Handgrip strength at admission and time to discharge in medical and surgical inpatients

Relationship between hemoglobin and grip strength in older adults: the ActiFE study

INTRODUCTION

Although anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin.

AIM

To analyze the association between hemoglobin and grip strength in community-dwelling older adults.

METHODS

We used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed.

RESULTS

In total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (β 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (β 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + .

DISCUSSION AND CONCLUSIONS

Our data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.

Can Muscular Parameters Predict Symptoms of Anxiety and Depression?

Major depressive disorder and anxiety disorders are among the major public health issues. Therefore, identifying predictors of symptoms of depression and anxiety holds fundamental importance to avoid the aggravation of these conditions. Muscle strength and function (e.g., handgrip strength and timed-stands test) are widely recognized predictors of health outcomes; however, their association with symptoms of depression and anxiety is still not completely understood. This study investigated the associations between handgrip strength and timed-stands test scores with symptoms of depression and anxiety. In addition, we examined whether individuals exhibiting greater strength levels demonstrate reduced symptoms of anxiety and depression compared to those with lower levels of strength. This is a community-based, cross-sectional study. Participants were recruited through social media and underwent a semi-structured interview to record sociodemographic characteristics, comorbidities, use of tobacco and medication, and symptoms of anxiety (Beck's Anxiety Inventory [BAI]) and depression (Beck's Depressive Inventory [BDI]). Subsequently, anthropometric characteristics, handgrip strength, and functionality (i.e., timed-stands test) were assessed. In all, 216 individuals were evaluated. The adjusted regression model showed an inverse association between handgrip strength and anxiety (β = -0.22; 95% CI [-0.38, -0.07]; R2 = 0.07, p = .005) and depression symptoms (β = -0.25; 95% CI [-0.42, -0.07]; R2 = 0.05, p = .006). Similarly, timed-stands test scores were associated with anxiety (β = -0.33; 95% CI [-0.54, -0.13]; R2 = 0.09, p = .002) and depression (β = -0.32; 95% CI [-0.56, -0.09]; R2 = 0.06, p = .008). Furthermore, the low-strength group showed higher values on the BAI (9.5 vs. 5.9 arbitrary units; p = .0008) and BDI than the high-strength group (10.8 vs. 7.9 arbitrary units; p = .0214). When individuals were stratified by the timed-stands test, the low timed-stands group demonstrated higher values on the BAI (9.9 vs. 5.5 arbitrary units; p = .0030) and BDI than the high timed-stands group (11.2 vs. 7.5 arbitrary units; p < .0001). The results highlight muscular parameters as significant predictors associated with anxiety and depression symptoms.

Does Hand Grip Strength (HGS) Predict Functional Independence Differently in Patients Post Hip Replacement Due to Osteoarthritis versus Patients Status Post Hip Replacement Due to a Fracture?

Purpose

The aim of the study was to determine whether hand grip strength (HGS) predicts functional independence in older patients who have undergone hip replacement due to osteoarthritis versus older patients who have undergone hip replacement surgery due to fracture.

Patients and Methods

The study included 239 patients aged 65 and over in the first weeks after total hip replacement during rehabilitation treatment. Multivariate linear regression was used to determine HGS as a predictor of activities of daily living (ADL) and instrumental activities of daily living (IADL) in both groups: patients post hip replacement due to osteoarthritis and patients post hip replacement due to a fracture.

Results

Analysis showed that pre-rehab HGS in the osteoarthritis group predicts improved activities of daily living after rehabilitation (ADL, OR = 1.098; CI 95% 1.052-1.147 and IADL, OR = 1.182; CI 95% 1.103-1.267) and 6 months after (ADL, OR = 1.191; CI 95% 1.066-1.329 and IADL, OR = 1.096; CI 95% 1.012-1.186). In the fracture group, HGS predicts the ADL (OR = 1.081; CI 95% 1.015-1.152) after rehabilitation, and IADL after rehabilitation (OR = 1.122; CI 95% 1.046-1.205) and 6 months after (OR = 1.090; 95% CI 1.021-1.64).

Conclusion

HGS in patients after hip replacement surgery predicts functional independence in basic and complex activities of daily living. This can allow the identification of osteoarthritis patients with low hand grip - who can be considered as patients with a higher risk of an unsatisfying outcome of surgery. These patients should undergo pre-rehabilitation and should be monitored, and/or supported in terms of rehabilitation after discharge.

