Hand Grip Strength and nutritional status in hospitalized oncological patients

STEEMBURGO, Thais; AVERBUCH, Natália Cristina; BELIN, Christy Hannah Sanini; BEHLING, Estela Beatriz

doi:10.1590/1678-98652018000500006

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Sumário

ORIGINAL ARTICLES • Rev Nutr 31 (5) • Sep-Oct 2018 • https://doi.org/10.1590/1678-98652018000500006 copy

Hand Grip Strength and nutritional status in hospitalized oncological patients

Força de Preensão Manual e estado nutricional em pacientes oncológicos hospitalizados

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate the nutritional status and functional capacity of hospitalized adult patients.

Methods

Cross-sectional study of adult oncology patients at Hospital de Clínicas de Porto Alegre. Patients were evaluated according to Solid Tumors and Hematologic Tumors. The nutritional status was obtained using Patient Generated Subjective Global Assessment, and the functional capacity was evaluated by Handgrip Strength using a Jamar^® dynamometer – and the Performance Index of the Eastern Cooperative Oncology Group.

Results

This study evaluated 76 patients (56±17 years old, 35.5% female), 63.2% with Solid Tumors and 36.8% with Hematologic Tumors. According to the Patient Generated Subjective Global Assessment, 53.9% of the patients were moderately and severely malnourished and demonstrated functional capacity, according to the Handgrip Strength and Performance Index of the Eastern Cooperative Oncology Group, of 47.9% and 32.2%, respectively. The functional capacity instruments showed a moderate agreement (Kappa=0.427, p<0.001) and positive correlation (r=0.136, p=0.028). Severely malnourished patients had a lower Handgrip Strength when compared to well nourished (24.0±10.4 vs. 34.2±16.6kg, p=0.015). The results were confirmed among moderately and severely malnourished patients, who were rated at the 40 percentile, considered low functional capacity.

Conclusion

In this study, hospitalized oncological patients presented poor nutritional status and low functional capacity. The Patient Generated Subjective Global Assessment identifies the nutritional specification earlier. In addition, Handgrip Strength dynamometry can be a useful tool to evaluate the low functional capacity and nutritional status. It can be included in cancer patient’s evaluation, along with other nutritional assessment tools.

Keywords
Handgrip Strength; Nutritional status; Hospitalized patients; Neoplasms

Nutritional status/Functional capacity	Solid Tumors (n=48)		Hematologic Tumors (n=28)		p-value
Nutritional status/Functional capacity	n	%	n	%	p-value
PG-SGA (categories) ¹ 1 number and prevalence (%)
(A)Well-nourished	19	39.6	16	57.2	0.285^* * Chi-square test for categorical variables. Statistical significance: p≤0.05. Values expressed as:
(B)Moderately malnourished	19	39.6	9	32.1
(C)Severely malnourished	10	10.8	3	10.7
PG-SGA (score) ¹ 1 number and prevalence (%)
0-1	3	6.3	2	07.1	0.433^* * Chi-square test for categorical variables. Statistical significance: p≤0.05. Values expressed as:
2-3	6	12.5	7	25.0
4-8	16	33.3	10	35.7
≥9	23	47.9	9	32.2
HGS (percentile) ¹ 1 number and prevalence (%)
≤20	14	29.2	10	35.7	0.548^* * Chi-square test for categorical variables. Statistical significance: p≤0.05. Values expressed as:
[20-40]	25	52.1	11	39.3
[40-60]	7	14.6	7	25.0
[60-80]	1	02.1	0	00.0
≥80	1	02.1	0	00.0
PS- ECOG ¹ 1 number and prevalence (%)
0	16	33.3	7	25.0	0.580^* * Chi-square test for categorical variables. Statistical significance: p≤0.05. Values expressed as:
1	18	37.5	9	32.1
2	6	12.5	7	25.0
3	7	14.6	5	17.9
4	1	02.1	0	00.0

Nutritional status/ Functional capacity	Well-Nourished (A) (n=35)	Moderately Malnourished (B) (n=28)	Severely Malnourished (C) (n=13)	p-value
PG-SGA (score)¹ 1 Mean and Standard Deviation.	4.2 ± 2.7	11.5 ± 5.5	18.0 ± 4.7	<0.001^* * ANOVA;
Maximum HGS (Kg)¹ 1 Mean and Standard Deviation.	34.2 ± 16.6	25.1 ± 10.3	24.0 ± 10.4	0.015^* * ANOVA;
Percentil <40² 2 Number and prevalence (%).	24 (40.0%)	24 (40.0%)	12 (20.0%)	0.109^* ** Chi-square test;
Percentil ≥40² 2 Number and prevalence (%).	11 (68.8%)	4 (25.0%)	1 (6.3%)	0.109^* ** Chi-square test;
PS-ECOG (index)³ 3 Median (P25–P75).	1.0 (0.0-3.0)	1.0 (0.0-4.0)	3.0 (1.0-3.0)	0.004^* ***** Kruskal-Wallis test. Statistical significance: p≤0.05. Values expressed as:
ECOG <2² 2 Number and prevalence (%).	27 (54.0%)	17 (34.0%)	6 (12.0%)	0.103^ Chi-square test;
ECOG ≥2² 2 Number and prevalence (%).	8 (30.8%)	11 (42.3%)	7 (₂₆.9%)	0.103^ Chi-square test;

HGS	Gender									Age
	Male (n=49)				Female (n=27)				p-value	<60y old (n=37)				≥60y old (n=39)				p-value
	n		(%)		n		(%)			n		(%)		n		(%)
Percentile
≤20	8		16.3		16		59.3			15		40.5		9		23.1		0.183^ Chi-square test for categorical variables. Statistical significance: p≤0.05. Values expressed as:
20-40	25		51.0		11		0.7			13		35.1		23		59.0
40-60	14		28.6		0		0.0		<0.001^ Chi-square test for categorical variables. Statistical significance: p≤0.05. Values expressed as:	7		19.0		7		17.9
60-80	1		2.0		0		0.0			1		2.7		0		0.0
≥80	1		2.0		0		0.0			1		2.7		0		0.0
	M	±		SD	M	±		SD		M	±		SD	M	±		SD
Maximum (kg)¹ 1 Mean and standard deviation; 2 Number and prevalence (%).	35.4	±		11.1	18.7	±		4.9	<0.001^* * Student's t-test;	30.0	±		14.7	29.1	±		9.1	0.807^* * Student's t-test;

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[1] Correspondência para/Correspondence to: T STEEMBURGO. E-mail: <tsteemburgo@gmail.com>.