Validade da força de preensão palmar isolada e combinada com a mini avaliação nutricional na identificação do risco de desnutrição em idosos hospitalizados

Abstract

Background: Malnutrition prevalence in hospitalized elderly varies between 2 and 80%, depending on a diversity of factors involved in the diagnosis, such as the heterogeneity of the elderly population, place where they live and diagnostic criteria used. Moreover, malnutrition etiology is multifactorial, leading to an increased morbidity and mortality. Researchers have recently proposed the use of the hand grip strength (HGS) for the nutritional state screening, due to its simple, rapid and low-cost application. This proposal was based on previous studies demonstrating that malnutrition leads to atrophy of type II muscle fibers and alterations of the Z band, reducing strength even before changes in anthropometric measurements can be observed. Aim: The aims of the present study were: (1) to determine the validity of HGS isolated and combined with the Mini Nutritional Assessment (MNA®) and Mini Nutritional Assessment-short form (MNA®-SF) in the malnutrition risk identification in hospitalized elderly; (2) to analyze the association of HGS with sociodemographic, anthropometric, medical clinical variables, nutritional status and malnutrition risk; (3) to determine a HGS cutoff value for malnutrition risk identification.Methods: This was a cross-sectional and analytical study that involved the evaluation of 281 hospitalized elderly patients in a university hospital in Porto Alegre/Brazil. The investigated population was composed of clinical and surgical patients that were able to perform the HGS assessment by means of the Jamar® dynamometer. The nutritional status was determined through the Global Subjective Assessment (GSA) and the malnutrition risk was evaluated through the MNA® and MNA®-SF. The HGS association and correlation analysis with the sociodemographic, anthropometric and medical variables, as well as the nutritional status and nutritional risk, were performed through the Mann-Whitney test, Kruskal-Wallis followed by SNK, and Spearman’s correlation. For the ROC curves regarding the HGS associated with the GSA, and determination of the HGS accuracy when isolated or combined with MNA® and MNA®-SF, two categories were considered: eutrophic and at malnutrition risk/malnourished. Results: The majority of the evaluated elderly patients were males (58.0%), with a mean age of 69.1±6.6 years old (60-94 years old). The prevalence of nutritional risk/malnutrition was 44.5% according to GSA, 51.2% by MNA® and 66.2% by MNA®-SF. Median HGS was significantly lower in females [9.17 kg (6.00-21.42) versus 19.67 kg (14.67-24.33); P<0.001], in individuals ≥80 years old [12.67 (7.33-19.33) versus 16.00 kg (10.00-22.08); P<0.001]; and with low-income [13.17 kg (8.00-20.00) versus 19.50 kg (14.42-26.58); P<0.001]. HGS was significantly associated with the nutritional status (P<0.001). Mean HGS was significantly higher in eutrophic individuals when compared to malnourished individuals (evaluated by the three nutritional status instruments). HGS combined with MNA® or MNA®-SF showed a higher sensitivity (93.6 %; IC95%: 0.833-0. 969 and 98.4%; IC95%: 0.943-0.997, respectively) than did HGS isolated (63.2%; IC95%: 0.563-0.698) in malnutrition risk identification. Conclusion: In summary, HGS can be considered a sensitive tool in the malnutrition screening in hospitalized elderly patients when combined with MNA® or MNA®-SF.