Prevalence of Malnutrition in Hospitalized Patients in Lebanon Using Nutrition Risk Screening (NRS-2002) and Global Leadership Initiative on Malnutrition (GLIM) Criteria and Its Association with Length of Stay

(1) Background: Prevalence studies on hospital malnutrition are still scarce in the Middle East region despite recent global recognition of clinical malnutrition as a healthcare priority. The aim of this study is to measure the prevalence of malnutrition in adult hospitalized patients in Lebanon using the newly developed Global Leadership Initiative on Malnutrition tool (GLIM), and explore the association between malnutrition and the length of hospital stay (LOS) as a clinical outcome. (2) Methods: A representative cross-sectional sample of hospitalized patients was selected from a random sample of hospitals in the five districts in Lebanon. Malnutrition was screened and assessed using the Nutrition Risk Screening tool (NRS-2002) and GLIM criteria. Mid-upper arm muscle circumference (MUAC) and handgrip strength were used to measure and assess muscle mass. Length of stay was recorded upon discharge. (3) Results: A total of 343 adult patients were enrolled in this study. The prevalence of malnutrition risk according to NRS-2002 was 31.2%, and the prevalence of malnutrition according to the GLIM criteria was 35.6%. The most frequent malnutrition-associated criteria were weight loss and low food intake. Malnourished patients had a significantly longer LOS compared to patients with adequate nutritional status (11 days versus 4 days). Handgrip strength and MUAC measurements were negatively correlated with the length of hospital stay. (4) Conclusion and recommendations: the study documented the valid and practical use of GLIM for assessing the prevalence and magnitude of malnutrition in hospitalized patients in Lebanon, and highlighted the need for evidence-based interventions to address the underlying causes of malnutrition in Lebanese hospitals.

Physical performance tests and in-hospital outcomes in elective open chest heart surgery

Background

Physical performance tests are essential for a comprehensive health assessment, and have been described as predictors of disability and muscle mass decline after open chest heart surgery (OHS). We evaluated the association between physical performance tests with clinical outcomes after OHS in younger and older patients. Moreover, the ability of physical performance tests and European System for Cardiac Operative Risk Evaluation (Euroscore II) to predict death was assessed.

Methods

Elective OHS patients were evaluated before surgery with handgrip strength (HGS), 30-s Chair-Stand Test (30sCST), and timed up and go test (TUGT). The outcomes were post-surgical complications, total length of stay (LOS), time to walk (TW), time in invasive mechanical ventilation (TIMV), and in-hospital mortality. Data were stratified between patients < 60 (younger) and ≥ 60 years old (older).

Results

A total of 166 patients were included in the study (older, n = 89). The only physical test associated with mortality in the adjusted models was HGS in older patients (p = 0.03). Among older patients, both Euroscore II (AUC = 0.77) and HGS (AUC = 0.80) demonstrated good ability to predict death. Combining HGS and Euroscore II did not increase accuracy for mortality prediction (AUC = 0.83).

Conclusion

HGS performance was comparable to a well-established surgical risk score in evaluating in-hospital mortality after OHS, only in older patients. Functional testing before OHS could be a tool to improve risk stratification in these patients. Future intervention studies aiming to improve functional capacity before elective OHS can further clarify the impact of physical fitness in surgical recovery.

Association between Barthel Index, Grip Strength, and Physical Activity Level at Admission and Prognosis in Community-Acquired Pneumonia: A Prospective Cohort Study

Background: Impaired functional status is a risk factor for hospitalization in patients with community-acquired pneumonia (CAP). The aim was to determine the influence of functional status and physical activity level on severe outcomes, including length of stay, admission to the intensive care unit (ICU), readmission, and mortality in patients with CAP. Methods: A prospective cohort study among patients hospitalized with CAP. Functional status was assessed with the Barthel index and grip strength, and physical activity level was assessed using the international physical activity questionnaire. Linear regression was used to assess the association with length of stay, and logistic regression was used to assess the risk of severe outcomes. Results: Among 355 patients admitted with CAP, 18% had a low Barthel index (<80), 45% had a low grip strength, and 75% had a low physical activity level. Low Barthel index was associated with increased risk of ICU admission (OR 3.6, 95% CI 1.2−10.9), longer length of stay (27.9%, 95% CI 2.3−59.7%), readmission within 30, 90, and 180 days (OR 2.1−2.4, p < 0.05), and mortality within 90 and 180 days (OR 4.2−5.0, p < 0.05). Low grip strength was associated with increased risk of 90 days readmission (OR 1.6, 95% CI 1.0−2.6, p < 0.05) and mortality within 30, 90, and 180 days (OR 2.6−3.2, p < 0.05). Low physical activity level was associated with increased risk of readmission within 90 and 180 days (OR 1.8−2.1, p < 0.05) and mortality within 30, 90, and 180 days (OR 3.3−5.5, p < 0.05). Conclusions: Impaired functional status and low physical activity level were associated with a longer length of stay and increased risk of ICU admission, readmission, and mortality in patients hospitalized with CAP. Routine assessment of functional status and physical activity level in clinical care could enable early identification of individuals with excess risk for a poor prognosis. Trial registration: ClinicalTrials.gov, NCT03795662.

