Espesura del Músculo Aductor del Pulgar para evaluación nutricional: una revisión sistemática

Pereira, Priscila Moreira de Lima; Neves, Felipe Silva; Bastos, Marcus Gomes; Cândido, Ana Paula Carlos

doi:10.1590/0034-7167-2017-0913

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 71 (6) • Nov-Dec 2018 • https://doi.org/10.1590/0034-7167-2017-0913 copiar

Espesura del Músculo Aductor del Pulgar para evaluación nutricional: una revisión sistemática

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Revisar de forma sistemática las constataciones científicas acerca de la eficacia de la medida de la Espesura del Músculo Aductor del Pulgar para evaluación nutricional de los individuos bajo diversas condiciones clínicas.

Método:

Estudio de revisión sistemática, realizado conforme la metodología Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Resultados:

Se incluyeron 13 artículos originales publicados entre 2004 y 2016. La medida se presentó asociada/correlacionada a los parámetros de evaluación del estado nutricional (peso, índice de masa corporal y Evaluación Subjetiva Global) y a los marcadores de masa muscular (como circunferencia braquial, circunferencia muscular braquial, área muscular braquial, circunferencia de la pantorrilla y masa muscular). Todas estas correlaciones fueron débiles o moderadas.

Conclusión:

La medida puede ser utilizada en diferentes poblaciones, siendo capaz de estimar el estado nutricional y la masa muscular. Sin embargo, se sugiere que se emplee de forma complementaria la evaluación nutricional, no constituyendo un parámetro único de diagnóstico/monitoreo.

Descriptores:
Antropometría; Evaluación Nutricional; Estado Nutricional; Composición Corporal; Pesos y Medidas Corporales

Quality criteria	Response
1. Have the research question and objectives been clearly described?	Yes or no
2. Have the ethical aspects been met?	Yes or no
3. Have the sample calculations and eligibility criteria, as well as the sources and methods of recruitment/selection of participants been duly presented?	Yes or no
4. Were the nutritional assessment procedures reported and consistent with national/international standards?	Yes or no
5. Was the dominance of hands (right-handed or left-handed) considered for APMT measurement?	Yes or no
6. Were the procedures for data analysis performed consistently?	Yes or no
7. Were the confounding factors controlled in the statistical analyzes?	Yes or no
8. Were the results presented clearly and interpreted correctly?	Yes or no
9. Were the limitations of the study, taking into account potential sources of bias or inaccuracy, mentioned?	Yes or no
10. Was the conclusion succinct and appropriate for the research question?	Yes or no

