Evaluating Changes in Handgrip Strength in Children With Cystic Fibrosis: A Pilot Study

Gibson, Hannah Taylor; McDonald, Catherine M.; Derrick, Jennifer Willahan; Eggett, Dennis L.; Bellini, Sarah Gunnell

doi:10.1002/ncp.10067

Cited by 10 publications

(23 citation statements)

References 33 publications

(113 reference statements)

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“…As mentioned earlier, DEXA scans provide information on body composition, which has important implications on BMD. LBM was found to be more strongly associated with pulmonary functions than BMI 29 . HGS is reflective of LBM.…”

Section: Discussionmentioning

confidence: 82%

Understanding the interplay between factors that influence bone mineral density in CF

Gur

Bar‐Yoseph

Diab

et al. 2020

Pediatric Pulmonology

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Background and Objectives Multiple factors affect bone mineral density (BMD) in cystic fibrosis (CF). Our aim was to perform comprehensive analyses of parameters potentially contributing to BMD. Methods A prospective single‐center study assessing BMD, and correlations with multiple parameters including pancreatic status, lung functions, 6‐minute walk test (6MWT), clinical score (modified Shwachman‐Kulczycki [SK] score), vitamin D, nutritional intake, hand grip strength (HGS), habitual physical activity (smart watches), and quality of life (SF‐36 questionnaire). Results Forty CF patients, mean age 18.3 ± 8.1 years, forced expiratory volume in 1 second 74.7% ± 17.9% predicted. Fifteen (37.5%) and 11 (27.5%) had osteopenia and osteoporosis, respectively. BMD was similar in pancreatic sufficient (pancreatic sufficient [PS], n = 15) and insufficient (pancreatic insufficient [PI], n = 25); median hip z score −1.5 ((−2.7)−(+0.2)) vs −1.5 ((−3.5)−(+0.7)), P = .79; spine −0.8 ((−2.2)−(+2)) vs −1.2 ((−4.4)−(+1.5)), P = .39 in PS vs PI, respectively. BMD correlated with HGS (r = .72, P < .001 hip; r = .52, P = .001 spine) and fat‐free mass index (r = .81, P < .001 hip; r = .63, P < .001 spine). BMD z score correlated weakly with SK score and moderately with SF‐36 general health. Data from smart watches, nutrition questionnaires, and 6MWT did not correlate with BMD. In a multivariate model, age and SK score predicted spine z score BMD. Conclusions A substantial number of CF patients have low BMD. Similar rates in PS and PI suggest that other factors, such as disease severity, may contribute to low BMD. SK and age, which can easily be obtained even with limited resources, were the best predictors of low BMD. Further larger multicenter studies are warranted to evaluate the contribution of multifactorial etiologies to low BMD in CF.

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Section: Discussionmentioning

confidence: 82%

Understanding the interplay between factors that influence bone mineral density in CF

Gur

Bar‐Yoseph

Diab

et al. 2020

Pediatric Pulmonology

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“…6,7 Findings such as these have led to a growing interest in measuring body composition in individuals with CF; however, the various measurement methods are often unreliable, too costly, or not feasible in the CF population. 8 Dual energy x-ray absorptiometry (DEXA), hydrostatic weighing, and air displacement plethysmography are reliable gold standards for measuring body composition, but they are costly and, particularly in the case of hydrostatic weighing, not clinically feasible. Using triceps skin fold and mid-arm circumference measurements to calculate arm muscle area has a wide margin of error, and measurements are often unreliable because of low interrater reliability.…”

Section: Introductionmentioning

confidence: 99%

“…Using triceps skin fold and mid-arm circumference measurements to calculate arm muscle area has a wide margin of error, and measurements are often unreliable because of low interrater reliability. 8 Bioelectrical impedance analysis (BIA), even when using the more expensive multifrequency BIA machines ($5000-$19,000 USD), also have reliability issues. A recent validation study of 110 recreationally active adults aged 18-25 years found that BIA measured a 4%-9% difference in percent body fat compared with DEXA, with BIA tending to underestimate percent body fat compared with DEXA.…”

Section: Introductionmentioning

confidence: 99%

“…13 When standard protocols are followed, clinicians can efficiently take GS measurements and be confident in the fidelity of repeated measurements by virtue of a well-established history of intratester and intertester reliability and validity, as studied in multiple disciplines and populations. 8,13 Although GS measurements have been used in children and adolescents without CF, [13][14][15] there is only 1 small pilot study that measured GS in 23 children and adolescents ((aged 6-18 years) with CF. 8 In this pilot study, GS measurements were taken 5 months before hospitalization, days 5-7 during a hospital admission for pulmonary exacerbation, and then again ∼6 weeks' posthospitalization.…”