Handgrip strength predicts length of hospital stay in an abdominal surgical setting: the role of frailty beyond age

BACKGROUND

Chronological age per se cannot be considered a prognostic risk factor for outcomes after elective surgery, whereas frailty could be. A simple and easy-to-get marker for frailty, such as handgrip strength (HGS), may support the surgeon in decision for an adequate healthcare plan.

AIMS

The aims of this study were to: (1) determine the prevalence of frailty in an abdominal surgery setting independent of age; (2) evaluate the predictive validity of HGS for the length of hospital stay (LOS).

METHODS

This is a retrospective study conducted in subjects who underwent abdominal surgical procedures. Only subjects with complete cognitive, functional, nutritional assessments and available measurement of HGS at admission were included. A final cohort of 108 patients were enrolled in the study.

RESULTS

Subjects had a mean age of 67.8 ± 15.8 years (age range 19-93 years old) and were mostly men. According to Fried's criteria, 17 (15.7%, 4F/13 M) were fit, 58 (23.7%; 24F/34 M) were pre-frail and 33 (30.6%; 20F/13 M) were frail. As expected, HGS significantly differed between groups having frail lower values as compared with pre-frail and fit persons (fit: 32.99 ± 10.34 kg; pre-frail: 27.49 ± 10.35 kg; frail: 15.96 ± 9.52 kg, p < 0.0001). A final regression analysis showed that HGS was significantly and inversely associated with LOS (p = 0.020) independent of multiple covariates, including age.

DISCUSSION

Most of the population undergoing abdominal surgery is pre-frail or frail. The measurement of handgrip strength is simple and inexpensive, and provides prognostic information for surgical outcomes. Muscle strength, as measured by handgrip dynamometry, is a strong predictor of LOS in a surgical setting.

Handgrip strength predicts length of hospital stay in an abdominal surgical setting: the role of frailty beyond age

BACKGROUND

Chronological age per se cannot be considered a prognostic risk factor for outcomes after elective surgery, whereas frailty could be. A simple and easy-to-get marker for frailty, such as handgrip strength (HGS), may support the surgeon in decision for an adequate healthcare plan.

AIMS

The aims of this study were to: (1) determine the prevalence of frailty in an abdominal surgery setting independent of age; (2) evaluate the predictive validity of HGS for the length of hospital stay (LOS).

METHODS

This is a retrospective study conducted in subjects who underwent abdominal surgical procedures. Only subjects with complete cognitive, functional, nutritional assessments and available measurement of HGS at admission were included. A final cohort of 108 patients were enrolled in the study.

RESULTS

Subjects had a mean age of 67.8 ± 15.8 years (age range 19-93 years old) and were mostly men. According to Fried's criteria, 17 (15.7%, 4F/13 M) were fit, 58 (23.7%; 24F/34 M) were pre-frail and 33 (30.6%; 20F/13 M) were frail. As expected, HGS significantly differed between groups having frail lower values as compared with pre-frail and fit persons (fit: 32.99 ± 10.34 kg; pre-frail: 27.49 ± 10.35 kg; frail: 15.96 ± 9.52 kg, p < 0.0001). A final regression analysis showed that HGS was significantly and inversely associated with LOS (p = 0.020) independent of multiple covariates, including age.

DISCUSSION

Most of the population undergoing abdominal surgery is pre-frail or frail. The measurement of handgrip strength is simple and inexpensive, and provides prognostic information for surgical outcomes. Muscle strength, as measured by handgrip dynamometry, is a strong predictor of LOS in a surgical setting.

Acute changes in handgrip strength, lung function and health-related quality of life following cardiac surgery

Background

Handgrip strength (HGS), lung function and health-related quality of life (HRQoL) are relevant indicators of future cardiovascular risk and mortality. The impact of cardiac surgery on these predictive variables has been under-explored. The aim of this study was to determine the acute (within hospital) changes in HGS, lung function and HRQoL, and their relationships, in adults undergoing elective cardiac surgery. Further, the study examined the relationship between these variables and the predictors for lung function and HRQoL in these patients.

Methods

The study was a prospective cohort study that involved 101 patients who completed pre-operative (1–2 days before surgery) and physiotherapy discharge (5–7 days after surgery) assessments. Handgrip strength, lung function and HRQoL were assessed using JAMAR dynamometers, Vitalograph-Alpha or EasyOne spirometer, and Short-Form 36 questionnaire, respectively. Changes in these variables and their relationships were analysed using paired t-test and Pearson correlation coefficients, respectively. Prediction of lung function and HRQoL using HGS and other co-variates was conducted using regression analysis.

Results

At the time of physiotherapy discharge, lung function, HGS and the physical component of HRQoL were significantly (<0.001) reduced compared to their pre-operative values. Significant (<0.001) and moderate correlations were identified between HGS and lung function at pre-operation and physiotherapy discharge. Handgrip strength was a significant predictor of lung function pre-operatively but not at physiotherapy discharge. Pre-operative lung function and HRQoL, as well as other variables, were significant predictors of lung function and HRQoL during physiotherapy discharge.

