Journal
AMERICAN JOURNAL OF CLINICAL NUTRITION
Volume 114, Issue 2, Pages 731-740Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ajcn/nqab042
Keywords
handgrip strength; malnutrition; nutritional support; functional decline; mortality
Categories
Funding
- Swiss National Science Foundation
- Research Council of Kantonsspital Aarau, Switzerland
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The study investigated the prognostic implications of handgrip strength (HGS) in medical inpatients at nutritional risk. It found that a decrease in HGS was associated with increased risk of 30-day and 180-day mortality. Individualized nutritional support was most effective in reducing mortality in patients with low HGS.
Background: Disease-related malnutrition is associated with loss of muscle mass and impaired functional status. Handgrip strength (HGS) has been proposed as an easy-to-use tool to assess muscle strength in clinical practice. Objectives: We investigated the prognostic implications of HGS in patients at nutritional risk with regard to clinical outcomes and response to nutritional support. Methods: This was a secondary analysis of the randomized controlled, multicenter, Effect of Early Nutritional Support on Frailty, Functional Outcome, and Recovery of Malnourished Medical Inpatients Trial, which compared the effects of individualized nutritional support with usual hospital food in medical inpatients at nutritional risk. Our primary endpoint was 30-d all-cause mortality. The association between sex-specific HGS and clinical outcomes was investigated using multivariable regression analyses, adjusted for randomization, age, weight, height, nutritional risk, admission diagnosis, comorbidities, interaction terms, and study center. We used interaction terms to investigate possible effect modification regarding the nutritional support intervention. Results: Mean SD HGS in the 1809 patients with available handgrip measurement was 17.0 7.1 kg for females and 28.9 +/- 11.3 kg for males. Each decrease of 10 kg in HGS was associated with increased risk of 30-d mortality (female: adjusted OR: 2.11; 95% CI: 1.23, 3.62, P = 0.007; male: adjusted OR: 1.44; 95% CI: 1.07, 1.93, P = 0.015) and 180-d mortality (female: adjusted OR: 1.45; 95% CI: 1.0, 2.10, P = 0.048; male: adjusted OR: 1.55; 95% CI: 1.28, 1.89, P < 0.001). Individualized nutritional support was most effective in reducing mortality in patients with low HGS (adjusted OR: 0.29; 95% CI: 0.10, 0.82 in patients in the <= 10th percentile compared with OR: 0.98; 95% CI: 0.66, 1.48 in patients in the >10th percentile; P for interaction = 0.026). Conclusions: In medical inpatients at nutritional risk, HGS provided significant prognostic information about expected mortality and complication risks and helps to identify which patients benefit most from nutritional support. HGS may thus improve individualization of nutritional therapy.
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