Association Between Mid-Upper Arm Circumference and Perceived Stress in Chinese adults and elderly: A Cross-Sectional Study

Yun Li¹Lu Ren²Shouzhuan Bao³Duohong Yang^4*

• ¹Central China Normal University School of Physical Education, Wuhan, China
• ²Hubei Sports Vocational College, Hubei, China
• ³Faculty of Artificial Intelligence in Education, Central China Normal University, Wuhan, China
• ⁴Central China Normal University, Wuhan, China

Aims: This study aimed to explore the relationship between mid-upper arm circumference and perceived stress in Chinese adults and elderly. Methods: The present study employed cross-sectional data from the CHNS collected during the 2015 survey cycle, involving 8,455 adults and elderly respondents. Perceived stress was assessed utilizing the 14-item Perceived Stress Scale (PSS-14), with scores dichotomized based on the median value. Logistic regression models adjusted for demographic, socioeconomic, and lifestyle variables were applied to examine this associations. To further explore MUAC's potential as an individual-level indicator, receiver operating characteristic (ROC) analyses were performed. Results: Compared to participants in the lowest mid-upper arm circumference tertile, those classified within the highest tertile exhibited significantly lower odds of reporting high perceived stress (adjusted OR = 0.71, 95% CI: 0.71–0.93, P = 0.002). Subgroup analyses revealed that the inverse association between MUAC and perceived stress was more obvious among adult aged 60 years and older, suburban residents, non-smokers, participants with lower educational levels, and those in the western and northeastern regions. Sensitivity analyses also confirmed the robustness of these findings. The RCS analysis revealed a linear inverse association, with perceived stress declining notably when MUAC exceeded 32.23 cm. ROC analysis indicated that threshold values varied slightly across subgroups, ranging from 27.5–32.4 cm in males (AUC: 0.52–0.60) and 26.2–32.2 cm in females (AUC: 0.51–0.54), with higher values in participants with BMI ≥ 30 kg/m² and slightly higher values in younger males. These findings suggest that MUAC has limited potential for identifying elevated perceived stress and should be regarded as exploratory rather than a validation of its screening utility. Conclusion: This study indicated that individuals with greater arm circumference tended to report lower stress levels in Chinese adults aged 60 years and older, suggesting exploratory evidence of MUAC's potential. However, its ability to discriminate perceived stress levels was limited, indicating that MUAC alone is not appropriate as an independent screening tool. It may serve as a simple, low-cost, and complementary indicator in population-based or resource-limited settings, pending further validation in longitudinal studies and integration with other anthropometric or psychosocial measures.