Conclusions

Undergoing cardiac surgery acutely and significantly reduced lung function, HGS and physical component of HRQoL in adults with cardiac disease. Assessment of HGS at physiotherapy discharge may be a poor indicator of operative changes in lung function and HRQoL. Clinicians may consider HGS as an inadequate tool in predicting lung function and HRQoL following cardiac surgery.

Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID-19: a prospective observational study

BACKGROUND

Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID-19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID-19 patients.

METHODS

We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS-CoV-2 during hospitalization and were excluded from the analyses.

RESULTS

The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (±15) years, body mass index of 29.5 (±6.9) kg/m² . The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07-2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex-specific mean and standard deviation (1.23 [95% CI: 1.06-1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ± 6.1 days) versus others (9.2 ± 8.4 days). Evidence of associations were also present for vastus lateralis cross-sectional area. The crude HR identified shorter hospital stay for patients with greater sex-specific standardized values (1.20 [95% CI: 1.03-1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross-sectional area (0.63 [95% CI: 0.46-0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross-sectional area was longer (10.8 ± 8.8 days) versus others (7.7 ± 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross-sectional area remained consistent and statistically significant after adjusting for other covariates.

CONCLUSIONS

Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID-19, which stresses the value of muscle health in prognosis of this disease.

Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy

Study Design

Retrospective case series.

Purpose

This study aimed to examine the efficacy of composite grip strength as a marker of surgical outcome in patients with moderate to severe degenerative cervical myelopathy.

Overview of Literature

Degenerative cervical myelopathy causes loss of dexterity, muscle strength, and sensations in the hand. The impact of surgical management on improvement in composite grip strength has received scant attention.

Methods

This retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre- and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score.

Results

A total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores.

Conclusions

Composite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.

Prediction and discrimination of skeletal muscle function by bioelectrical impedance vector analysis using a standing impedance analyzer in healthy Taiwanese adults

Background

Bioelectrical impedance vector analysis (BIVA) has been used for prediction of muscle performance. However, little is known about BIVA in Asian adults, and even less is known about using standing BIVA devices. Standing impedance analyzer allows quicker and more convenient way to gather data than conventional supine analyzer and is more suitable for clinical practice. This study aimed to investigate the relations between muscle function and BIVA parameters measured with a standing impedance analyzer in healthy Taiwanese adults.

Methods

A total of 406 healthy subjects (age 34.5 ± 17.3 years, body mass index 24.1 ± 4.1 kg/m²) were recruited for BIVA and handgrip strength (HGS) measurements. Impedance parameters, including resistance (R) and reactance (Xc), were measured and normalized to body size by dividing by height (H). The resulting phase angle (PhA) was calculated. HGS in the dominant, left, and right hands were referred to as HGS_DH, HGS_LH, and HGS_RH, respectively. All subjects were divided into 5 grades according to HGS.

Results

Muscle strength in the dominant, right, and left arms was correlated with variables in the order of sex, weight, age, height, Xc/H, and R/H (all, p < 0.001). Using all 6 variables, the determination coefficients were 0.792, 0.782, and 0.745, respectively, whereas the standard errors of estimates were 56.89, 58.01, and 56.67 N for HGS_DH, HGS_LH, and HGS_RH, respectively. HGS was positively correlated with PhA, and negatively correlated with Xc/H and R/H.

Conclusions

BIVA parameters measured with a standing impedance analyzer and anthropometric variables can predict and discriminate muscle function with good performance in healthy Asian adults.

Association of handgrip strength with patient-reported outcome measures after total hip and knee arthroplasty

About 33% patients with osteoarthritis undergoing total hip/knee arthroplasty are not satisfied with the outcome, warranting the need to improve patient selection. Handgrip strength (HGS) has been suggested as a proxy for overall muscle strength and may be associated with post-arthroplasty function. This study aims to assess the association of pre-operative HGS with change in hip/knee function and quality of life in patients with arthroplasty. 226 hip (THA) and 246 knee (TKA) arthroplasty patients were included in this prospective cohort study. Pre-operative HGS was assessed by means of a dynamometer and the HOOS/KOOS and SF-36 questionnaires were collected before arthroplasty and 1 year thereafter. The association of HGS with score change on each sub-domain of the included questionnaires was assessed by linear regression models, adjusting for sex, body mass index and baseline score. Mean pre-operative HGS was 26 kg for patients undergoing THA and 24 kg for those undergoing TKA. HGS was positively associated with an increased improvement score on “function in sport and recreation”-domain in hip (β = 0.68, P = 0.005) and knee (β = 0.52, P = 0.049) and “symptoms”-domain in hip (β = 0.56, P = 0.001). For patients with THA, HGS was associated with the “quality of life” domain (β = 0.33, P = 0.033). In patients with TKA, HGS was associated with the physical component score (β = 0.31, P = 0.001). All statistically significant effects were positive, indicating that with greater pre-operative HGS, an increased gain in 1-year post-surgery score was observed. HGS can be used as a tool to inform patients with OA who are future candidates for a prosthesis about the possible improvements of certain aspects of life after arthroplasty.

