = 0.000. In [Table 4], MUAC and BMI had highly similar and have a significant correlation.
Table 1: Distribution of mid-upper arm circumference interpretation of patients (n=150)

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Table 2: Distribution of body mass index interpretation of patients (n=150)

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Table 3: Comparison of mean values of mid-upper arm circumference and body mass index (n=150)

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Table 4: Correlation between mid-upper arm circumference and body mass index with oral submucous fibrosis patients (n=150)

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  Discussion Top


OSMF is a distressing and debilitating disease with malignant potential.[3] The incidence of OSMF is increasing like an epidemic among youngsters in the Indian and South-East Asian population. The etiology for OSMF is still obscure, and various factors have been proposed; betel nut chewing is the most important.[13] The lack of awareness, aggressive marketing strategies of these products, and failure to impart primary preventive measures have also contributed to a considerable increase in the incidence of OSMF among the rural and urban younger population.[14] Measurements of adult MUAC have long been known to reflect changes in adult body weight, and the major determinants of MUAC, arm muscle and subcutaneous fat, are both important determinants of survival in starvation.[5] In our study, the majority of patients (49 out of 150) were 26–35 years old with male predominance. Similar results of age and gender variables were reported in the study carried out by Tang et al.[15] in China. Furthermore, the similar data distribution was seen in a study conducted by Singh et al.[16] In our study, males were found to be dominating (around 91%), as they were using the gutkha products more because of easy availability in all the places, whereas females being more conscious about their health and esthetic value, probably felt uncomfortable to ask the vendors in getting the gutkha products. This is one of the reasons which is responsible for a high male: female ratio, which is in agreement with a study conducted by Ahmad et al.[17] The betel nut contained component “arecoline” which plays a major role in the pathogenesis of OSMF.[3] All study participants were presented with an adverse habit history of betel nut chewing in the present study; nutrition and oral health are interrelated; perhaps, nutrition is a major factor in infection, inflammation, and prognosis of a disease.[5] In this study, BMI and clinical staging of patients with OSMF revealed a statistically significant correlation. However, lower BMI may be associated with lower socioeconomic status and malnutrition.[6] Therefore, it is important to screen the OSMF condition and the estimation of nutritional condition. It should be an important part of health-care services, especially in rural areas. The study conducted by Tang et al.[18] on the elderly by means of MUAC was used as the method to assess the nutritional status of adults. Similarly, in our study, MUAC and clinical staging of patients with OSMF revealed a statistically significant correlation. Moreover, a study conducted by Yallamraju et al.[5] evaluated the MUAC as a useful tool and found an inverse relation between MUAC and clinical staging and observed that patients with OSMF were unable to eat due to burning, ulcers, and inability to open mouth, which affects the overall health of the individual. Limitations of the study can be comprised as a small sample size, and the specific measure of variables can be evaluated in different stages of OSMF.


  Conclusion Top


BMI and MUAC both are effective and similar in measuring the nutritional status of OSMF patients, and the nutritional status of OSMF patients decreased with an increase in severity and stage of OSMF.

Acknowledgment

All the authors would like to acknowledge the principal of the dental college at the study setting and all study participants for their support and cooperation during the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Reddy V, Wanjari PV, Banda NR, Reddy P. Oral submucous fibrosis: Correlation of clinical grading to various habit factors. Int J Dent Clin 2011;3:21-4.  Back to cited text no. 1
    
2.
Ekanayaka RP, Tilakaratne WM. Oral submucous fibrosis: Review on mechanisms of pathogenesis and malignant transformation. J Carcinogene Mutagene 2013;S5:1-11.  Back to cited text no. 2
    
3.
Afroz N, Hasan SA, Naseem S. Oral submucous fibrosis a distressing disease with malignant potential. Indian J Community Med 2006;31:270-77.  Back to cited text no. 3
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4.
Ali FM, Aher V, Prasant MC, Bhushan P, Mudhol A, Suryavanshi H. Oral submucous fibrosis: Comparing clinical grading with duration and frequency of habit among areca nut and its products chewers. J Cancer Res Ther 2013;9:471-6.  Back to cited text no. 4
    
