Original Article
European Journal of Clinical Nutrition (2007) 61, 1128–1135; doi:10.1038/sj.ejcn.1602627; published online 31 January 2007
Handgrip strength as a hospital admission nutritional risk screening method
Guarantor: LC Matos.
Contributors: LCM, MMT and TFA all contributed to the study design. Data collection was performed by LCM and MMT. LCM, MMT and TFA completed data analysis. The paper was written by LCM and TFA and edited by LCM, MMT and TFA.
L C Matos1,2, M M Tavares1,3 and T F Amaral1
- 1Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- 2Hospital Geral de Santo António (SA), Porto, Portugal
- 3Hospital Pedro Hispano, ULS Matosinhos, Matosinhos, Portugal
Correspondence: Professor TF Amaral, Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua Dr Roberto Frias, 4200-465 Porto, Portugal. E-mail: amaral.tf@gmail.com
Received 21 April 2006; Revised 24 November 2006; Accepted 27 November 2006; Published online 31 January 2007.
Abstract
Objective:
To investigate if handgrip strength (HGS) could be used as a single screening procedure in identifying patients who are classified as being undernourished or nutritionally-at-risk at hospital admission.
Design:
Cross-sectional study. In the second day of hospital admission, HGS was evaluated and results were compared with Nutritional Risk Screening (NRS-2002).
Setting:
Two public hospitals in Porto, Portugal, a university and a district one.
Subjects:
A probabilistic sample of 50% in-patients from each hospital of 314 patients (age range of 18–96) was studied. Patients were considered eligible if they were 
18 years old and able to give informed consent. Hand pain, upper limb deformities, incapacity to perform muscle strength measurements and pregnancy were considered further exclusion criteria.
Results:
Patients identified as undernourished by NRS-2002 (37.9%) were older, shorter and lighter, with a lower functional capacity, a longer length of stay and a lower HGS (P<0.001). When comparing patients with lower HGS (first quartile) with those with the highest HGS (fourth quartile), this parameter revealed good sensitivity (86.7%) and specificity (70.2%) and a k=0.56. Multivariate analysis showed that patients with higher HGS had an independent decreased risk of being at nutritional risk (P for trend <0.001) odds ratio=0.19 (95% confidence interval=0.08–0.48). Our entire sample of hospitalized patients was -1.96 Z-score below the HGS cutoff of distribution data for healthy individuals.
Conclusions:
HGS identifies a high proportion of nutritionally-at-risk patients and can be a reliable first screening tool for nutritional risk in hospitals.
Sponsorship:
Fundação Ilídio Pinho and Reitoria of the University of Porto – Programa Investigação Científica na Pré-graduação.
Keywords:
handgrip strength, screening, disease-related malnutrition, hospital
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