Handgrip strength and adductor pollicis muscle thickness as predictors of postoperative complications after major operations of the gastrointestinal tract

Low-cost and fast-performing indicators of muscle mass loss are good predictors of clinical outcomes in hospitalized patients: A longitudinal observational study

BACKGROUND

"Gold standard" methods for muscle mass (MM) assessment are expensive and difficult to use in clinical practice. The present study aimed to evaluate the association between easy-to-apply and low-cost indicators of MM and clinical outcomes in hospitalized patients.

METHODS

In this cohort study, calf circumference [CC], adductor pollicis muscle thickness [APMT], midarm muscle circumference [MAMC], and arm muscle area [AMA] were measured within 48 h of admission to detect MM loss, and it was also evaluated by physical examination. Patients were followed up until discharge for collection of in-hospital death and length of hospital stay (LOS) data, and they were contacted by phone to assess hospital readmission and mortality at 6 months after discharge.

RESULTS

We evaluated 601 patients (55.8 ± 14.8 years). Moderate/severe loss of MM (hazard ratio [HR], 4.12; 95% CI, 1.26-13.49), low CC (HR, 3.67; 95% CI: 1.07-12.55), low MAMC (HR, 5.20; 95% CI, 1.48-18.35), and low AMA (HR, 14.28; 95% CI, 1.80-113.14) were predictors of in-hospital mortality. Moderate/severe loss of MM was a predictor of prolonged LOS (odds ratio [OR], 2.27; 95% CI, 1.53-3.36), hospital readmission (OR, 4.14; 95% CI, 1.26-13.55), and mortality at 6 months (OR, 3.20; 95% CI, 1.71-6.01). Low CC (OR, 2.49; 95% CI, 1.27-4.85) and low APMT (OR, 3.22; 95% CI, 1.56-6.66) were associated with death 6 months after discharge.

CONCLUSION

Easy-to-apply and low-cost indicators of MM were associated with negative clinical outcomes and should be part of nutrition assessment in hospitals.

Effectiveness of adductor pollicis muscle thickness as risk marker for sarcopenia in Central-West Brazilian elderly communities

OBJECTIVES

The aim of this study was to determine sensitivity, specificity, and best cutoff point for adductor pollicis muscle thickness (APMT) for diagnosis of sarcopenia in elderly community centers.

METHODS

This was a cross-sectional study comprising 321 elderly individuals from four community centers in Cuiabá, Central-West region of Brazil. The main outcome variables were calf circumference (CC; cm) and the APMT (mm). A receiver operating characteristic curve was built to assess the accuracy of APMT having CC as a golden pattern for sarcopenia. The best cutoff point was defined by Youden's J statistic.

RESULTS

The area under curve of APMT was 0.70 (95% confidence interval [CI], 0.63-0.76; P < 0.001) for all individuals, 0.74 (95% CI, 0.67-0.81; P < 0.001) for women, and 0.71 (95% CI, 0.58-0.85; P =.01) for men. The best cutoff point defined by Youden's J statistic was 17.63 mm for all individuals, the same for women. and 18.51 mm for men.

CONCLUSION

The APMT can be used for the diagnosis of sarcopenia. The optimal cutoff points for APMT are 17.63 mm for women and 18.51 mm for men in elderly communities in the Central-West Region of Brazil.

Low Muscle Mass Is a Predictor of Malnutrition and Prolonged Hospital Stay in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Longitudinal Study

BACKGROUND

Malnutrition in chronic obstructive pulmonary disease (COPD) patients is more prevalent during times of exacerbation. Fat-free mass index (FFMI), calf circumference (CC), and adductor muscle pollicis thickness (AMPT) can be used to identify reduced muscle mass and have been found to be good predictors of clinical outcomes in other conditions, but they have not been investigated in COPD. Therefore, this study evaluated low muscle mass as predictor of malnutrition, prolonged length of stay (LOS), and in-hospital death in COPD patients.

METHODS

This prospective cohort study was carried out in hospitalized patients with COPD exacerbation. Malnutrition diagnosis was performed by Subjective Global Assessment, and muscle mass was assessed by FFMI, calculated using fat-free mass from bioelectrical impedance, CC, and AMPT. Clinical outcomes (LOS and in-hospital death) were collected from records.

RESULTS

One hundred seventy-six patients were included (68.2 ± 10.4 years old, 56.2% women); 74.2% were classified as Global Initiative of Chronic Obstructive Lung Disease 2 or 3 and 58.2% as malnourished. The median LOS was 11 (7-19) days, and the incidence of death was 9.1%. Low FFMI and CC predicted malnutrition (low CC: odds ratio [OR], 4.6; 95% CI, 2.2-9.7 and low FFMI: OR, 8.8; 95% CI, 3.7-20.8) and were associated with prolonged LOS (low CC: OR, 2.3; 95% CI, 1.1-4.6 and low FFMI: OR, 2.5; 95% CI, 1.3-4.8).