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Yallamraju SR, Mehrotra R, Sinha A, Gattumeedhi SR, Gupta A, Khadse SV. Use of mid upper arm circumference for evaluation of nutritional status of OSMF patients. J Int Soc Prev Community Dent 2014;4:S122-5.  Back to cited text no. 5
    
6.
US Department of Health and Human Services. Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks. National Heart, Lung, and Blood Institute (Ed.), Aim for a Healthy Weight. Bethesda, MD: National Institutes of Health; 2015. Available from: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_dis.htm. [Last accessed on 2019 Aug 29].  Back to cited text no. 6
    
7.
Roy NC. Use of mid-upper arm circumference for evaluation of nutritional status of children and for identification of high-risk groups for malnutrition in rural Bangladesh. J Health Popul Nutr 2000;18:171-80.  Back to cited text no. 7
    
8.
Manual AP. National Health and Nutrition Examination Survey. Atlanta, Ga, USA: Manual AP; 2007.  Back to cited text no. 8
    
9.
Tsai AC, Chang TL, Yang TW, Chang-Lee SN, Tsay SF. A modified mini nutritional assessment without BMI predicts nutritional status of community-living elderly in Taiwan. J Nutr Health Aging 2010;14:183-9.  Back to cited text no. 9
    
10.
More CB, Gupta S, Joshi J, Varma SN. Classification system for oral submucous fibrosis. J Indian Acad Oral Med Radiol 2012;24:24.  Back to cited text no. 10
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11.
World Health Organization. Physical Status: The Use of and Interpretation of Anthropometry, Report of a WHO Expert Committee. World Health Organization; 1995.  Back to cited text no. 11
    
12.
Chakraborty R, Bose K, Bisai S. Mid-upper arm circumference as a measure of nutritional status among adult Bengalee male slum dwellers of Kolkata, India: Relationship with self-reported morbidity. Anthropol Anz 2009;67:129-37.  Back to cited text no. 12
    
13.
Khanna SS, Karjodkar FR. Circulating immune complexes and trace elements (Copper, Iron and Selenium) as markers in oral precancer and cancer: A randomised, controlled clinical trial. Head Face Med 2006;2:33.  Back to cited text no. 13
    
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Kadani M, Satish BN, Maharudrappa B, Prashant KM, Hugar D, Allad U, et al. Evaluation of plasma fibrinogen degradation products and total serum protein concentration in oral submucous fibrosis. J Clin Diagn Res 2014;8:ZC54-7.  Back to cited text no. 14
    
15.
Tang JG, Jian XF, Gao ML, Ling TY, Zhang KH. Epidemiological survey of oral submucous fibrosis in Xiangtan City, Hunan Province, China. Community Dent Oral Epidemiol 1997;25:177-80.  Back to cited text no. 15
    
16.
Singh A, Lanke RB, Shetty R, Akifuddin S, Sahu M, Singh N, et al. Effect of habits and nutritional status on clinical grading and histopathological staging in patients with oral sub mucous fibrosis. J Clin Diagn Res 2015;9:ZC49-52.  Back to cited text no. 16
    
17.
Ahmad MS, Ali SA, Ali AS, Chaubey KK. Epidemiological and etiological study of oral submucous fibrosis among gutkha chewers of Patna, Bihar, India. J Indian Soc Pedod Prev Dent 2006;24:84-9.  Back to cited text no. 17
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18.
Tang AM, Dong K, Deitcher M, Chung M, Maalouf-Manasseh Z, Tumilowicz A, et al. Use of cutoffs for mid-u0pper arm circumference (MUAC) as an indicator or predictor of nutritional and health-related outcomes in adolescents and adults: A systematic review. Food and Nutrition Technical Assistance III Project (FANTA). Washington, DC: United States Agency for International Development (USAID); 2013. p.1-39.  Back to cited text no. 18
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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