British Journal of Nutrition

Human and Clinical Nutrition

The effectiveness of BMI, calf circumference and mid-arm circumference in predicting subsequent mortality risk in elderly Taiwanese

Alan C. Tsaia1a2 c1 and Tsui-Lan Changa3

a1 Department of Healthcare Administration, Asia University, 500 Liufeng Road, Wufeng, Taichung 41354, Taiwan

a2 Department of Health Services Management, School of Public Health, China Medical University, Taichung, 404 Taiwan

a3 Hsin Yung Ho Hospital, Taoyuan, Taiwan


BMI, mid-arm circumference (MAC) and calf circumference (CC) are anthropometric indicators often included in geriatric health measurement scales. However, their relative effectiveness in predicting long-term mortality risk has not been extensively examined. The present study aimed to evaluate the relative effectiveness of these anthropometrics in predicting long-term mortality risk in older adults. The study prospectively analysed the ability of these indicators in predicting 4-year follow-up mortality risk of a population-representative sample of 4191 men and women, 53 years of age or older in the ‘Survey of Health and Living Status of the Elderly in Taiwan’. Cox regression analyses were performed to evaluate the association of follow-up mortality risk with low ( < 21 kg/m2) or high ( ≥ 27 kg/m2) BMI, low MAC ( < 23·5/22 cm for men/women) and low CC ( < 30/27 cm) respectively, according to Taiwanese-specific cut-off points. Results showed that low CC and low MAC were more effective than low BMI in predicting follow-up mortality risk in 65–74-year-old elderly. But low CC and low BMI were more effective than low MAC in ≥ 75-year-old elderly, and low BMI was more effective than low MAC or low CC in 53–64-year-old persons. High BMI was not effective in predicting mortality risk in any of these age ranges. These results suggest that in elderly adults, CC is more effective than BMI in predicting long-term mortality risk. Thus, more consideration to CC and MAC in designing geriatric health or nutritional measurement scales is recommended.

(Received February 12 2010)

(Revised August 04 2010)

(Accepted August 05 2010)

(Online publication December 06 2010)


c1 Corresponding author: A. C. Tsai, fax +1 886 4 2332 1206, email


Abbreviations: CC, calf circumference; MAC, mid-arm circumference