Nutritional status and gait speed in a nationwide population-based sample of older adults

The association between nutritional status and gait speed remains unclear. This study described gait speed in older adults and quantified the association between overweight, obesity, undernutrition risk and gait speed. Gait speed as potential indicator of nutritional outcomes was also explored. A cross-sectional analysis was conducted in a population-based sample of 1,500 older adults ≥65 years old. Compared to “normal body mass index” women, odds ratio for a slow gait speed was approximately 2-fold higher in“overweight”, 4-fold higher in “obese” and 6-fold higher in women at “undernutrition risk”. “Undernutrition risk” category resulted from joining “undernutrition risk/undernutrition”. For men, these associations were in the same direction, but the odds ratio estimates halved. In women, identified gait speed cut-offs were 0.87 m/s for “obesity” and 0.79 m/s for “undernutrition risk”. In men, 0.94 m/s is the cut-off in which most older adults were correctly classified relative to “undernutrition risk”. About half of Portuguese older adults presented a gait speed ≤0.8 m/s. Overweight, obesity and undernutrition risk were directly and increasingly associated with slow gait speed, but approximately twice as high in women compared to men. Gait speed revealed potential utility in marking nutritional problems, but further investigation is recommended.

Comparison of Jamar and Bodygrip Dynamometers for Handgrip Strength Measurement

Guerra, RS, Amaral, TF, Sousa, AS, Fonseca, I, Pichel, F, and Restivo, MT. Comparison of Jamar and Bodygrip dynamometers for handgrip strength measurement. J Strength Cond Res 31(7): 1931-1940, 2017-Studies that compared the agreement between Jamar and other models of dynamometers for handgrip strength (HGS) measurement have exhibited variability in the provided results. The lack of comparability between dynamometers led to the development of the Bodygrip dynamometer. This study aims to examine the reliability of the Bodygrip for HGS measurement, to compare it with the Jamar, and to explore the HGS differences between instruments considering the ergonomic effect of using the Bodygrip with 2 different handles. A cross-sectional study was conducted in free-living (n = 114, 18-89 years) and inpatient (n = 50, 65-93 years) volunteers. Nondominant HGS was tested randomly with the Jamar and Bodygrip, the latter using 2 different handles-curved and straight types. Handgrip strength was obtained for each participant under the same conditions. Each individual performed 2 HGS measurements with each dynamometer, and the maximum HGS value was considered for dynamometers comparison. Differences in the maximum HGS value between the 2 devices (Jamar-Bodygrip), intraclass correlation coefficients (ICCs), Bland and Altman plots, and limits of agreement were obtained. Correlation between the highest HGS measurement obtained for the nondominant hand with the Jamar and with the Bodygrip using each handle was excellent (ICCs: 0.93-0.95). Mean differences of -0.5 (limits of agreement: -4.6; 3.5) kgf with the curved handle and of 1.0 (-7.7; 9.7) kgf with the straight handle for the free-living participants were obtained, whereas for inpatients these values were -1.0 (-3.8; 1.9) kgf and 2.1 (-3.3; 7.5) kgf, respectively, for the curved and straight handles. The Bodygrip is comparable to the Jamar in free-living adults and in hospitalized older adults, exhibiting excellent interinstrument reliability. The Bodygrip with the curved handle produces results closer to the Jamar when compared with Bodygrip with the straight handle, which emphasizes the importance of grip handle ergonomics to measurement reliability.

Handgrip Strength in Chronic Obstructive Pulmonary Disease. Associations with Acute Exacerbations and Body Composition

RATIONALE

Handgrip strength (HGS) predicts mortality in the elderly, but its determinants and clinical significance in chronic obstructive pulmonary disease (COPD) has not been defined.

OBJECTIVES

We tested associations of HGS with pectoralis muscle area (PMA), subcutaneous adipose tissue (SAT), imaging characteristics, and lung function in smokers with COPD, and evaluated the cross-sectional and longitudinal associations of HGS with acute respiratory events.

METHODS

We analyzed demographic, clinical, spirometry, HGS, and imaging data of 272 subjects with COPD, obtaining measures of airway thickness, emphysema, PMA, and SAT from chest computed tomography scans. We tested associations of lung function and imaging characteristics with HGS, using linear models. HGS association to acute respiratory events at enrollment and during follow-up (mean, 2.6 years) was analyzed using adjusted logistic models.