CONCLUSION

Simple, inexpensive, and noninvasive parameters of muscle mass-FFMI and CC-are good predictors of malnutrition and prolonged LOS in COPD patients experiencing exacerbation.

Association between preoperative potential sarcopenia and survival of cancer patients undergoing major surgical procedures

ABSTRACT Objective: to evaluate the impact of probable sarcopenia (PS) on the survival of oncological patients submitted to major surgeries. Method: prospective cohort bicentrical study enrolling adult oncological patients submitted to major surgeries at Cancer Hospital and Santa Casa de Misericordia in Cuiabá-MT. The main endpoint was the verification of postoperative death. Demographic and clinical data was collected. PS was defined as the presence of 1) sarcopenia risk assessed by SARC-F questionnaire and 2) low muscle strength measured by dynamometry. The cumulative mortality rate was calculated for patients with either PS or non PS using Kaplan Meier curve. The univariate and multivariate Cox regression model was used to evaluate the association of mortality with various investigated confounding variables. Results: a total of 220 patients with a mean (SD) age of 58.7±14.0 years old, 60.5% males participated of the study. Patients with PS had higher risk to postoperative death (RR=5.35 95%CI 1.95-14.66; p=0,001) and for infectious complications (RR=2.45 95%CI 1.12-5.33; p=0.036). The 60 days mean survival was shorter for patients with PS: 44 (IQR=32-37) vs 58 (IQR=56-59) days (log rank <0,001). The Cox multivariate regression showed that PS was an independent risk factor (HR=5.8 95%CI 1.49-22.58; p=0.011) for mortality. Conclusion: patients bearing PS submitted to major oncological surgery have less probability of short term survival and preoperative PS is an independent risk for postoperative mortality.

Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil

Hand grip strength (HGS) is recognized as an important health indicator, but validated reference values that can be applied to the evaluation of individuals in different populations are still lacking. This work aimed to identify correlations between HGS and anthropometric variables and to establish HGS reference values for adult and elderly populations. This is a population-based cross-sectional study considering the subsets of individuals with healthy right or left upper limbs from a sample of 1,609 adults and elderly residents in Rio Branco, Acre, Brazil. Descriptive statistics of anthropometric measures and HGS values at maximum performance based on three measurements of the two hands were obtained, and Pearson correlations between these variables were applied. Percentile distributions were estimated for right and left HGS by sex and age group. Men presented, in general, a maximum HGS 57% higher than women (43.4 kg vs. 27.6 kg), and also higher HGS levels in the different age groups. In both sexes, the highest HGS values were observed in the age group of 30 to 39 years (men, 46.9 kg; women, 29.4 kg), with a subsequent decline. HGS presented a negative correlation with age and a weak to moderate positive correlation with anthropometric variables, among men and women. The median HGS of men was reduced by about 46% between the ages of 30 and 39 years and 80 years and over (right hand, 46.4 to 23.7 kg; left hand, 42.2 to 23.5 kg) and by about 44% in women (right hand, 29.0 to 16.4 kg, left hand, 27.3 to 15.2 kg). The values identified are a reference for HGS behavior among healthy adults and seniors, although they do not discriminate individuals with specific health conditions. They can be used in rehabilitation programs and subsidize future studies aimed at exploring their potential application in the evaluation of the health condition of adults and elderly individuals.

Use of adductor pollicis muscle thickness in hospitalized or ambulatory patients: a systematic review

Objective:

to analyze the use of the Adductor Pollicis Muscle Thickness (APMT) as an anthropometric parameter and prognostic indicator in hospitalized or ambulatory patients.

Method:

systematic review carried out the Web of Science, SCOPUS and Lilacs databases.

Results:

Twenty-three studies were performed on critical, surgical, oncological, nephropathic and hepatopathic patients, collecting data on bibliographic reference, study site, objectives, number of patients, age group, methodology, main results and conclusion. APMT proved to be a good anthropometric parameter for evaluation of nutritional status in critical patients without edema, and surgical, oncological and nephropathic patients, but presented poor performance for diagnosis of malnutrition in hepatopathic patients. It was a good prognostic indicator for mortality in critical, nephropathic and oncological patients, and also a good predictor of hospitalization in nephropathic patients. There was an association with neurological complications in Hepatic Encephalopathy (HE) in the case of hepatophatic patients, but it was not a predictor of postoperative complications in surgical patients.

