Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures

AIM: To evaluate nutritional status and its relation to cognitive and physical function and quality of life in elderly female patients with hip fractures. METHODS: Nutritional status was assessed in 42 women (80+/-7 years old) using the body mass index (BMI), triceps skin fold, arm muscle circumference and serum levels of insulin-like growth factor (IGF-1) and its binding protein (BP) IGFBP-1. Handgrip strength was measured. The Short Portable Mental Status Questionnaire was used to assess cognitive function and the Nottingham Health Profile to asses quality of life. RESULTS: Low BMI (<== 20) and reduced IGF-1 and IGFBP-1 levels were detected in 50% of the patients. BMI correlated with IGF-1 (p< 0.02) and with hand grip strength (P< 0.001). Hand grip strength correlated with arm muscle circumference (P< 0.05). Cognitive dysfunction was detected in 18% of the patients, and a correlation was found between cognitive function and BMI (P< 0.01). The Nottingham Health Profile assessment indicated a lower quality of life in underweight patients as compared to others (P< 0.05). CONCLUSIONS: Half of the elderly women with hip fractures displayed signs of protein-energy malnutrition. Underweight was associated with reduced serum levels of IGF-1, muscle fatigue, cognitive dysfunction and a low quality of life rating, i.e. a cluster of factors which may unfavourably influence the postoperative course in a large proportion of hip fracture patients.     

A practical posture for hand grip dynamometry in the clinical setting

BACKGROUND & AIMS: The optimal testing position for hand grip strength, which is a useful functional measure of nutritional status, is open to debate. We therefore examined the systematic difference between different postures in order to establish a methodology that is clinically relevant, easy to perform and reproducible. METHODS: Grip strength was measured in the dominant and non-dominant hands with a strain gauge dynamometer in three positions: lying at 30 degrees in bed with elbows supported, seated in an armchair with elbows supported and in a chair with elbows unsupported. The average of three readings made in each position, each 1 min apart, was recorded. RESULTS: 55 normally nourished subjects (26 male) were studied. Mean (95% CI) grip strengths measured in the dominant hand with the subject in bed, sitting in an armchair and sitting in a chair were 45.7 (42.3-49.2), 46.3 (42.9-49.8) and 48.5 (45.4-51.7) kg, respectively for males. Corresponding values for females were 29.4 (27.0-31.8), 29.3 (26.8-31.9) and 31.6 (28.8-34.3) kg. There was no significant difference (Student t-paired test) between measurements made in bed and on an armchair (P = 0.49), but the measurements made in a chair were significantly higher than those made in bed (P = 0.001) and in an armchair (P = 0.004). No statistical difference was present, comparing the three separate measurements in each position (Student t-paired test). CONCLUSIONS: Measurement of grip strength using hand dynamometry is reproducible and consistent. As all patients are not able to sit in a chair with elbows unsupported, in clinical practice it is more practicable to perform hand dynamometry with the elbows supported in a bed or armchair.     

The effect of starvation on skeletal muscle function in man

Measuring skeletal muscle function may be a diagnostic aid to detect malnutrition. To evaluate this hypothesis 11 lean women were studied before and after 5 days of total starvation. Skeletal muscle function was assessed as hand grip strength and as adductor pollicis muscle function after electrical stimulation of the ulnar nerve. The muscle function variables were force of contraction at 5, 10, 20 and 50 Hz stimulation, relaxation rate and endurance. In addition some currently used anthropometric and biochemical nutritional indices were serially determined. Hand grip strength was decreased (p < 0.05) and the function of the adductor pollicis muscle was altered with a higher contraction force at 10 Hz (p < 0.01), a slower relaxation rate (p < 0.05) and a reduced endurance (p < 0.05). These changes were all within the normal ranges. Triceps skin fold and arm muscle circumference were not changed after a mean weight loss of 3.3 kg (p < 0.05). However blood glucose, insulin and triiodothyronine all decreased (p < 0.01) indicating a metabolic adaptation to starvation. Prealbumin (p < 0.05) and fibronectin (p < 0.01) were also lowered. In conclusion, skeletal muscle function was significantly altered after five days of total starvation. However, to identify short term nutritional depletion in clinical practice the changes in muscle function were too small to be diagnostically useful.     

