Handgrip strength: Best practice for a rapid nutrition screening and risk stratification in male patients with alcoholic liver cirrhosis, a classification and regression tree analysis study.
alcoholic liver cirrhosis
hand-grip strength
malnutrition
mortality
nutrition assessment
nutrition screening
nutrition status
Journal
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
ISSN: 1941-2452
Titre abrégé: Nutr Clin Pract
Pays: United States
ID NLM: 8606733
Informations de publication
Date de publication:
08 Jul 2022
08 Jul 2022
Historique:
revised:
25
05
2022
received:
18
11
2021
accepted:
28
05
2022
entrez:
8
7
2022
pubmed:
9
7
2022
medline:
9
7
2022
Statut:
aheadofprint
Résumé
Rapid nutrition screening (NS) is vital for apt management in patients with alcoholic liver cirrhosis (ALC). To identify a quick method of NS having high reliability and prognostic significance. NS of patients with ALC was assessed using mid-upper arm circumference (MUAC), handgrip strength (HGS), fat-free mass index (FFMI), and the Royal Free Hospital-Global Assessment (RFH-GA). Baseline clinical and biochemical information were recorded along with 90-day survival data. The classification and regression tree method was used to classify HGS, MUAC, and FFMI values as well nourished (WN), moderately malnourished (MM), and severely malnourished (SM), and their concordance with RFH-GA categories was assessed using Kendall tau-b coefficient. The prognostic proficiency of each method was tested by Cox regression analysis. According to the RFH-GA, of 140 male patients with ALC, 13 of 140 (9.3%) were WN, 93 of 140 (66.4%) were MM, and 34 of 140 (26.8%) were SM. HGS has the strongest association with the RFH-GA (Kendall tau-b = 0.772; diagnostic accuracy -81.4%). HGS was found to be the independent predictor of 90-day mortality (26 of 140 [18.6%]; hazard ratio, 0.93; 95% CI, 0.88-0.98; P = 0.002) after adjusting for age, body mass index, and disease severity. The hazard of mortality was 8.5-times higher in patients with ALC with HGS < 22 kg as compared with those with HGS > 29. HGS is a reliable tool for rapid NS. HGS < 22 kg suggests a high risk for severe malnutrition and is strongly associated with short-term mortality in male patients with ALC.
Sections du résumé
BACKGROUND
BACKGROUND
Rapid nutrition screening (NS) is vital for apt management in patients with alcoholic liver cirrhosis (ALC).
AIM
OBJECTIVE
To identify a quick method of NS having high reliability and prognostic significance.
METHODS
METHODS
NS of patients with ALC was assessed using mid-upper arm circumference (MUAC), handgrip strength (HGS), fat-free mass index (FFMI), and the Royal Free Hospital-Global Assessment (RFH-GA). Baseline clinical and biochemical information were recorded along with 90-day survival data. The classification and regression tree method was used to classify HGS, MUAC, and FFMI values as well nourished (WN), moderately malnourished (MM), and severely malnourished (SM), and their concordance with RFH-GA categories was assessed using Kendall tau-b coefficient. The prognostic proficiency of each method was tested by Cox regression analysis.
RESULTS
RESULTS
According to the RFH-GA, of 140 male patients with ALC, 13 of 140 (9.3%) were WN, 93 of 140 (66.4%) were MM, and 34 of 140 (26.8%) were SM. HGS has the strongest association with the RFH-GA (Kendall tau-b = 0.772; diagnostic accuracy -81.4%). HGS was found to be the independent predictor of 90-day mortality (26 of 140 [18.6%]; hazard ratio, 0.93; 95% CI, 0.88-0.98; P = 0.002) after adjusting for age, body mass index, and disease severity. The hazard of mortality was 8.5-times higher in patients with ALC with HGS < 22 kg as compared with those with HGS > 29.
CONCLUSION
CONCLUSIONS
HGS is a reliable tool for rapid NS. HGS < 22 kg suggests a high risk for severe malnutrition and is strongly associated with short-term mortality in male patients with ALC.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2022 American Society for Parenteral and Enteral Nutrition.
Références
McClain CJ, Barve SS, Barve A, Marsano L. Alcoholic liver disease and malnutrition. Alcohol Clin Exp Res. 2011;35(5):815-820.
Stephenson GR, Moretti EW, El-Moalem H, Clavien PA, Tuttle-Newhall JE. Malnutrition in liver transplant patients: preoperative subjective global assessment is predictive of outcome after liver transplantation. Transplantation. 2001;72(4):666-670.
Merli M, Giusto M, Gentili F, et al. Nutritional status: its influence on the outcome of patients undergoing liver transplantation. Liver Int. 2010;30:208-214.
Buchard B, Boirie Y, Cassagnes L, Lamblin G, Coilly A, Abergel A. Assessment of malnutrition, sarcopenia and frailty in patients with cirrhosis: which tools should we use in clinical practice? Nutrients. 2020;12(1):186.
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.