Author (year)	Place	Designing	Objectives	N	Characteristicsofthesample
Cortez et al (2016) ⁽²⁰⁾20 Cortez AF, Tolentino JC, Aguiar MRA, Elarrat RM, Passos RBF. Association between adductor pollicis muscle thickness, anthropometric and immunological parameters in HIV-positive patients. Clin Nutr ESPEN[Internet]. 2016[cited 2017 Dec 12];17:105-9. Available from: https://www.sciencedirect.com/science/article/pii/S2405457716302753 https://www.sciencedirect.com/science/ar...	Rio de Janeiro (RJ), Brazil	Cross-sectionalstudy	To estimate APMT and to compare it with immunological and anthropometric parameters of HIV-infected persons.	103	HIV-infected outpatients of both sexes (54.4% men), age 44.1 ± 11.9 years old.
Neves et al (2016) ⁽²¹⁾21 Neves AM, Führer CD, Almeida JCD, Hammes TO. Músculo adutor do polegar como ferramenta de avaliação nutricional em pacientes portadores do vírus da imunodeficiência humana. Clin Biomed Res[Internet]. 2016[cited 2017 Dec 12];36(4):214-21. Available from: http://seer.ufrgs.br/index.php/hcpa/article/view/66344 http://seer.ufrgs.br/index.php/hcpa/arti...	Porto Alegre (RS), Brazil	Cross-sectionalstudy	To evaluate the performance of APMT as a tool for the diagnosis of malnutrition in HIV infected patients.	48	HIV patients from a hospital emergency, of both sexes (56.2% women), age 43.0 ± 11.2 years old.
Valente et al (2016) ⁽²²⁾22 Valente KP, Silva NMF, Faioli AB, Barreto MA, Moraes RAG, Guandalini VR. Espessura do músculo adutor do polegar na avaliação nutricional de pacientes cirúrgicos. Einstein[Internet]. 2016[cited 2017 Dec 12];14(1):18-24. Available from: www.scielo.br/pdf/eins/v14n1/pt_1679-4508-eins-14-1-0018.pdf www.scielo.br/pdf/eins/v14n1/pt_1679-450...	Vitória (ES), Brazil	Cross-sectionalstudy	To evaluate the correlation of APMT with anthropometric measures, BMI and GSA in the nutritional diagnosis of surgical patients.	150	Patients candidates for surgery, of both sexes (56.0% men), age 42.7 ± 12.0 years old.
Ghorabi et al (2016) ⁽²³⁾23 Ghorabi S, Ardehali H, Amiri Z, Shariatpanahi ZV. Association of the adductor pollicis muscle thickness with clinical outcomes in intensive care unit patients. Nutr Clin Pract[Internet]. 2016[cited 2017 Dec 12];31(4):523-6. Available from: https://doi.org/10.1177/0884533615621547 https://doi.org/10.1177/0884533615621547...	Tehran, Iran	Cross-sectionalstudy	To evaluate whether APMT is useful in identifying malnutrition and in predicting clinical outcomes.	127	Patients of a ICU, of both sexes (54.3% women), age of 51.3 ± 20.4 years old.
Bielemann et al (2016) ⁽¹⁶⁾16 Murad MH, Montori VM, Loannidis JPA, Jaeschke R, Devereaux PJ, Prasad K, et al. How to read a systematic review and meta-analysis and apply the results to patient care users guides to the medical literature. JAMA[Internet]. 2014[cited 2017 Dec 12];312(2):171-9. Available from: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2014.5559 https://jamanetwork.com/journals/jama/fu...	Pelotas (RS), Brazil	Cohortstudy	To evaluate the relationship between APMT and muscle mass in a sample of adults.	3485	Adults from a 1982 birth cohort of both sexes (50.2% women).
Karst et al. (2015) ⁽²⁴⁾24 Karst FP, Monteiro R, Vieira SB. Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit. Rev Bras Ter Intensiva[Internet]. 2015[cited 2017 Dec 12];27(4):369-75. Available from: http://www.scielo.br/pdf/rbti/v27n4/en_0103-507X-rbti-27-04-0369.pdf http://www.scielo.br/pdf/rbti/v27n4/en_0...	Rio Grande do Sul, Brazil	Cross-sectionalstudy	To verify the relationship between APMT and GSA and to correlate it with other anthropometric methods.	83	Patients from the ICU of a cardiology hospital, of both sexes (62.0% men), age 68.6 ± 12.5 years old.
Gonzalez et al (2014)(25)	Pelotas (RS), Brazil	Cross-sectionalstudy	To test the validity of APMT as a nutritional parameter in hospitalized patients, using GSA as gold standard.	361	Patients hospitalized in a surgical ward of both sexes (60.2% women), age 49.6 ± 17.8 years old.
Ghorabi et al (2014) ⁽²⁶⁾26 Ghorabi S, Vahdat Shariatpanahi Z, Amiri Z. Measurement of adductor pollicis muscle thickness in a healthy population in Iran and its correlation with other anthropometric parameters. Mal J Nutr[Internet]. 2014[cited 2017 Dec 12];20(2):237-43. Available from: https://www.researchgate.net/publication/270566213_Measurement_of_Adductor_Pollicis_Muscle_Thickness_in_a_Healthy_Population_in_Iran_and_Its_Correlation_with_other_Anthropometric_Parameters https://www.researchgate.net/publication...	Tehran, Iran	Cross-sectionalstudy	To determine APMT in different age groups and to analyze its correlation with other anthropometric parameters in healthy adults.	432	Healthy adults of both sexes (65.7%women), age 37.4 ± 13.4 years old.
