Value of handgrip strength to predict clinical outcomes and therapeutic response in malnourished medical inpatients: Secondary analysis of a randomized controlled trial

Tribolet, Pascal; Kaegi-Braun, Nina; Baumgartner, Annic; Fehr, Rebecca; Baechli, Valerie; Geiser, Martina; Deiss, Manuela; Gomes, Filomena; Kutz, Alexander; Hoess, Claus; Pavlicek, Vojtech; Schmid, Sarah; Bilz, Stefan; Sigrist, Sarah; Brändle, Michael; Benz, Carmen; Henzen, Christoph; Thomann, Robert; Rutishauser, Jonas; Aujesky, Drahomir; ... (2021). Value of handgrip strength to predict clinical outcomes and therapeutic response in malnourished medical inpatients: Secondary analysis of a randomized controlled trial The American Journal of Clinical Nutrition, 114(2), pp. 731-740. 10.1093/ajcn/nqab042

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Background: Disease-related malnutrition is associated with loss of muscle mass and impaired functional status. Handgrip strength (HGS) has been proposed as an easy-to-use tool to assess muscle strength in clinical practice. Objectives: We investigated the prognostic implications of HGS in patients at nutritional risk with regard to clinical outcomes and response to nutritional support. Methods: This was a secondary analysis of the randomized controlled, multicenter, Effect of Early Nutritional Support on Frailty, FunctionalOutcome, and Recovery of MalnourishedMedical Inpatients Trial, which compared the effects of individualized nutritional support with usual hospital food in medical inpatients at nutritional risk. Our primary endpoint was 30-d all-cause mortality. The association between sex-specific HGS and clinical outcomes was investigated using multivariable regression analyses, adjusted for randomization, age, weight, height, nutritional risk, admission diagnosis, comorbidities, interaction terms, and study center. We used interaction terms to investigate possible effect modification regarding the nutritional support intervention. Results: Mean ± SD HGS in the 1809 patients with available handgrip measurement was 17.0 ± 7.1 kg for females and 28.9 ± 11.3 kg formales. Each decrease of 10 kg in HGSwas associated with increased risk of 30-d mortality (female: adjusted OR: 2.11; 95% CI: 1.23, 3.62, P = 0.007; male: adjusted OR: 1.44; 95% CI: 1.07, 1.93, P = 0.015) and 180-d mortality (female: adjusted OR: 1.45; 95% CI: 1.0, 2.10, P = 0.048; male: adjusted OR: 1.55; 95% CI: 1.28, 1.89, P < 0.001). Individualized nutritional support was most effective in reducing mortality in patients with low HGS (adjusted OR: 0.29; 95% CI: 0.10, 0.82 in patients in the ≤10th percentile compared with OR: 0.98; 95% CI: 0.66, 1.48 in patients in the >10th percentile; P for interaction = 0.026). Conclusions: In medical inpatients at nutritional risk, HGS provided significant prognostic information about expected mortality and complication risks and helps to identify which patients benefit most from nutritional support. HGS may thus improve individualization of nutritional therapy. This trial was registered at clinicaltrials.gov as NCT02517476. Am J Clin Nutr 2021;00:1–10. Keywords: handgrip strength, malnutrition, nutritional support, functional decline, mortality

Item Type:	Journal Article (Original Article)
Division/Institute:	School of Health Professions > Nutrition and Dietetics
Name:	Tribolet, Pascal; Kaegi-Braun, Nina; Baumgartner, Annic; Fehr, Rebecca; Baechli, Valerie; Geiser, Martina; Deiss, Manuela; Gomes, Filomena; Kutz, Alexander; Hoess, Claus; Pavlicek, Vojtech; Schmid, Sarah; Bilz, Stefan; Sigrist, Sarah; Brändle, Michael; Benz, Carmen; Henzen, Christoph; Thomann, Robert; Rutishauser, Jonas; Aujesky, Drahomir; Rodondi, Nicolas; Donzé, Jacques; Stanga, Zeno; Mueller, Beat and Schuetz, Philipp
Subjects:	R Medicine > R Medicine (General)
ISSN:	0002-9165
Language:	English
Submitter:	Pascal Tribolet
Date Deposited:	17 Jan 2022 15:08
Last Modified:	17 Jan 2022 15:08
Publisher DOI:	10.1093/ajcn/nqab042
ARBOR DOI:	10.24451/arbor.16233
URI:	https://arbor.bfh.ch/id/eprint/16233