Handgrip Strength, but Not 5‐Meter Walk, Adds Value to a Clinical Nutrition Assessment

Abstract

Background: Decreased physical functioning is associated with malnutrition and common in acute care patients; determining loss of function is often considered part of a comprehensive nutrition assessment. Handgrip strength (HGS) and 5-meter timed walk (5m) are functional measures used in a variety of settings. This analysis sought to determine which functional measure could be added to a hospital nutrition assessment, based on its feasibility and capacity to discriminate patient subgroups. Methods: Eligible medical patients (no delirium/dementia, admitted from community; n = 1250), recruited from 5 hospitals that participated in a previous multisite action research study, provided data on demographics, HGS, 5m, nutrition status, perceived disability, and other characteristics. Results: Significantly more patients (z = 17.39, P < .00001) were able to complete HGS than 5m (92% versus 43%, respectively). Median HGS was 28.0 kg for men and 14.7 kg for women. Of patients who completed the 5m, mean completion time was 8.98 seconds (median, 6.79 seconds, SD = 6.59). 5m and HGS scores were significantly worse with patientperceived disability (z = −9.56, t = 10.69, respectively; P < .0001; 95% confidence interval [CI], [7.33, 10.63]; [1.76, 3.18]). HGS was associated with nutrition status (t = 4.13, P < .001; 95% CI [2.02, 5.67]), although it showed poor validity as a single nutrition indicator. Conclusions: These data indicate that HGS is a more useful functional measure than 5m when added to a hospital nutrition assessment. Determination of HGS cutpoints to identify low strength in acute care patients will promote its use. (Nutr Clin Pract.

Reduced Handgrip Strength in Hospital Admission Predicts Prolonged Hospital Stay and Death but Is Not Accurate to Identify Malnutrition: A Longitudinal Study of Reduced Handgrip Strength in Hospitalized Patients

“…Another study including 1250 patients showed that malnourished (SGA-B or SGA-C) patients had significantly lower HGS; however, they also noted that HGS is not an accurate screening tool for malnutrition. 27 Although HGS is significantly associated with SGA, HGS showed poor validity as a single nutrition indicator in the majority of cited studies, 13,26,27 as demonstrated in the current study. Therefore, HGS as an isolated measure for malnutrition diagnosis does not seem to yield accurate results.…”

“…In a cross‐sectional study with a sample of 668 adult patients, Guerra et al 13 also showed a weak correlation between PG‐SGA score and HGS values ( r = −0.290; P < .001). Another study including 1250 patients showed that malnourished (SGA‐B or SGA‐C) patients had significantly lower HGS; however, they also noted that HGS is not an accurate screening tool for malnutrition 27 . Although HGS is significantly associated with SGA, HGS showed poor validity as a single nutrition indicator in the majority of cited studies, 13,26,27 as demonstrated in the current study.…”

<p>Grip Strength: An Indispensable Biomarker For Older Adults</p>

“…40 Although finding a significant association between grip strength and nutritional status, McNicholl described grip strength as having "poor validity as a single nutrition indicator". 41 As more of the patients they tested completed a grip strength assessment (92%) than a 5 meter walking assessment (43%), they concluded that grip strength "is a more useful functional measure" than the 5 meter walk test.…”

Can Muscle Mass Be Maintained with A Simple Resistance Intervention in the Older People? A Cluster Randomized Controlled Trial in Thailand

“…Examining a sample of older Chinese inpatients who were tested upon admission, Zhang et al noted that those with lower grip strength were at greater risk of malnutrition, as measured by nutritional risk screening and subjective comprehensive assessment [ 46 ]. McNicholl found a significant association between grip strength and nutritional status, but indicated that grip strength “has little validity as a single nutritional indicator” [ 47 ]. Since more tested patients completed the grip strength assessment (92%) than the 5-m walk assessment (43%), they concluded that grip strength is "a more useful functional indicator" than the 5-m walk test [ 47 ].…”