RESULTS

HGS correlated with PMA, SAT, forced expiratory volume, and airway thickness, but not with body mass index or emphysema severity. In adjusted regression models, HGS was directly (β, 1.5; 95% confidence interval [CI], 0.1-3.0) and inversely (β, -3.3; 95% CI, -5.1 to -0.9) associated with one standard deviation of PMA and SAT, respectively, independent of body mass index and emphysema. In regression models adjusted for age, sex, body mass index, race, pack-years smoked, current smoking, chronic bronchitis, FEV1% predicted, emphysema, and airway metrics, HGS was associated with exacerbation risk; in cross-sectional analyses, there was an increment of 5% in the risk of exacerbations for each 1-kg decrement in HGS (risk ratio, 1.05; 95% CI, 1.01-1.08), and there was a similar risk during follow-up (risk ratio, 1.04; 95% CI, 1.01-1,07).

CONCLUSIONS

In ever-smokers with COPD, HGS is associated with computed tomography markers of body composition and airway thickness, independent of body mass index and emphysema. Higher HGS is associated with lower exacerbation frequency.

Handgrip strength values of Portuguese older adults: a population based study

Background

Handgrip strength is used to identify sarcopenia and frailty phenotypes, being a potential predictor of mortality in older adults. However, uniformity is lacking in the reference values. This study aimed to describe handgrip strength values of older population aged ≥65 years in Portugal, considering the possible influence of anthropometric parameters.

Methods

A cross-sectional study was conducted in Portugal, among 1500 older adults aged ≥65 years old, according to “The Nutrition UP 65 Study Protocol”. Demographic data were collected and cognitive performance, subjective general health, physical activity, anthropometric parameters and nutritional status were assessed and analysed. Handgrip strength data was obtained with a Jamar dynamometer. A Pubmed/Medline search was carried out to compare handgrip strength data between Portuguese older adults and other older populations.

Results

Handgrip strength was higher among men than among women (30.3 ± 9.2 Kgf vs 18 ± 5.4 Kgf, p < 0.001, respectively). In general, handgrip strength values of Portuguese older adults were lower than other older populations. In our sample, age, cognitive and nutritional status, self-reported sitting time and practice of physical activity were significantly correlated with handgrip strength in both sexes. Concerning anthropometric parameters, height was the most significantly correlated with handgrip strength (r = 0.34, p < 0.001, in women and r = 0.40, p < 0.001, in men).

Conclusion

This study described, for the first time, handgrip strength values of Portuguese population aged ≥65 years, according to age and to sex-specific tertiles of height. The definition of handgrip strength reference values in this age group merits further reflection.

Handgrip Strength and Malnutrition (Undernutrition) in Hospitalized Versus Nonhospitalized Children Aged 6-14 Years

BACKGROUND

Diagnosing undernutrition in hospitalized pediatric populations is crucial to provide timely nutrition interventions. Handgrip strength (HGS), a measurement of muscle function, is a reliable indicator of undernutrition. However, limited research exists on HGS in hospitalized pediatric patients. The primary aim of this study was to determine if HGS differed between hospitalized children within 48 hours of admission and nonhospitalized children. A secondary purpose was to describe the association of HGS with height, weight, body mass index (BMI), mid upper arm circumference (MUAC), activity level, disease severity, nutrition risk, and nutrition intervention.

METHODS

One hundred nine hospitalized and 110 nonhospitalized patients aged 6-14 years participated in this cross-sectional nonequivalent control group design study. Weight, height, MUAC, and HGS were measured within 48 hours of hospital admission for the hospitalized group or immediately following a well-child visit for the control group.

RESULTS

Based on analysis of covariance, the HGS was estimated to be 12.4 ± 0.37 kgF (mean ± SE) for hospitalized subjects and 13.1 ± 0.37 for nonhospitalized subjects ( P = .2053). HGS was associated with age ( P < .0001), height ( P < .0001), dominant hand ( P < .0001), and MUAC z scores ( P = .0462).

CONCLUSION

HGS was not significantly different between hospitalized and nonhospitalized participants, although anthropometric measurements were similar between groups. A strong relationship was demonstrated between HGS and BMI and MUAC z scores. Further research is needed that examines serial HGS measurements, feasibility in hospitalized patients, and the association of HGS measurements and nutrition risk.

Nutritional status and weakness following pediatric hematopoietic cell transplantation

Survivorship after pediatric HCT has increased over the past decade. Focus on long-term care and well-being remains critical due to risk of poor dietary habits and exaggerated sedentary behavior, which can lead to muscle weakness, increased risk for obesity, and cardiometabolic disorders. Nutrition and physical activity are key factors in survivorship; however, data are limited. Comprehensive nutritional assessments, including nutrition-focused physical examination, grip strength, and food/activity surveys, were completed in 36 pediatric HCT survivors (aged 2-25 years). Patients were divided into undernutrition, normal-nutrition, and overnutrition categories. Fifty percent of participants were classified as normal nutrition, 22% undernutrition, and 28% overnutrition. Few patients met the U.S. Dietary Guidelines recommended intake for vegetables, fiber, saturated fat, and So FAS. Patients in the undernutrition group demonstrated significantly lower grip strength than those in the normal- and overnutrition groups. When grip strength was normalized to body mass, patients in the overnutrition group had the highest prevalence of weakness. Using NHANES reference data, maximum grip strength and NGS cutoffs were identified that could significantly distinguish the nutrition groups. Comprehensive nutritional assessments and grip strength measurements are feasible, non-invasive, easy to perform, and inform both under- and overnutrition in pediatric HCT survivors.

