To assess the usefulness of mid-upper arm circumference (MUAC) as a substitute for body mass index (BMI: kg/m2) or an additional measure of adult nutritional state. Variously sampled adults aged 18-60 years from selected regions of five African countries, India, China and Papua New Guinea were measured. 2421 men and 3248 women were measured for their heights, weights and MUAC. Of these, 1569 men and 1905 women also had their triceps skinfold thickness measured, thus allowing additional estimates of muscle area circumferences and fat areas in the arm. MUAC and BMI were highly correlated in each national group; each group's MUAC differed from the overall mean MUAC at any BMI value by < 10%. Women's MUACs were smaller than men's at equivalent BMIs. Increases in MUAC with age were statistically significant but trivial. Muscle and fat measurements showed similar increases with BMI; a larger muscle mass in men explained their greater MUACs but muscle differences alone did not explain national variations in MUAC. The -1 SD MUAC value, taken as an independent measure of peripheral tissue wasting, readily distinguished those with a BMI < 16.0 from those with a BMI > 18.5; intermediate grades of BMI were poorly specified by MUAC values. MUAC values of 23.0 cm in men and 22.0 cm in women are useful cut-off points for simple screening of nutritional state. In combination with BMI it may provide a more refined classification of CED. This new combined classification scheme may be a better means of discriminating the at-risk underweight adults from those who are thin but not at risk.