握力单独无法成为围手术期老年患者营养不良的准确指标

　　美国肠外肠内营养学会、营养与饮食学会（A.N.D.）都推荐握力（HGS）作为成人营养不良的诊断标准之一。

　　为了探讨HGS在对老年人群中营养不良的诊断价值，澳大利亚昆士兰大学、皇家布里斯班和女子医院、昆士兰科技大学对99例65岁及以上老年外科患者进行HGS测定及营养评定。

　　结果发现，对于入院前、急性入院及出院后的老年患者而言，HGS均无诊断价值。对比营养不良组及非营养不良组老年患者的HGS结果，仅出院人群存在差异（P=0.017）。

　　因此，单独使用HGS指标对外科老年患者营养不良的诊断价值不足。

JPEN J Parenter Enteral Nutr. 2017;41(2):297-298.

Handgrip strength alone is not an accurate indicator of malnutrition in older patients before, during, or after admission to surgical wards.

Angela Byrnes; Adrienne Young; Alison Mudge; Merrilyn Banks; Judy Bauer.

University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia.

PURPOSE: Handgrip strength (HGS) has been proposed as a surrogate measure of nutrition status that may be more sensitive to changes in muscle function secondary to declining nutrition status than muscle mass or other body composition measures. In combination with other characteristics, HGS is recommended by the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics in identifying adult malnutrition. This study aimed to determine the accuracy of HGS as an indicator of malnutrition at different time points in an older (≥65 years) population.

METHODS: Patients ≥65 years were recruited from the surgical preadmission clinics and 2 general surgical wards at a large tertiary teaching hospital. Measures were undertaken at the preadmission appointment, during acute admission (days 4-6), and/or at postdischarge follow-up appointment. HGS was measured using a single Jamar hydraulic hand dynamometer following the standardized positioning and instruction prescribed by the American Society of Hand Therapists and recorded as the mean of 3 trials. Impaired HGS was defined as a value below the lower limit of the 95% confidence interval (CI) of the mean from age-, sex- and side-specific normative data. Nutrition status was assessed by a trained dietitian using the Patient-Generated Subjective Global Assessment (PG-SGA), with malnutrition defined as a global rating of SGA-B or SGA-C. Dichotomized HGS and PG-SGA measures were used to determine diagnostic accuracy. Mean HGS of malnourished and not malnourished patients was compared at each time point by independent samples t test, with standardized HGS calculated by converting observed HGS to a percent of the lower limit of the 95% CI of the mean.

RESULTS: A total of 99 patients (mean [SD] age 73.5 [6.4] years, 60% male) were recruited, corresponding to 30 preadmission, 74 acute, and 36 postdischarge measures. Impaired HGS was not able to accurately identify malnutrition in preadmission, acute, or postdischarge patients. When mean standardized HGS was compared between malnourished and not malnourished groups, a difference was observed at postdischarge follow-up only (96.0% [SD 8.6%] vs 108.2% [SD 20.7%], t(33.7) = -2.511, P = .017).

CONCLUSIONS: As a standalone measure, HGS was not found to be a suitable surrogate measure of nutrition status before, during, or after admission to surgical wards in an older population. As such, assessment of nutrition status via validated tool by an appropriately trained clinician remains the preferred method.

DOI: 10.1177/0148607116686023