Conclusion:

APTM was considered a good anthropometric parameter in most clinical conditions, except in patients with liver disease and a good prognostic indicator for mortality in critical, oncological and nephropathic patients, and a predictor of neurological complications in HE. Further prognostic investigation, standardization of cutoff points and evaluation of sensitivity and specificity are required.

Thickness of the adductor pollicis muscle: Accuracy in predicting malnutrition and length of intensive care unit stay in critically ill surgical patients: Thickness of the adductor pollicis muscle in surgical critically patients

BACKGROUNDS & AIMS

new techniques for assessment of nutritional status of critically ill and surgical patients have been investigated to overcome inherent limitations of conventional method. The current study aimed to evaluate the ability of thickness of the adductor pollicis muscle (TAPM) in detecting malnutrition and predicting morbidity and mortality in critically ill surgical patients.

METHODS

cohort study of adult patients, assessed within the 48 h of admission to the surgical intensive care unit (ICU) of a public hospital. TAPM measurements of the non-dominant hand were performed with patients lying supine. TAPM values lower than the 5th percentile for age and sex were adopted to identify malnutrition. Patients were followed up until discharge for measurement of the following parameters: length of ICU stay, time on mechanical ventilation, length of hospital stay, and hospital mortality.

RESULTS

fifty-nine surgical ICU patients, with mean age of 60.0 ± 17.4 years were included in the current study. There was a positive, weak-to-moderate correlation between TAPM and anthropometric indicators (r = 0.338 to r = 0.579; p < 0.01). The ability of TAPM in identifying patients with malnutrition (diagnosed by global subjective assessment) was assessed by ROC curve analysis, and an area under the ROC curve of 0.611 (95%CI: 0.459-0.762; p = 0.151) was found. TAPM < p5 increased the risk of ICU length of stay >3 days (RR = 2.92; 95%CI 1.09-7.81; p = 0.032). Relative frequencies of malnourished and well-nourished patients according to TAPM were not different between survivors and non-survivors (p = 0.814).

CONCLUSION

TAPM showed unsatisfactory accuracy in predicting malnutrition. Although TAPM was not a good mortality predictor, reduced TAPM (< p5) values increased the risk of a prolonged ICU stay (>3 days).

The Relationship Between Strength Measurements and Anthropometric Indicators (BMI and Skinfold Thickness) in Ellisras Rural Adolescents Aged 9–15 Years: Ellisras Longitudinal Study

Purpose. Handgrip strength and arm hang have been recognized as predictors of muscle strength and presented as biomarkers for important health outcomes and overall fitness of an individual. The aim of the study was to investigate the relationship between arm hang and handgrip strength with BMI and skinfold thickness.

Method. The total of 769 children (391 boys and 378 girls) aged 9-15 years underwent a series of anthropometric and strength measurements with the use of standard procedures. Linear regression was applied to assess the relationship of arm hang and handgrip strengths with body mass index and skinfold thickness.

Results. The prevalence of undernutrition and low strength measurements was high (1.7-85%) while the prevalence of overweight and obesity was low (1.5-4.2%) in the Ellisras children aged 9-15 years. Boys showed a significantly higher (p < 0.05) mean arm hang (9.6-13.1 kg) than girls (4.0-5.1 kg) aged 11-15 years. There was a significant (p < 0.05) association between low strength and underweight among Ellisras rural children when unadjusted (OR = 0.650; 95% CI = 0.487-0.867) and adjusted (OR = 0.650; 95% CI = 0.489-0.868) for age and gender.

Conclusions. The prevalence of undernutrition and poor strength was high. An association was observed between arm hang and anthropometric indicators while handgrip showed no significant association with anthropometric indicators. Further studies are needed to investigate the association between strength and undernutrition over time.

Nurse Assessment of Nutritional Status to Identify Patients at Risk for Complications After Pancreatic Resection

Purpose/Objectives: To determine if serum prealbumin (PAB) levels can be used by nurses to predict patients who may be at higher risk for postoperative complications after pancreatic surgeries. Design: A quantitative, retrospective study. Setting: One cancer center at an urban medical center in Detroit, Michigan. Sample: A convenience sample of 41 patients with resectable pancreatic neoplasms. Methods: Descriptive study with cross-sectional data using chart review to obtain preoperative PAB levels and perioperative data. Main Research Variables: Pancreatic leak, chyle leak, gastroparesis, sepsis, heart attack, length of hospital stay, and readmissions. Findings: There was a higher incidence of pancreatic leak reported after a distal pancreatectomy; however, this complication was not associated with a low PAB of ≤20 mg/dl. Patients with a diagnosis of adenocarcinoma or who underwent a pancreaticoduodenectomy experienced a longer hospital stay. Conclusions: Results did not reinforce the relationship between preoperative nutritional status and outcomes in pancreatic surgery. Implications for Nursing: Surgical oncology nurses should be aware of the importance of presurgical risk assessment and optimization. Tailored implementation of nutritional prehabilitation to improve patient outcomes after resection of pancreatic neoplasms should be studied more comprehensively.

