Use of adductor pollicis muscle thickness in hospitalized or ambulatory patients: a systematic review

Abstract

Objective: to analyze the use of the Adductor Pollicis Muscle Thickness (APMT) as an anthropometric parameter and prognostic indicator in hospitalized or ambulatory patients. Method: systematic review carried out the Web of Science, SCOPUS and Lilacs databases. Results: Twenty-three studies were performed on critical, surgical, oncological, nephropathic and hepatopathic patients, collecting data on bibliographic reference, study site, objectives, number of patients, age group, methodology, main results and conclusion. APMT proved to be a good anthropometric parameter for evaluation of nutritional status in critical patients without edema, and surgical, oncological and nephropathic patients, but presented poor performance for diagnosis of malnutrition in hepatopathic patients. It was a good prognostic indicator for mortality in critical, nephropathic and oncological patients, and also a good predictor of hospitalization in nephropathic patients. There was an association with neurological complications in Hepatic Encephalopathy (HE) in the case of hepatophatic patients, but it was not a predictor of postoperative complications in surgical patients. Conclusion: APTM was considered a good anthropometric parameter in most clinical conditions, except in patients with liver disease and a good prognostic indicator for mortality in critical, oncological and nephropathic patients, and a predictor of neurological complications in HE. Further prognostic investigation, standardization of cutoff points and evaluation of sensitivity and specificity are required.

Adductor pollicis muscle and handgrip strength: potential methods of nutritional assessment in surgical patients

“…A redução da EMAP, em relação ao valor de referência proposto 7 , juntamente com outras variáveis e métodos de avaliação nutricional, é capaz de estimar a perda de massa muscular, uma vez que o músculo adutor do polegar é consumido durante o catabolismo e o desuso. Por ser capaz de revelar alterações da composição muscular corporal, a EMAP identifica tanto o risco de desnutrição de pacientes durante hospitalização quanto a recuperação do estado nutricional de pacientes deambulantes ou acamados 24,32 .…”

“…Outro aspecto a ser discutido é que a precisão e a confiabilidade das medidas antropométricas são influenciadas por muitas variáveis, tais como: equipamentos, habilidade técnica, cooperação do indivíduo e variedade de padrões de referência 32 . No entanto, a facilidade da medida da EMAP, em pacientes hospitalizados, poderá contribuir na determinação de desfechos clínicos, conforme descreveram Caporossi et al 23 e Ghorabi et al 33 , em que a EMAP reduzida, em pacientes críticos, foi associada CONCLUSÃO Há associação positiva entre FPP e CB e entre EMAP, peso habitual, CB e albumina sérica e associação inversa entre EMAP, percentual de perda de peso e IMC em pacientes cirúrgicos, mesmo após ajuste para altura, sexo e idade.…”

“…A maior parte dos indivíduos com baixa EMAP tinham baixo peso quando avaliado pelo IMC, enquanto os indivíduos com excesso de peso apresentavam a EMAP classificada como normal (32,35…”

Early parenteral nutrition progression and nutritional parameters in critically ill patients

“…Although there is still no defined APMT cutoff point for all populations, the APMT estimate for healthy men and women is 12.5 mm and 10.5 mm, respectively 17 . As the adductor pollicis muscle is also consumed during catabolism and atrophied by inactivity 17 , it has been considered a good anthropometric parameter to evaluate muscle loss and malnutrition in most clinical conditions, including hospitalized patients 18 . In this study, median APMT (13 mm) observed (Table 1) was superior to the values proposed for healthy individuals 17 .…”

“…Despite these details, APMT is useful for clinical and prognosis purposes. Abnormal APMT values increase the LOS for approximately 5 days in patients without edema 18 . Each 1 mm decrease in APMT can increase the risk of death by 38% in ICU patients 21 .…”