9 / 105
N
utrition
assessment
–
M
odal
ergometry
R
ev
A
ssoc
M
ed
B
ras
2016; 62(7):612-615
613
etary intake and is present in over 50% of patients with
acute stroke, further increasing the risk of malnutrition
in these patients. Neurological, emotional, and cognitive
changes can also affect the nutrition of these patients.
Elderly patients (n=170) with diagnosis of stroke who
presented malnutrition or nutritional risk [body mass
index (BMI) ≤ 20 kg/m
2
, or unintentional loss of weight
greater than 5% in the last 3 to 6 months, or decreased
dietary intake in the last 5 days] were randomized to re-
ceive personalized nutrition combined with supplemen-
tation or routine care (control). Weight loss after 3 months
of follow-up was higher in the control group, but the
difference was not statistically significant. There was a
significant increase in palmar gripping force in the inter-
vention group, and decreased strength in the control
group (73.2
vs.
44.6%, p=0.001).
4
(
B
)
In cancer patients, malnutrition is common and is
associated with worse quality of life, increased morbidity
and mortality. One hundred and thirty patients aged 19
to 95 years, with malnutrition (22.3%) or risk of malnutri-
tion (42.3%), were followed during hospitalization in a
cancer hospital. One hundred and eleven (111) patients
had solid tumors and 19 hematopoietic neoplasms. Pa-
tients with less palmar gripping force on admission, which
accounted for more than half of the total, were discharged
later (> 15 days of hospitalization), while those with
higher values for strength stayed in the hospital for a
shorter period (discharged earlier than 15 days). Patients
malnourished or at risk of malnutrition and those with
low palmar gripping force values on admission were as-
sociated with increased risk of death during hospitaliza-
tion, regardless of age. This allowed us to distinguish who
would have a long hospital stay (Table 1).
5
(
B
)
TABLE 1
Palmar gripping force.
Palmar gripping
force
Length of hospital
stay-IQR
p-value hospital
discharge
High
6 (4.0-11.0)
<0.001
Intermediate
12 (7.3-23.3)
<0.001
Low
17 (7.0-32.0)
<0.001
IQR: interquartile range.
In order to assess palmar gripping force as a screening
method for the identification of patients (18 to 96 years
old) considered malnourished in hospital environment,
314 individuals with diseases including cardiovascular,
gastrointestinal, respiratory, neurologic, surgical, and
more were evaluated. All patients underwent the palmar
gripping force test, performed using a mechanical dyna-
mometer. The Nutritional Risk Screening (NRS-2002)
protocol was applied to assess the nutritional risk.
Patients identified as malnourished according to the
NRS-2002 (37.9%) had low values of palmar gripping force
(p<0.001). When patients with decreased palmar gripping
force were compared with those with greater force, this
parameter showed good specificity (70.2%) and sensitiv-
ity (86.7%), and positive and negative predictive values,
respectively, 69.9 and 86.8%, with 77.4% agreement, k=0.56.
Thus, it proved to be an appropriate tool for nutritional
screening in hospitals.
6
(
B
)
The liver is an essential metabolic organ for energy-
-protein control in the body. Patients with liver disease
show a greatly affected nutritional status, and energy-
-protein malnutrition is found in most patients with cir-
rhosis. Prevalence of ascites, postoperative mortality, and
post-transplant prognosis are all related to energy-protein
malnutrition. One hundred and forty-five (145) patients
were followed up; they were divided into three groups
(group 1 with 50 patients with cirrhosis; group 2, 46 pa-
tients with hypertension; and group 3, 49 patients with
functional gastrointestinal disease, which is the control
group). According to the gold standard Subjective Global
Assessment (SGA), malnutrition was found in 28% of pa-
tients in group 1, 13.1% in group 2, and there were no
malnourished patients in group 3. The palmar gripping
force test led to the detection of 63% of the malnourished
patients in group 1, 12.7% in group 2, and 4.08% in group
3. The sensitivity of the palmar gripping force test was
100%, while specificity reached 48.6%, positive predictive
value amounted to 37.9%, and negative value to 100%; k
test = 0.31 compared with the gold standard (SGA).
7
(
B
)
Assessing the palmar gripping force of 787 healthy
children from 6 to 10 years old, we identified a difference
in mean gripping force between the malnourished and the
well-nourished children, which was more noticeable among
the older children. Of the 116 boys and 112 girls classified
as malnourished using weight for age, only 24 and 22.3%,
respectively, had low values for grip strength.
8
(
B
)
When grip strength and height for age were used to
assess the prevalence of malnutrition, only 26.7% of the
boys and 22.9% of the girls with short stature presented
low values for gripping force. Similar results were observed
in children considered malnourished based on height for
weight.
8
(
B
)
Sensitivity of the muscle strength test as a nutrition-
al status index was not as high for both sexes, and 39.3%
was the highest value when the strength test was compared
with the height for age among the girls. Specificity of the
strength test was 94% compared with weight for age, and