Thickness of the adductor pollicis muscle in nutritional assessment of surgical patients

Objective

To evaluate the correlation between thickness of the muscle adductor pollicis and anthropometric measurements, body mass index and Subjective Global Assessment in the nutritional assessment of surgical patients.

Methods

The study population comprised patients admitted to the general and reconstructive surgery unit of a university hospital in the city of Vitória (ES), Brazil. The inclusion criteria were patients evaluated in the first 48 hours of admission, aged ≥20 years, hemodynamically stable, with no edema or ascites. Data analysis was performed using the software Statistical Package for Social Science 21.0, significance level of 5%.

Results

The sample consisted of 150 patients that were candidates to surgery, mean age of 42.7±12.0 years. The most common reasons for hospitalization were surgical procedures, gastrintestinal diseases and neoplasm. Significant association was observed between thickness of adductor pollicis muscle and Subjective Global Assessment (p=0.021) and body mass index (p=0.008) for nutritional risk. Significant correlation was found between thickness of adductor pollicis muscle and arm muscle circumference, corrected arm muscle area, calf circumference and body mass index. There were no significant correlations between thickness of adductor pollicis muscle and triceps skinfold and age.

Conclusion

The use of thickness of adductor pollicis muscle proved to be an efficient method to detect malnutrition in surgical patients and it should be added to the screening process of hospitalized patients, since it is easy to perform, inexpensive and noninvasive.

Association of the Adductor Pollicis Muscle Thickness With Clinical Outcomes in Intensive Care Unit Patients

BACKGROUND

Different parameters may be used to evaluate the nutrition status of individuals. However, their use in the critically ill is problematic, since the interference of acute disease or therapeutic measures on their results can affect their interpretation. The aim of this study was to assess whether measuring the adductor pollicis muscle is useful in identifying malnutrition and clinical outcomes in the intensive care unit (ICU).

MATERIALS AND METHODS

In total, 127 patients were enrolled in this prospective observational study. Serum albumin levels, anthropometrics, adductor pollicis muscle (APM) thickness, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were measured for each patient upon admission. APM thickness (APMT) was measured while the patient's elbow was flexed at a 90-degree angle and the forearm resting on the patient's torso.

RESULTS

The dominant and nondominant APMT were significantly correlated with all anthropometric measurements (r = 0.41-0.68, P < .001 and r = 0.42-0.66, P < .001 respectively). Multivariate regression analysis adjusted by other risk factors, including APACHE II score, serum albumin, and age, showed that among all anthropometric variables, the APMT has the highest correlation with mortality (odds ratio [OR], 5.6; 95% confidence interval [CI], 0.02-0.12; P < .001), length of stay >10 days (OR, 11.3; 95% CI, 4.42-29.1; P < .001), and organ failure (OR, 14.5; 95% CI, 6.5-38.4; P < .001).

CONCLUSIONS

The results showed that APMT is a low-cost, reliable, and easy method to assess nutrition status and to predict the patient's outcomes in the ICU.

Association of handgrip strength with self-reported diseases in adults in Rio Branco, Acre State, Brazil: a population-based study

This study aimed to analyze the association of handgrip strength with self-reported diseases and multimorbidity among adults in Rio Branco, Acre State, Brazil, through a population based survey involving 1,395 adults of both sexes. Associations by sex were estimated by logistic regression analysis. The mean handgrip strength in men (44.8kg) is higher than in women (29kg) and decrease with age. The mean handgrip strength difference between those classified as strong and weak was 21kg and 15.5kg for men and woman, respectively. Controlling for age group, body mass index and physical activity when it was relevant, men with low handgrip strength were more likely to have hypertension [OR = 2.21 91.35; 3.61)], diabetes [OR = 4.18 (1.35; 12.95)], musculoskeletal disorders [OR = 1.67 (1.07; 2.61)] and multimorbidity [OR = 1.99 (1.27; 3.12)]. Among woman, associations between handgrip strength and cardiovascular disease, dyslipidemia, musculoskeletal disorders and multimorbidity were not sustained in the multivariate models. This study endorses the use of handgrip strength as a health biomarker.