Grip strength among community-dwelling older people predicts hospital admission during the following decade

BACKGROUND

Lower grip strength on admission to hospital is known to be associated with longer stay, but the link between customary grip and risk of future admission is less clear.

OBJECTIVE

To compare grip strength with subsequent risk of hospital admission among community-dwelling older people in a U.K. setting.

DESIGN

Cohort study with linked administrative data.

SETTING

Hertfordshire, U.K.

SUBJECTS

A total of 2,997 community-dwelling men and women aged 59-73 years at baseline.

METHODS

The Hertfordshire Cohort Study (HCS) participants completed a baseline assessment between 1998 and 2004, during which grip strength was measured. Hospital Episode Statistics and mortality data to March 2010 were linked with the HCS database. Statistical models were used to investigate the association of grip strength with subsequent elective, emergency and long-stay hospitalisation and readmission.

RESULTS

There was a statistically significant negative association between grip strength and all classes of admission in women [unadjusted hazard ratio per standard deviation (SD) decrease in grip strength for: any admission/death 1.10 (95% CI: 1.06, 1.14), elective admission/death 1.09 (95% CI: 1.05, 1.13), emergency admission/death 1.21 (95% CI: 1.13, 1.31), long-stay admission/death 1.22 (95% CI: 1.13, 1.32) and unadjusted relative risk per SD decrease in grip strength for 30-day readmission/death 1.30 (95% CI: 1.19, 1.43)]. These associations remained significant after adjustment for potential confounding factors (age, height, weight for height, smoking, alcohol, social class). In men, unadjusted rates for emergency admission/death, long-stay admission/death and readmission/death were significantly associated with grip strength; associations that similarly withstood adjustment.

CONCLUSION

This study provides the first evidence that grip strength among community-dwelling men and women in the U.K. is associated with risk of hospital admission over the following decade.

Muscle strength: clinical and prognostic value of hand-grip dynamometry

PURPOSE OF REVIEW

Grip strength measured by dynamometry is well established as an indicator of muscle status, particularly among older adults. This review was undertaken to provide a synopsis of recent literature addressing the clinical and prognostic value of hand-grip dynamometry.

RECENT FINDINGS

Numerous large-scale normative grip strength projects have been published lately. Other recent studies have reinforced the concurrent relationship of grip strength with measures of nutritional status or muscle mass and measures of function and health status. Studies published in the past few years have confirmed the value of grip strength as a predictor of mortality, hospital length of stay, and physical functioning.

SUMMARY

As a whole, the recent literature supports the use of hand-grip dynamometry as a fundamental element of the physical examination of patients, particularly if they are older adults.

G×E Interaction Influences Trajectories of Hand Grip Strength

Age-related decline in grip strength predicts later life disability, frailty, lower well-being and cognitive change. While grip strength is heritable, genetic influence on change in grip strength has been relatively ignored, with non-shared environmental influence identified as the primary contributor in a single longitudinal study. The extent to which gene-environment interplay, particularly gene-environment interactions, contributes to grip trajectories has yet to be examined. We considered longitudinal grip strength measurements in seven twin studies of aging in the Interplay of Genes and Environment across Multiple Studies consortium. Growth curve parameters were estimated for same-sex pairs, aged 34-99 (N = 10,681). Fisher's test for mixture distribution of within-monozygotic twin-pair differences (N = 1724) was performed on growth curve parameters. We observed significant gene-environment interaction on grip strength trajectories. Finally, we compared the variability of within-pair differences of growth curve parameters by APOE haplotypes. Though not statistically significant, the results suggested that APOE ɛ2ɛ2/ɛ2ɛ3 haplotypes might buffer environmental influences on grip strength trajectories.