Hand grip strength--a simple prognostic indicator in surgical patients

This study evaluates hand grip strength as an indicator of nutritional status and a predictor of postoperative complications. Hand grip strength and other parameters of nutritional status, namely, midarm muscle circumference, forearm muscle circumference, triceps skinfold, percentage ideal body weight, serum albumin, and percent usual weight were determined preoperatively in 205 patients. Complications occurred in 28 patients (14%). Patients with at least one abnormal nutritional parameter had a higher incidence of postoperative complications. Their length of total and postoperative hospitalization was greater by 6.2 and 4.6 days, respectively (p less than 0.01). Grip strength was the most sensitive single parameter, but forearm muscle circumference and percentage ideal body weight were the most specific indices. Hand grip strength is a simple measure of nutritional status and an accurate prognostic indicator that requires further clinical evaluation.     

Nutritional status and performance capacity in internal medical patients

The nutritional status (3 anthropometric records, serum albumin and delayed cutaneous hypersensitivity (DCH)), recent weight loss, dynamometric capacity and mood were assessed in 205 recently admitted non-cancer internal medical patients. 20% of the subjects were classified as malnourished (3 of the 5 nutritional variables below the reference range). The occurrence of malnutrition was higher (1 3 ) in multiple organ dysfunction or chronic respiratory disease. In order to reduce the risk of overestimating malnutrition, the data for serum albumin and DCH were omitted when they appeared to be influenced by non-nutritional factors. Disease duration >2 years, old age and multiple organ dysfunction were independently related to malnutrition. Serum albumin correlated more strongly with the acute phase reactant, serum acid glycoprotein (r = 0.33, P < 0.001) than with the anthropometric variables (r < 0.24). Recalled recent weight loss >5% was found in 34% of the malnourished subjects. Malnourished, in comparison to wellnourished patients, exhibited reduced (p < 0.05) recordings for hand grip strength, peak expiratory flow and time of ambulation. Depressive tendencies were seen in malnourished women (p < 0.05).     

Body composition in the elderly: Total body water and anthropometry

Body composition measured with isotopic dilution was compared with anthropometric measurements. The study was carried out in 47 subjects from both sexes, 65 to 92 years old. Total body water (TBW), anthropometric measurements, and dynamometry were assessed. TBW was significatively higher in men than women and decreased with age. Dynamometry and fatfree mass were well correlated (r=0.73 in males and r=0.58 in females) and significantly different between sexes. A negative correlation was found for dynamometry with age, being significant for women. Linear regression equations to predict TBW from anthropometric measurements in males and females were obtained: Males: TBW(I)=19.349+0.617 weight(kg) — 0.931 mid-arm circumference(cm)+0.122 dynamometry (kg) Females: TBW(l)=−5.531+0.343 weight(kg)-0.213 triceps skinfold (mm)+ 0.148 dynamometry(kg) + 3.424 wrist diameter (cm). This simple model is proposed for use in epidemiological and field studies where other more sophisticated methods can not be applied.     

Grip strength as an index for assessment of nutritional status of children aged 6-10 years

The purpose of this study was to evaluate the use of grip strength as an index of nutritional status in 6-10 y old children. Seven hundred and eighty seven children (364 boys and 423 girls) in the age group of 6 to 10 y were selected from private and municipal schools, orphanages and slums in the cities of Mumbai and Pune, India. Grip strength was measured using the dominant hand. Height, weight, mid-arm circumference and triceps skinfold were also measured in all subjects. A significantly high correlation (p<0.01) was observed between grip strength and age for both sexes. Boys had a higher grip strength than girls at all ages. Grip strength was significantly correlated with height, weight, mid arm circumference, triceps skinfold, arm fat and arm muscle areas (p<0.01). Stepwise multiple regression analyses showed height, weight, triceps skinfold and age to be independent variables influencing grip strength. Grip strength was found to be a specific measure of lean body mass (75 to 94%), but sensitivity was quite low (about 25%). The positive predictive value was variable, ranging from 54.6 to 21.5%. The specificity, sensitivity and positive predictive values were very high when compared with arm muscle area. Grip strength may have a potential value as an additional test for nutritional assessment in field situations and clinical settings.     

Comparison between estimates of hand volume and hand strengths with sex and age with and without anthropometric data in healthy working people

Edema and hand strength measurements are useful for the recovery assessment of patients with a hand lesion. This work determined and compared estimates of hand volume, grip strengths (measured with a Jamar and a Collins dynamometer), and pinch strength (with a Jamar pinch gauge) in terms of sex and age with or without anthropometric indices in healthy working people. The sample included 100 subjects from within the staffs of two rehabilitation centres. For both grip strengths, multiple linear regression models including body height, weight, and arm muscle area were very good (multiple correlation coefficient R of about 0.84) and clearly better than those obtained with sex and age only. For pinch strength, the best estimate was obtained with sex and arm muscle area (R of 0.76); for hand volume, the model with sex, body height, and weight provided the best result (R of 0.93). These findings suggested that anthropometric indices easy to measure must be taken into account to estimate hand volume and hand strengths.     

