Value of handgrip strength to predict clinical outcomes and therapeutic response in malnourished medical inpatients: Secondary analysis of a randomized controlled trial.

Kaegi-Braun, Nina; Tribolet, Pascal; Baumgartner, Annic; Fehr, Rebecca; Baechli, Valerie; Geiser, Martina; Deiss, Manuela; Gomes, Filomena; Kutz, Alexander; Hoess, Claus; Pavlicek, Vojtech; Schmid, Sarah; Bilz, Stefan; Sigrist, Sarah; Brändle, Michael; Benz, Carmen; Henzen, Christoph; Thomann, Robert; Rutishauser, Jonas; Aujesky, Drahomir; ... (2021). Value of handgrip strength to predict clinical outcomes and therapeutic response in malnourished medical inpatients: Secondary analysis of a randomized controlled trial. (In Press). American journal of clinical nutrition American Society for Nutrition, Inc. 10.1093/ajcn/nqab042

[img] Text
KaegiBraun_AmJClinNutr_2021_AAM.pdf - Accepted Version
Restricted to registered users only until 8 April 2022.
Available under License Publisher holds Copyright.

Download (479kB) | Request a copy
[img] Text
KaegiBraun_AmJClinNutr_2021_epub.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (561kB) | Request a copy

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.This trial was registered at clinicaltrials.gov as NCT02517476.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Aujesky, Drahomir and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0002-9165

Publisher:

American Society for Nutrition, Inc.

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

16 Apr 2021 11:00

Last Modified:

22 Jun 2021 12:33

Publisher DOI:

10.1093/ajcn/nqab042

PubMed ID:

33829236

Uncontrolled Keywords:

functional decline handgrip strength malnutrition mortality nutritional support

BORIS DOI:

10.48350/155842

URI:

https://boris.unibe.ch/id/eprint/155842

Actions (login required)

Edit item Edit item
Provide Feedback