"I hate my arms"

No one ever has anything nice to say about fat upper arms. Countless women are shy about wearing sleeveless tops, embarrassed about how their arms look to others. They’ll resort to diets, potions and liposuction in attempts to spot reduce. A new study, led by a researcher at the Sheffield Institute for Studies on Ageing at the University of Sheffield in Sheffield, UK, actually found good news about larger upper arm circumferences, especially for older women. By now, it will be no surprise to readers that the media ignored this one.

In a study, published in the British Journal of Nutrition, researchers randomly selected 445 older patients as they were being admitted into the hospital for various reasons, and assessed their nutritional status. They took special care to differentiate underlying health problems from undernutrition and excluded from their study any with severe medical or psychiatric illnesses, bariatric surgery or other malabsorption problems, malignancies, those living in institutional settings, etc., explaining:

[N]utritional indices in ageing patients are affected by age-related changes, disability, illness and injury. In attempting to overcome some of the above challenges we excluded from the study all patients with severe medical and psychiatric illnesses such as liver, gastrointestinal, kidney or neoplasm. Also by adjusting for underlying disease state, age, drugs, functional capacity and acute-phase response on mortality it was possible to identify a potential independent effect of poor nutritional status on patients’ outcome.

The study participants people had physical and nutritional assessments 6 weeks and 6 months later, which also included anthropometric measurements, laboratory tests and disability/function evaluations. A year later, they looked to see who was still alive and found some interesting things.

Not surprisingly, those who died were older, average age of 78.7, with more health problems, on more medications and more likely to be men. Women made up only about one-third of those who died. But many of the findings defy popular beliefs, although they support the body of medical literature.

Smokers had no higher risks, but 65% of those who died were ex-smokers, even though they made up less than half of the original cohort.

And the “survivors had significantly higher fasting blood sugars” and albumin levels. The medical research has consistently shown a relationship between nutrition and nutritional reserves to improved outcomes among well and acutely ill elderly, they report.

“Low serum albumin levels were related to poor outcome not just during the acute phase following acute illness but throughout the recovery period, an effect unlikely to be explained by the catabolic state alone,” they wrote. In other words, these findings aren’t explained by weight loss associated with severe illness. It has also been well established in the medical literature, they said, that protein and energy [calorie] shortfalls are strong predictors of mortality, both in the hospital and in the community.

Similarly, low BMI is also a “significant and independent predictor of shortened survival in older patients.” Survivors were fatter and more were “overweight” than in “normal” weight ranges. This concurs with other studies, such as an observation of “18,316 Italian patients [which] found low BMI to be a significant and independent predictor of shortened survival in older patients.”

Which brings us to arm sizes. In this study, survivors had graded and significantly higher MUACs — mid-upper arm circumferences. A strong relationship between MUAC and mortality has been reported before, they noted.

“MUAC is a composite measure of muscle and fat stores,” they said. In fact, arm circumference is so useful in assessing nutritional status in older adults, the authors reported, “it has better prognostic value than BMI in predicting death in older adults.” You might be interested in seeing the differences in one-year survival based on upper arm circumferences among the people at the time they entered the hospital [the top line #4 represents those with the biggest arms and highest probabilities for survival]:

Overall nutritional status and not restricting calories prior to becoming sick was associated with significantly lower risks of dying among older people. Not unlike the findings seen among all ages. It's not proof of causation, of course, but certainly consistent with every study to date. What made this study unique was its positive news about those big arms that many women find objectionable. While many point to them with disdain, maybe they’re not such a terrible asset after all.