AUTHOR=Li Yun , Ren Lu , Bao Shouzhuan , Yang Duohong 

TITLE=Association between mid-upper arm circumference and perceived stress in Chinese adults and older adults: a cross-sectional study

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1677284

DOI=10.3389/fpubh.2025.1677284

ISSN=2296-2565

ABSTRACT=AimsThis study aimed to explore the relationship between mid-upper arm circumference and perceived stress in Chinese adults and older adults.MethodsThe present study employed cross-sectional data from the CHNS collected during the 2015 survey cycle, involving 8,455 adults and older adults 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.ResultsCompared 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.ConclusionThis 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.