慢性阻塞性肺病患者营养状况与肺通气功能关系的研究

目的探讨慢性阻塞性肺病(chronicobstructivepulmonarydisease,COPD)患者营养状况对肺通气功能的影响。方法对149例COPD患者根据其营养状况分为营养正常组和营养不良组,再进行肺通气功能测定,观察指标包括最大通气量(MVV),用力肺活量(FVC),第一秒用力呼气容积(FEV1),最大呼气流量(PEF),最大呼气中段流量(MMEF)。结果营养不良组与营养正常组比较,MVV、FVC、PEF、FEV1等反映呼吸肌的指标相差非常显著(P<0.001),且两组在COPD病程同一阶段(肺气肿、肺心病)肺通气功能各值比较也显示营养不良组呼吸肌力等指标比正常组降低明显(P<0.05)。结论COPD合并营养不良对与呼吸肌有关的肺通气功能指标有明显影响。     

Definition of Respiratory Sarcopenia With Peak Expiratory Flow Rate

ObjectivesRespiratory muscle strength decreases with advancing age, and respiratory muscle dysfunction may indicate respiratory sarcopenia. However, there is no consensus regarding the definition of respiratory sarcopenia. We aimed to create a definition of respiratory sarcopenia based on the peak expiratory flow rate (PEFR).DesignCross-sectional study.Setting and participantsCommunity-based study including 681 community-dwelling older people.MethodsBody composition, spirometry, grip strength, and walking speed were measured. Participants reported comorbidities and long-term insurance certification. Conventional sarcopenia was defined using skeletal muscle mass, grip strength, and walking speed adjusted for the Japanese population. Receiver operating characteristic (ROC) curve analysis of the cut-off values of PEFR for conventional sarcopenia and long-term care insurance certification were performed for both sexes without airway obstruction. In the ROC curve analysis, potential cut-off values were lowest quartile, lowest quintiles, and the standard deviation of PEFR. Multiple logistic regression analysis was performed with respiratory sarcopenia as a dependent variable defined by each cut-off value and other variants as independent variables.ResultsThe ROC curve analysis for conventional sarcopenia and long-term care insurance certification showed significance for both sexes, and we determined cut-off values from those results. The multiple logistic regression model using PEFR values 1 standard deviation below the mean had the highest accuracy; thus, we accepted these cut-off values (4.40 L/s for men, 3.21 L/s for women) for the definition of respiratory sarcopenia.Conclusions/ImplicationsThe definition of respiratory sarcopenia based on PEFR was useful and correlated with conventional sarcopenia and long-term care insurance certification among community-dwelling older people. In this study, respiratory sarcopenia was determined by PEFR alone. Other parameters may need to be considered.     

Repeatability of grip strength and dexterity tests and the effects of age and gender

OBJECTIVES: Users of hand-held vibratory tools report reductions in grip strength and manual dexterity. This study quantified the test-retest repeatability of grip strength and manual dexterity tests, investigated effects of gender and age, and determined normative measures in different subject groups. METHODS: A total of 72 subjects in four groups (both genders and two age ranges) participated: men and women aged 18 to 25 years and 45 to 55 years. Grip strength was measured with a hand-held dynamometer, and dexterity measured with the Purdue pegboard. We assessed repeatability using one subject group (18 to 25-year-old men) who attended over three successive weeks. RESULTS: Repeated measures of grip strength were correlated for both hands and for each combination of weekly tests (P=0.01), and there were no significant changes in strength over weeks. Repeated measures of dexterity were correlated in both hands (P=0.01) for all test combinations, except between weeks 1 and 3 in the non-dominant hand (P=0.15). Further analysis suggested an improvement in dexterity, consistent with a practice effect. In both age groups, grip strength of the men was significantly greater than that of the women (P<0.01), but there were no gender differences in dexterity scores (P>0.1). There were no significant effects of age for either grip strength or dexterity (P>0.1). CONCLUSIONS: Both tests showed sufficient repeatability, with no age effect on either grip or manual dexterity (between approximately 20 to 55 years), although a decline in grip and dexterity is expected at greater ages. Dexterity scores were similar in both genders for the groups studied. Grip strength was greater in men. Occupational effects might exist for both tests, irrespective of any occupational disorder, and might be reflected in increases or decreases in grip strength and dexterity.     