Section: Introductionmentioning

confidence: 99%

“…8,13 Although GS measurements have been used in children and adolescents without CF, [13][14][15] there is only 1 small pilot study that measured GS in 23 children and adolescents ((aged 6-18 years) with CF. 8 In this pilot study, GS measurements were taken 5 months before hospitalization, days 5-7 during a hospital admission for pulmonary exacerbation, and then again ∼6 weeks' posthospitalization. The study found that GS z-scores significantly increased after hospitalization, but there was no association between GS z-scores and BMI z-scores or GS z-scores and forced expiratory volume in 1 second percent predicted (FEV1pp).…”

Section: Introductionmentioning

confidence: 99%

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The Association of Grip Strength, Body Mass Index, and Lung Function in Youth with Cystic Fibrosis

et al. 2020

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Compared with body mass index (BMI), lean body mass and fat-free mass are strongly associated with lung function in children and adolescents with cystic fibrosis (CF). Methods of measuring body composition in youth with CF are often unreliable, expensive, or not clinically feasible. Grip strength (GS), a measure of muscle function, is used as a surrogate for muscle mass and is an indicator of nutrition status. This quality improvement project explored the feasibility of measuring GS in medically stable youth with CF, aged 6-21 years. A total 361 GS measurements were performed by using a digital hand dynamometer in youth from a single CF center. Using reference tables that were created for this project by merging data from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys, youth with CF were found to be weaker than age-and gender-matched peers, even when controlled for differences in size. A positive association (P < .001) was found between GS percentile and lung function, as measured by forced expiratory volume in 1 second percent predicted (FEV1pp). Statistical analysis revealed that both BMI percentile and absolute GS (AGS) percentile were positively associated with FEV1pp and with each other, primarily at the lower levels of BMI percentile (<50%) and AGS percentile (<50%). GS may provide a reliable, less expensive, and clinically feasible alternative to body composition measurements in monitoring nutrition status in youth with CF, especially in youth whose BMI is in the <50th percentile.

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Utility of Mid‐Upper Arm Circumference in Diagnosing Malnutrition in Children With Cystic Fibrosis

et al. 2020

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Background: Standardized diagnostic indicators for malnutrition using growth percentile z-scores (weight for length or body mass index [BMI]) and mid-upper arm circumference (MUAC) z-scores are being used in clinical practice; however, their application to the pediatric cystic fibrosis (CF) population is not well described. In this study, we aim to compare growth percentile z-scores and MUAC z-scores in diagnosing and classifying malnutrition in children with CF and assess the relationship between their degree of malnourishment and corresponding pulmonary function tests (PFTs). Methods: In this retrospective observational outpatient study of 49 pediatric CF patients, data were collected on baseline characteristics, anthropometrics, and PFTs over 12 months. Agreement in malnutrition diagnoses was quantified by Cohen κ statistics. Pearson test assessed the correlation between MUAC and BMI z-scores as well as PFTs and anthropometrics. Serial anthropometrics and PFTs were obtained and compared for a subset of patients (n = 28). Results: Growth percentile and MUAC z-scores were positively correlated in diagnosing malnutrition (Pearson correlation r = 0.87), but MUAC z-scores identified more patients as malnourished compared with growth percentile z-scores (49% vs 12%, Cohen κ of 0.22 [95% CI, 0.04-0.40]). There was no significant relationship between anthropometrics and PFTs. MUAC z-scores increased significantly over time, but BMI z-scores did not show this trend. Conclusions: Our small-scale data suggest a promising role for MUAC z-scores in classifying malnutrition and in measuring changes in nutrition status over time in pediatric CF.

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Evaluating Changes in Handgrip Strength in Children With Cystic Fibrosis: A Pilot Study

Abstract: HGS z scores and FEV significantly increased at follow-up. HGS z scores were lower than the standard even though mean BMI z scores classified participants as normal nutrition status.

Cited by 10 publications

References 33 publications

Understanding the interplay between factors that influence bone mineral density in CF

Understanding the interplay between factors that influence bone mineral density in CF

The Association of Grip Strength, Body Mass Index, and Lung Function in Youth with Cystic Fibrosis

Utility of Mid‐Upper Arm Circumference in Diagnosing Malnutrition in Children With Cystic Fibrosis

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