Handgrip strength as a surrogate marker of lean mass and risk of malnutrition in paediatric patients

Abstract

Background & aims: The use of handgrip strength (HGS) as a proxy of nutritional status in sick children has not been studied. This study created HGS centile charts in healthy children and explored the utility of HGS z-scores as markers of body composition and screening of malnutrition risk in sick children. Methods: Data from 535 healthy children aged 5e16 years were used for the development of HGS centiles adjusted either for age or height. In 595 sick children, relationships between HGS z-scores with body composition, malnutrition risk (Paediatric Yorkhill Malnutrition Score-PYMS), length of hospital stay (LOS) and biomarkers of disease severity were explored. The use of HGS z-score to identify sick children in need of further dietetic assessment was investigated. Results: Children scoring at high malnutrition risk with PYMS had lower HGS z-scores for age (by 0.51 SD, p < 0.001) and height (by 0.46 SD, p ¼ 0.001) than those who scored low. A HGS z-score at cut-offs of À0.81 SD and À1.2 SD for age and height, respectively, was predictive of need for dietetic intervention in sick children with sensitivity of 79% and 70% and specificity of 56% and 69%, respectively. HGS z-scores were predictive of fat free mass (FFM) in sick and healthy (all p < 0.001) children, while fat mass was not. HGS z-scores were inversely related with plasma CRP (rho, age: À0.21; height: À0.23, both p ¼ 0.001). HGS was not predictive of LOS. Conclusion: HGS is predictive of FFM, could compliment assessment of malnutrition risk, and may help identify children for further dietetic intervention on admission to hospital.

Impact of critical illness and withholding of early parenteral nutrition in the pediatric intensive care unit on long-term physical performance of children: a 4-year follow-up of the PEPaNIC randomized controlled trial

“…Importantly, physical outcome measures were never worse for patients who had been exposed to an early macronutrient deficit in the PICU under the late-PN strategy, as compared with early full feeding of patients under the early-PN strategy. This is reassuring in view of the documented association between malnutrition in children and poorer physical function, such as lower handgrip strength [ 21 – 23 ], and further endorses de-implementation of the use of early-PN in the PICU. The present study also showed that, unfortunately, late-PN also did not improve any measure of physical function, unlike previously demonstrated beneficial effects on several measures of neurocognitive functioning and emotional and behavioral problems [ 10 , 11 ].…”

“…This study had first shown that, as compared with initiating parenteral nutrition (PN) within 24 h after admission to supplement insufficient enteral nutrition (early-PN), withholding of supplemental PN in the first week in the PICU (late-PN) improved short-term PICU outcomes [ 17 ]. However, as underfeeding has been related to worse cognitive performance, behavioral problems, and impaired physical development of otherwise healthy children [ 18 – 23 ], there were concerns about potential adverse long-term consequences of the low caloric and macronutrient intake with late-PN for health and physical and neurocognitive development. Therefore, patients were invited for an extensive investigation of these outcomes 2 and 4 years after PICU admission, in comparison with healthy children.…”

Malnutrition Patterns in Children with Chronic Kidney Disease

“…Moreover, we currently do not know whether dynapenia concurs with muscle mass loss in children with CKD. Muscle strength was significantly correlated to muscle mass in a recent pediatric study [ 60 ], while muscle force relative to muscle size was reduced in a study evaluating muscle torque to calf muscle cross-sectional area [ 61 ].…”

Measurement Tools of Pediatric Nutrition and Health Suitable or Adaptable for Low- and Middle-Income Countries in Field Research Settings

“…Handgrip strength (HGS) is an economical and field-friendly tool that provides an indirect measure of FFM, muscular strength, and malnutrition status of an individual [52,53]. HGS measures are obtained by using a dynamometer, where the individual fully exerts their strength by squeezing the dynamometer with their dominant hand to measure grip pressure [53].…”