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

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