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R
ibas
DF
et
al
.
612
R
ev
A
ssoc
M
ed
B
ras
2016; 62(7):612-615
GUIDELINES IN FOCUS
Nutrition assessment – Modal ergometry
A
valiação
nutrológica
– E
rgometria modal
Authorship:
Associação Brasileira de Nutrologia (ABRAN)
Participants:
Ribas DF
1
, Kelman G
2
, Buzzini RF
2
, Simões RS
2
, Bernardo WM
2
Final draft:
March 11, 2016
1
Sociedade Brasileira de Nutrologia
2
Programa Diretrizes, Brazilian Medical Association
http://dx.doi.org/10.1590/1806-9282.62.07.612The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standard-
ize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, de-
pending on the conditions and the clinical status of each patient.
E
vidence
collection method
This policy followed the pattern of a systematic review with
retrieval of evidence based on the principles of evidence-
-based medicine (EBM), according to which clinical experi-
ence is integrated with the ability to critically analyze and
rationally apply scientific information, thus improving the
quality of medical care. EBMuses existing scientific evidence
available at the time, with good internal and external valid-
ity, applying its results to the clinical practice.
1,2
Systematic reviews are considered today as level I
evidence for any clinical question as systematically sum-
marize information on a particular topic based on pri-
mary studies (clinical trials, cohort studies, case-control
or cross-sectional studies). The methodology used for this
is reproducible, and integrates information on effective-
ness, efficiency, efficacy, and safety.
1,2
We ask the questions in a structured way, summarized
by the acronym PICO, where P is the patient or popula-
tion, I intervention or indicator, C is comparison or con-
trol, and O is the outcome. Based on a structured question,
the keywords or descriptors that will form the basis of
the search for evidence in the various available databases
are identified
1,2
(Annex I).
C
linical
question
What is the role of modal ergometry in the measurement
of muscle strength in children, adolescents or adults?
G
rade
of
recommendation
and
strength
of
evidence
•
•
A: Experimental or observational studies of higher
consistency.
•
•
B: Experimental or observational studies of lower
consistency.
•
•
C: Case reports/non-controlled studies.
•
•
D: Opinions without critical evaluation, based on con-
sensus, physiological studies or animal models.
O
bjective
To determine the role of modal ergometry in the measure-
ment of muscle strength while assessing the nutrition
status of children, adolescents and adults.
C
onflict
of
interest
No conflict of interest was declared by the participants
in the development of this guideline.
I
ntroduction
Impairment of muscle strength is a well-known phenom-
enon that occurs in diseases related to poor nutrition. A
reduced nutritional supply results in compensatory loss
of body protein, mostly from the muscles. Decline in
muscle protein synthesis can also occur in diseases re-
lated to poor nutrition. Reduced muscle strength is, in
turn, associated with a loss of physical functionality and
a negative impact on the recovery of acute diseases or
surgery, which partly explains a high predictive power of
muscle function tests. The palmar gripping force test
reflects the maximum strength derived from the contrac-
tion of intrinsic and extrinsic muscles that support the
contraction of the joints in the hands. Despite its good
correlation with other muscle function tests, such as the
knee extension test and the peak expiratory flow test, it
cannot be used to replace the evaluation of lower-limb
muscle function.
3
(
D
)
Approximately 9 to 35% of patients admitted with a
diagnosis of acute stroke, either ischemic or hemorrhag-
ic, are malnourished. Dysphagia contributes to poor di-