营养指标预测口腔颌面恶性肿瘤患者术后局部并发症

对10个营养指标与口腔颌面恶性肿瘤患者术后局部并发症之间的关系进行了比较研究.结果表明,上臂肌围(MAMC)、握力(GS)、肌酐身高指数(CHI)及白蛋白(ALB)与术后局部并发症的发生有关(P<0.05),这四个指标可用于预测术后并发症发生情况;而理想体重百分率(I%).体重下降率(P%)、三头肌皮脂厚度(TSF)、上臂围(MAC)、运铁蛋白(TNF)及总淋巴细胞计数(TLC)则无意义.GS是最简便、准确的预测并发症指标.     

Estimation of the desirable body weight of selected lebanese adult females

Several anthropometric measurements were taken on a total of 387 healthy Lebanese single females 18–25 years of age, whose heights fell within a range of 153.5–167.4 cm. The selected subjects were neither under-or overweight as Judged by overall body appearance. A total of 142 subjects possssing triceps and abdomen skinfold thickness; and mid-thigh circumference values either below or above a certain range set for these three parameters were later excluded from the study. This step was necessary in order to leave, in the final sample, only those subjects with moderate body fat content which met our definition of having desirable body weights. Correlation coefficients (r) of selected anthropometric parameters to actual body weight (Wt) were calculated for the remaining 245 subjects. The results showed the body frame size (BFS) parameter (the sum of the wrist and ankle circumferences; and shoulders' length) to have the highest correlation (r=0.75) followed by body height (r=0.70). When individually tested, the parameters making up BFS showed moderate correlations to actual Wt. A moderate correlation (r=0.52) was also reported for mid-arm muscle circumference (MAMC). Results of multiple regression analysis, with actual Wt as the dependent variable, showed an improvement in the accuracy of estimation of desirable Wt upon the stepwise addition of BFS and MAMC to Ht. The outcome of the study was the development of regression equations based on Ht, BFS and MAMC parameters which can estimate the desirable Wt of adult females irrespective of their frame size and degree of leanness or obesity, within a standard error of estimate ranging from 2.0–2.2 kg depending on the equation used.     

SGA and measures for muscle mass and strength in surgical Vietnamese patients

OBJECTIVE: This study compared the outcome of the Subjective Global Assessment (SGA) in preoperative surgical patients with objective measurements of muscle mass and strength and with biochemical data. A secondary aim was to test the influence of inflammatory activity on muscle strength. METHODS: Two hundred seventy-four consecutive patients who were admitted for elective major abdominal surgery were assessed using the SGA, anthropometry, muscle strength, and laboratory measurements (hemoglobin, protein, albumin, C-reactive protein, and lymphocytes). Normal values for midarm muscle circumference (MAMC) and handgrip strength were obtained in a healthy control group. For all other variables, normal values available for the Vietnamese population were used. RESULTS: Of 274 patients (151 men, 123 women) assessed, 61 (22.3%) were classified as SGA class A (well nourished), 97 patients (35.4%) as class B (moderately malnourished), and 116 patients (42.3%) as class C (severely malnourished). There were significant differences in age, body weight, percentage of weight loss, triceps skinfold thickness, MAMC, and serum albumin across the three SGA classes. Almost all patients rated class A had normal MAMC and handgrip strength. However, a large proportion of patients rated as B or C also had normal MAMC and handgrip strength (38% of men, 50% of women). Handgrip strength per square meter correlated with serum albumin (r = 0.278, P < 0.001) and this correlation persisted when handgrip strength was controlled for MAMC (r = 0.296, P < 0.001 in men; r = 0.237, P < 0.01 in women). CONCLUSION: The SGA correctly identifies patients with normal muscle mass and strength but a substantial number of patients rated SGA B or C have normal muscle mass and strength. Muscle strength is not only positively associated with muscle mass but also negatively with inflammatory activity.     