Muscular strength as a strong predictor of mortality: A narrative review

Muscular strength, an important component of physical fitness, has an independent role in the prevention of chronic diseases whereas muscular weakness is strongly related to functional limitations and physical disability. Our purpose was to investigate the role of muscular strength as a predictor of mortality in health and disease. We conducted a systematic search in EMBASE and MEDLINE (1980-2014) looking for the association between muscular strength and mortality risk (all-cause and cause-specific mortality). Selected publications included 23 papers (15 epidemiological and 8 clinical studies). Muscular strength was inversely and independently associated with all-cause mortality even after adjusting for several confounders including the levels of physical activity or even cardiorespiratory fitness. The same pattern was observed for cardiovascular mortality; however more research is needed due to the few available data. The existed studies failed to show that low muscular strength is predictive of cancer mortality. Furthermore, a strong and inverse association of muscular strength with all-cause mortality has also been confirmed in several clinical populations such as cardiovascular disease, peripheral artery disease, cancer, renal failure, chronic obstructive pulmonary disease, rheumatoid arthritis and patients with critical illness. However, future studies are needed to further establish the current evidence and to explore the exact independent mechanisms of muscular strength in relation to mortality. Muscular strength as a modifiable risk factor would be of great interest from a public health perspective.

Functional assessment of nutrition status

Functional status assessment has been recommended as a part of a complete nutrition assessment for decades, but the specific components of this assessment have eluded a consensus definition. The recent Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus criteria for identification of malnutrition include functional assessment determined by handgrip dynamometry, with the understanding that this technique is not practical for use in some patient populations. Other techniques for functional assessment include physical performance measures such as timed gait and chair stands, as well as activities of daily living tools such as the Katz Index, Lawton Scale, and Karnofsky Scale Index. Manual muscle testing and computed tomography scan assessment of lean tissue are other tools that show promise in correlating functional and nutrition assessments. Functional assessment parameters may be least well correlated with nutrition status in older individuals. Despite a number of scientific studies of a variety of tools for functional assessment, there is to date no definitive tool for use in all individuals in all settings. Nutrition scientists and clinicians must continue to collaborate with colleagues in physical and occupational therapy, geriatrics, and nursing to refine current functional assessment tools to more effectively correlate with nutrition and malnutrition assessment parameters.

Handgrip strength measurement as a predictor of hospitalization costs

BACKGROUND

Undernutrition status at hospital admission is related to increased hospital costs. Handgrip strength (HGS) is an indicator of undernutrition, but the ability of HGS to predict hospitalization costs has yet to be studied.

OBJECTIVE

To explore whether HGS measurement at hospital admission can predict patient's hospitalization costs.

SUBJECTS/METHODS

A prospective study was conducted in a university hospital. Inpatient's (n=637) HGS and undernutrition status by Patient-Generated Subjective Global Assessment were ascertained. Multivariable linear regression analysis, computing HGS quartiles by sex (reference: fourth quartile, highest), was conducted in order to identify the independent predictors of hospitalization costs. Costs were evaluated through percentage deviation from the mean cost, after adjustment for patients' characteristics, disease severity and undernutrition status.

RESULTS

Being in the first or second HGS quartiles at hospital admission increased patient's hospitalization costs, respectively, by 17.5% (95% confidence interval: 2.7-32.3) and 21.4% (7.5-35.3), which translated into an increase from €375 (58-692) to €458 (161-756). After the additional adjustment for undernutrition status, being in the first or second HGS quartiles had, respectively, an economic impact of 16.6% (1.9-31.2) and 20.0% (6.2-33.8), corresponding to an increase in hospitalization expenditure from €356 (41-668) to €428 (133-724).

CONCLUSIONS

Low HGS at hospital admission is associated with increased hospitalization costs of between 16.6 and 20.0% after controlling for possible confounders, including undernutrition status. HGS is an inexpensive, noninvasive and easy-to-use method that has clinical potential to predict hospitalization costs.

Handgrip strength and associated factors in hospitalized patients

BACKGROUND

Handgrip strength (HGS) is a marker of nutrition status. Many factors are associated with HGS. Age, height, body mass index, number of diagnoses, and number and type of drugs have been shown to modify the association between undernutrition and HGS. Nevertheless, other patient characteristics that could modify this association and its joint modifier effect have not been studied yet.

OBJECTIVE

To evaluate the association of inpatients' HGS and undernutrition considering the potential modifier effect of cognitive status, functional activity, disease severity, anthropometrics, and other patient characteristics on HGS.

METHODS

A cross-sectional study was conducted in a university hospital. Sex, age, abbreviated mental test score, functional activity score, Charlson index, number of drugs, Patient-Generated Subjective Global Assessment (PG-SGA) score, body weight, mid-arm muscle circumference, adductor pollicis muscle thickness, body height, wrist circumference, hand length, and palm width were included in a linear regression model to identify independent factors associated with HGS (dependent variable).

RESULTS

The study sample was composed of 688 inpatients (18-91 years old). All variables included in the model were associated with HGS (β, -0.16 to 0.38; P ≤ .049) and explained 68.5% of HGS. Age, functional activity decline, Charlson index, number of drugs, PG-SGA score, body weight, and wrist circumference had a negative association with HGS. All other studied variables were positively associated with HGS.

CONCLUSION

Nutrition status evaluated by PG-SGA was still associated with HGS after considering the joint effect of other patient characteristics, which reinforces the value of HGS as an indicator of undernutrition.