The use of hand grip strength as a predictor of nutrition status in hospital patients
Introduction
Malnutrition is a common and ongoing problem among hospital patients.1 Studies in developed countries report that malnourished patients account for between 20 and 60 percent of the hospitalised population.2, 3, 4 In this setting, malnutrition has been independently associated with compromised health, including medical complications, prolonged recovery from illness and surgery, and an increased rate of mortality.2, 5 Identification of hospital patients who are malnourished or at a high risk of malnutrition is therefore essential in clinical nutrition best practice. Recognising these patients as early as possible facilitates earlier nutritional intervention and improved health outcomes.
A variety of nutrition assessment tools are used in hospitals, many of which rely on weight or physical assessment.6 One such tool is the scored Patient Generated Subjective Global Assessment (PG-SGA), a validated means of triaging patients according to nutritional status and need for nutritional support using a physical assessment.7 However, research into the physiological changes in the malnourished human body suggests that a change in muscle function may be useful as an early indication of malnutrition.8 A nutrition assessment tool based on an objective measure of physical function may therefore be valuable,9 particularly in circumstances where weight is not known or accurate physical assessment is difficult due to a lack of trained staff. Hand grip strength (HGS), a commonly used tool for assessment of muscle function in clinical settings,10 has gained considerable attention as an indicator of nutrition status in recent research.11
A systematic review of HGS as a nutritional marker by Norman and colleagues suggests that this measure would be a good indicator of nutrition status.11 The review also highlights the potential monitoring capabilities of HGS to detect improvements in nutritional status following supplementation.11 HGS is a rapid, cost-effective and a user friendly tool10 that has high test and re-test reliability, as well as high inter-rater reliability.12 HGS could therefore provide a number of benefits over existing nutrition assessment methods, which are more time consuming and require higher skill levels. Despite the promising evidence and benefits of HGS as a nutrition assessment tool, to our knowledge there have been no published articles exploring the potential of HGS to independently predict nutrition status in a standard hospital population.
To evaluate HGS as a nutrition assessment tool, we have undertaken a study of hospital patients from the Joondalup Health Campus in Western Australia, with the aim to investigate the relationship between PG-SGA and HGS values. It was hypothesised that HGS would show a significant correlation with PG-SGA score as well as being an independent predictor of PG-SGA score and nutrition status.
Section snippets
Participants
This observational study combined cross-sectional and longitudinal methods using both prospective and retrospective data. The study was conducted at Joondalup Health Campus (JHC), Western Australia, with approval from the Human Research Ethics Committees of JHC and Edith Cowan University.
The retrospective data included in this study was collected from medical, surgical and rehabilitation ward patients between January and June 2011. Complete data sets were retrieved from dietetic inpatient notes
Patient characteristics
A total of 294 patients were eligible for entry into the study. Seventy seven of these patients were subsequently excluded for reasons including incomplete data collection (n = 54), inability to complete the HGS assessment (n = 11), hand dynamometer failure (n = 5), non-compliance with requests (n = 2), confusion (n = 2), aggression (n = 1), hand malformation (n = 1), and being discharged before collection of informed consent (n = 1). The remaining 217 patients qualified for inclusion. Of these
Discussion
In this observational study of a heterogeneous group of well nourished and malnourished hospital patients, we found a significant association between HGS and nutrition status, as defined by PG-SGA score and category. Furthermore, we demonstrated that baseline HGS may independently predict nutrition status and that monitoring measures of HGS have the potential to independently predict change in nutrition status over time. The ability of HGS to account for variation in nutrition status differed
Conclusion
The association between HGS and nutrition status we observed in our study indicates the potential of HGS to provide valuable information to health care professionals working with malnourished patients. Our research contributes to the literature in this field by demonstrating that HGS may independently predict nutrition status, as determined by PG-SGA score and category, which confirms our hypothesis. Although we do not recommend that HGS should replace existing nutrition assessment tools in a
Statement of authorship
H.P. and V.K. were responsible for the conception and design of this study, and overseeing of data collection. A.F and A.C were responsible for data collection and interpretation of the results. A.C carried out the statistical analysis and A.F. drafted the manuscript. T.O. provided methodology guidance and statistical support as well as mentoring of A.F and A.C. All authors were involved in editing the manuscript.
Sources of funding
No funding was provided for any component of this study.
Conflict of interest
The authors declare that they have no conflict of interest regarding this article.
Acknowledgements
We would like to thank the JHC Dietetic Department for assistance with data collection, and the JHC patients who kindly participated in the research. We would also like to thank Kimberley Voo for statistical support, and Nicholas Flood and Sarah Cox for assistance with manuscript editing.
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