Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit

Abstract

Objective To verify the relationship between the adductor pollicis muscle thickness test and the subjective global assessment and to correlate it with other anthropometric methods.Methods This observational cross-sectional study was conducted in the intensive care unit of a cardiology hospital in the state of Rio Grande do Sul, Brazil. The hospitalized patients underwent subjective global assessment and adductor pollicis muscle thickness tests on both hands, along with measurement of the right calf circumference. Laboratory parameters, length of stay, vital signs and electronic medical record data and tests were all collected.Results The study population included 83 patients, of whom 62% were men. The average age was 68.6 ± 12.5 years. The most common reason for hospitalization was acute myocardial infarction (34.9%), and the most common pathology was systolic blood pressure (63.9%), followed by diabetes mellitus (28.9%). According to subjective global assessment classifications, 62.7% of patients presented no nutritional risk, 20.5% were moderately malnourished and 16.9% were severely malnourished. Women had a higher nutritional risk, according to both the subjective global assessment and the adductor pollicis muscle thickness test, the cutoff for which was < 6.5mm (54.8%; p = 0.001). The pathology presenting the greatest nutritional risk was congestive heart failure (p = 0.001). Evaluation of the receiver operating characteristic (ROC) curve between adductor pollicis muscle thickness and subjective global assessment showed the accuracy of the former, with an area of 0.822.Conclusion Adductor pollicis muscle thickness proved to be a good method for evaluating nutritional risk.

Adductor Pollicis Muscle Thickness for nutritional assessment: a systematic review

“…The highest values of APMT were found in the studies of Cortez et al (20) , carried out with outpatients infected with HIV (APMT-DH = 16.2 ± 4.3 mm, APMT-NDH = 14.8 ± 4.3 mm), Ghorabi et al (23) , which included patients of the ICU (APMT-DH = 14.5 ± 3.6 mm, APMT-NDH = 13.4 ± 3.6 mm), and Bragagnolo et al (7) , with patients who were candidates for large surgery in the gastrointestinal tract (APMT-DH = 12.6 ± 3.2 mm, APMT-NDH = 12.2 ± 2.9 mm). The lowest values were from the studies by Karst et al (24) carried out with ICU patients at a cardiology hospital (APMT-DH = 8.0 ± 3.0 mm; APMT-NDH = 7.3 ± 2.7 mm), Neves et al (21) , who evaluated patients with HIV from a hospital emergency service (APMT-RH = 9.6 ± 4.7 mm, APMT-LH = 8.9 ± 3.5 mm), and Pereira et al (27) , with patients on hemodialysis (APMT = 10.0 ± 4.5 mm).…”

“…From the final sample, 13 studies were published between 2004 and 2016, with only two longitudinal (18)(19) and the other with a cross-sectional design (5,7,(20)(21)(22)(23)(24)(25)(26)(27)(28) . Regarding the samples, two studies were carried out with HIV-infected individuals (20)(21) , two with patients candidates for surgery (7,22) , two with patients admitted to the Intensive Care Unit (ICU) (23)(24) , two with patients in the hospital ward (25,28) , two with chronic kidney patients on hemodialysis (18,27) and three with healthy individuals (5,19,26) . The characteristics of the studies included in the review are presented in Chart 2.…”

“…Chart 1 -Quality criteria assessed for the confirmation of eligibility of the studies to be included in the review All of the studies have properly described the EMAP measurement methodology, as proposed by Lameu et al (5) , and used the simple arithmetic mean from three measurements. Most adopted the Lange ® (5,7,(18)(19)(20)(21)25,28) brand analog adipometer, three from Cescorf ® (22,24,27) and two from Vogel ® (23,26) .…”

Subjective Global Assessment Can Be Performed in Critically Ill Surgical Patients as a Predictor of Poor Clinical Outcomes

“…Sheean et al evaluated 27 hospitalized patients in an ICU and reported a prevalence of undernutrition of 50% . In another study conducted with 86 patients, 37.4% were classified as undernourished . Sungurtekin et al evaluated 124 patients and identified undernutrition in 37%, while Hejazi et al identified 28.8% undernutrition on ICU admission .…”

“…15 In another study conducted with 86 patients, 37.4% were classified as undernourished. 16 Sungurtekin et al evaluated 124 patients and identified undernutrition in 37%, 17 while Hejazi et al identified 28.8% undernutrition on ICU admission. 18 A prospective cross-sectional study performed with surgical patients in Vietnam demonstrated a high rate of undernutrition; 28.8% were classified as moderately undernourished, while 26.9% were classified as severely undernourished.…”