广州市6~9岁儿童握力及握力指数研究

目的 探讨广州市6~9岁儿童握力及握力指数大小,为儿童肌肉和力量发育评估及临床测试标准提供参考依据。方法 2016年1-12月在广州市招募474名6~9岁儿童,采用Jamar握力计进行握力测试,并测量体重,计算握力体质量指数。结果 以1岁为一个年龄段,6~9岁男童左(右)手握力均值±标准差分别为7.9±1.7(8.5±1.9),9.5±2.0(10.3±2.3),11.0±2.8(11.6±3.0),12.3±2.5(13.2±2.8)kg;女生分别为7.3±2.0(7.7±2.0),8.3±1.6(8.9±1.7),9.8±2.3(10.7±2.5),10.2±2.2(11.4±2.7)kg;男童左(右)手握力指数均值±标准差分别为36.1±7.3(38.9±7.5),39.1±7.7(42.3±8.0),38.7±7.9(41.2±8.7),38.5±9.6(41.0±10.0);女童则分别为35.2±8.8(36.6±8.3),36.1±6.5(38.7±6.3),37.0±7.7(40.3±8.0),37.4±7.6(41.6±9.0)。男、女童右手握力、握力指数均显著高于左手,同侧手男生握力、握力指数在各年龄段均显著高于女生(P<0.05)。随着年龄增加,男女童握力均显著增高。男生左右手握力指数及女生左手握力指数在各年龄段间差异无统计学意义。结论 初步建立了广州市6~9岁学龄儿童握力、握力指数的参考值范围。     

Prospective study of food intake and nutritional status in HIV infection

Weight loss is a common feature of Human Immunodeficiency Virus (HIV) infection. The aetiology of such weight loss is multifactorial; however the relative importance of factors involved is unknown. In order to test the hypothesis that a gross reduction of food intake is one of the factors responsible for weight loss seen in HIV disease, we prospectively measured food intake for 7 days in 11 male HIV antibody positive subjects and nine male control subjects. Anthropometric measurements were taken to assess nutritional status and fat absorption was assessed using 1–¹⁴C Triolein breath test. In the 3 months preceding the study mean weight loss was 3.9±1.2 kg. (s.e.m.) for the HIV antibody positive group. Protein and energy intakes were not significantly different between the two groups. HIV infected subjects had significantly lower mid-arm muscle circumference (MAMC) and grip strength (GS). Fat malabsorption of a minor degree was detected in only three subjects. These data suggest that constitutionally well HIV infected subjects have reduced MAMC and GS in the face of apparently adequate protein and energy intakes.     

Estimation of resting energy expenditure by anthropometry

The role of anthropometry in estimating resting energy expenditure (REE) has been assessed in 142 clinically stable patients. Ninety eight patients had cancer (54 weight stable, 44 weight losing) and 44 patients had nonmalignant illness (27 weight stable, 17 weight losing). Mid-arm muscle circumference (MAMC) measurements correlated significantly with REE measured by indirect calorimetry in each of the groups studied. Weight loss significantly affected this correlation whereas cancer did not. The correlation in weight stable patients was poorer than that in weight losing patients, possibly reflecting inaccuracy of anthropometric measurements due to subcutaneous adipose tissue. Significant correlations were also observed between mid-arm circumference (MAC) and REE, and between MAMC and whole body oxygen consumption.REE can be estimated from MAMC measurements in weight stable and weight losing patients with benign or malignant disease. This simple method may be of value in estimating REE where indirect calorimetry facilities are unavailable.     

Muscle strength and muscle endurance of middle-aged women and men associated to type,duration and intensity of muscular load at work

Summary Muscle strength and muscle endurance in groups with different occupational muscular load was studied among 60 women and 69 men. The mean age of the subjects was 52.0 ± 3.4 years. Isometric grip and trunk strength were measured on dynamometers, and dynamic muscle endurance by sit-ups. A job analysis was done with the AET method including the assessment of intensity, duration and type of muscular work of each subject. According to the job analysis, the subjects were classified into groups with low or high muscular load at work. The maximal isometric hand grip strength of women with a load classified as long duration of static or dynamic load on the hands at work was 86 and 88%, respectively of the strength of those with a load of short duration. The women with high intensity in static work had a grip strength of 86% of those with low intensity. These differences in strength among women between the high and low load groups were statistically significant (P < 0.05). No other statistically significant differences in muscle strength or muscle endurance between the high and low work load groups were found, although the high work load group had systematically the lowest muscle strength and muscle endurance in almost all comparisons. Muscle strength and muscle endurance was, however, not a discriminating factor between the group classifications of static and dynamic work. The results indicated that the muscle strength and muscle endurance of middle-aged employees was systematically lower among those with high muscular load compared to those with low load at work.     

Age-Related Variations of Muscle Mass,Strength, and Physical Performance in Community-Dwellers: Results From the Milan EXPO Survey

Objectives

Declining muscle mass and function are hallmarks of the aging process. The preservation of muscle trophism may protect against various negative health outcomes. Age- and sex-specific curves of muscle mass, strength, and function, using data from a large sample of community-dwelling people, are necessary.