Solomons NW, Allen LH. The functional assessment of nutritional status: principle, practice and potential. Nutr Rev. 1983;41(2):33-50.
Beaudart C, Rolland Y, Cruz-Jentoft AJ, et al. Assessment of muscle function and physical performance in daily clinical practice: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Calcif Tissue Int. 2019;105(1):1-14.
Norman K, Stobäus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011;30(2):135-142.
Bohannon RW, Magasi SR, Bubela DJ, Wang YC, Gershon RC. Grip and knee extension muscle strength reflect a common construct among adults. Muscle Nerve. 2012;46(4):555-558.
Bruyère O, Beaudart C, Reginster JY, et al. Assessment of muscle mass, muscle strength and physical performance in clinical practice: an international survey. Eur Geriatr Med. 2016;7(4):243-246.
Morgan MY, Madden AM, Soulsby CT, Morris RW. Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology. 2006;44(4):823-835.
Kalafateli M, Mantzoukis K, Choi Yau Y, et al. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the model for end-stage liver disease score. J Cachexia Sarcopenia Muscle. 2017;8(1):113-121.
Gunsar F, Raimondo ML, Jones S, et al. Nutritional status and prognosis in cirrhotic patients. Aliment Pharmacol Ther. 2006;24(4):563-572.
Tandon P, Ney M, Irwin I, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012;18(10):1209-1216.
Frisancho AR. Triceps skin fold and upper arm muscle size norms for assessment of nutritional status. Am J Clin Nutr. 1974;27(10):1052-1057.
Fess EE. Grip strength. In: Casanova JS, ed. Clinical Assessment Recommendations. 2nd ed. American Society of Hand Therapists; 1992:41-45.
Walaa M. Influence of different testing postures on hand grip strength. Eur J Sci Res. 2014;10(36):1857-7881.
Bishop CW, Bowen PE, Ritchey SJ. Norms for nutritional assessment of American adults by upper arm anthropometry. Is J Clin Nutr. 1981;34(11):2530-2539.
Krall EA, Dwyer JT. Validity of a food frequency questionnaire and a food diary in a short-term recall situation. J Am Diet Assoc. 1987;87(10):1374-1377.
Figueiredo FA, Dickson ER, Pasha TM, et al. Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease. Liver Transpl. 2000;6(5):575-581.
Sharma P, Rauf A, Matin A, Agarwal R, Tyagi P, Arora A. Handgrip strength as an important bed side tool to assess malnutrition in patient with liver disease. J Clin Exp Hepatol. 2017;7(1):16-22.
Andreatta Gottschall CB, Feijó Nunes F, Deutrich Aydos ME, et al. Contribution of dynamometry and the Royal Free Hospital Global Assessment to the nutritional assessment of patients with chronic liver diseases. Rev Chil Nutr. 2012;39(4):152-158.
Gaikwad NR, Gupta SJ, Samarth AR, Sankalecha TH. Handgrip dynamometry: a surrogate marker of malnutrition to predict the prognosis in alcoholic liver disease. Ann Gastroenterol. 2016;29(4):509-514.
Daphnee DK, John S, Vaidya A, Khakhar A, Bhuvaneshwari S, Ramamurthy A. Hand grip strength: a reliable, reproducible, cost-effective tool to assess the nutritional status and outcomes of cirrhotics awaiting liver transplant. Clin Nutr ESPEN. 2017;19:49-53.
Sidhu SS, Saggar K, Goyal O, et al. Muscle strength and physical performance, rather than muscle mass, correlate with mortality in end-stage liver disease. Eur J Gastroenterol Hepatol. 2021;33(4):555-564.
Innes E. Handgrip strength testing: a review of the literature. Aust Occup Ther J. 1999;46(3):120-140.
Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40(4):423-429.
Ciocîrlan M, Cazan AR, Barbu M, Mănuc M, Diculescu M, Ciocîrlan M. Subjective global assessment and handgrip strength as predictive factors in patients with liver cirrhosis. Gastroenterol Res Pract. 2017;2017:8348390.
Fernandes SA, Bassani L, Nunes FF, Aydos MED, Alves AV, Marroni CA. Nutritional assessment in patients with cirrhosis Arq Gastroenterol. 2012;49(1):19-27.
Andersen H, Borre M, Jakobsen J, Andersen PH, Vilstrup H. Decreased muscle strength in patients with alcoholic liver cirrhosis in relation to nutritional status, alcohol abstinence, liver function, and neuropathy. Hepatology. 1998;27(5):1200-1206.
Wang CW, Feng S, Covinsky KE, et al. A comparison of muscle function, mass, and quality in liver transplant candidates: results from the functional assessment in liver transplantation study. Transplantation. 2016;100(8):1692-1698.
Hsu KJ, Liao CD, Tsai MW, Chen CN. Effects of exercise and nutritional intervention on body health, and physical composition, metabolic performance in adults with sarcopenic obesity: a meta-analysis. Nutrients. 2019;11(9):2163.