Pereira et al (2013) ⁽²⁷⁾27 Pereira RA, Caetano AL, Cuppari L, Kamimura MA. Adductor pollicis muscle thickness as a predictor of handgrip strength in hemodialysis patients. J Bras Nefrol[Internet]. 2013[cited 2017 Dec 12];35(3):177-84. Available from: http://www.scielo.br/pdf/jbn/v35n3/en_v35n3a03.pdf http://www.scielo.br/pdf/jbn/v35n3/en_v3...	São Paulo (SP), Brazil	Cross-sectionalstudy	To test APMT as a nutritional marker in patients undergoing hemodialysis.	73	Patients on hemodialysis, of both sexes (57.5% men), age 52.3 ± 17.0 years old.
Cobero et al (2012) ⁽²⁸⁾28 Cobero FE, Gomes MCB, Silva AP, Bernardi JLD, McLellan KCP. Adductor pollicis muscle measurement is associated with anthropometric indicator of muscle mass and fat mass of hospitalized patients. J Brazilian Soc Food Nutr[Internet]. 2012[cited 2017 Dec 12];37(2):174-82. Available from: http://fi-admin.bvsalud.org/document/view/mrzgj http://fi-admin.bvsalud.org/document/vie...	São Paulo (SP), Brazil	Cross-sectionalstudy	To verify the association of APMT with anthropometric parameters and GSA in hospitalized patients.	112	Patients hospitalized in wards of both sexes (59.8% men), age 53.0 ± 17.0 years old.
Oliveira et al (2012) ⁽¹⁸⁾18 Oliveira CMC, Kubrusly M, Mota RS, Choukroun G, Brandão Neto J, Silva CAB. Adductor pollicis muscle thickness: a promising anthropometric parameter for patients with chronic renal failure. J Ren Nutr[Internet]. 2012[cited 2017 Dec 12];22(3):307-16. Available from: https://www.jrnjournal.org/article/S1051-2276(11)00149-X/fulltext https://www.jrnjournal.org/article/S1051...	Fortaleza (CE), Brazil	Cohortstudy	To analyze, in a 12-month period of follow-up, the correlation of APMT with impedance markers, anthropometry and laboratory parameters, as well as its association with morbidit /mortality in hemodialysis patients.	143	Patients on hemodialysis, of both sexes (58.0% men), age 52.2 ± 16.6 years old.
Bragagnolo et al (2009) ⁽⁷⁾7 Bragagnolo R, Caporossi FS, Dock-Nascimento DB, Aguilar-Nascimento JE. Espessura do músculo adutor do polegar: um método rápido e confiável na avaliação nutricional de pacientes cirúrgicos. Rev Col Bras Cir[Internet]. 2009[cited 2017 Dec 12];36(5):371-6. Available from: http://www.scielo.br/pdf/rcbc/v36n5/03.pdf http://www.scielo.br/pdf/rcbc/v36n5/03.p...	Cuiabá (MT), Brazil	Cross-sectionalstudy	To correlate APMT with anthropometric, biochemical and clinical parameters in surgical patients.	87	Patients candidates for large surgery in the gastrointestinal tract hospitalized in the ward, of both sexes (51.7% women), aged 53.8 ± 15.9 years old.
Lameu et al (2004) ⁽⁵⁾5 Lameu EB, Gerude MF, Campos AC, Luiz RR. The thickness of the adductor pollicis muscle re?ects the muscle compartment and may be used as a new anthropometric parameter for nutritional assessment. Curr Opin Clin Nutr Metab Care[Internet]. 2004[cited 2017 Dec 12];7(3):293-301. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15075921 https://www.ncbi.nlm.nih.gov/pubmed/1507...	Rio de Janeiro (RJ), Brazil	Cross-sectionalstudy	Provide the first estimates of APMT in healthy individuals.	421	Healthy adults of both sexes (50.4% women), age 44.9 ± 19.4 years old.

Author (year)	APMT values (mean ± standard deviation)			Mainresults
Author (year)	Male	Female	Total	Mainresults
Cortez et al (2016) ⁽²⁰⁾20 Cortez AF, Tolentino JC, Aguiar MRA, Elarrat RM, Passos RBF. Association between adductor pollicis muscle thickness, anthropometric and immunological parameters in HIV-positive patients. Clin Nutr ESPEN[Internet]. 2016[cited 2017 Dec 12];17:105-9. Available from: https://www.sciencedirect.com/science/article/pii/S2405457716302753 https://www.sciencedirect.com/science/ar...	APMT-DH = 17.9 ± 3.9 mm. APMT-NDH = 16.7 ± 3.8 mm.	APMT-DH ^a a Statistically significant difference between genders (P <0.05); = 14.1 ± 3.8 mm. APMT-NDH ^a a Statistically significant difference between genders (P <0.05); = 12.5 ± 3.8 mm.	APMT-DH = 16.2 ± 4.3 mm. APMT-NDH = 14.8 ± 4.3 mm.	* APMT-DH showed correlations with weight (r = 0.52), BMI (r = 0.43), BC (r = 0.46), BMC (r = 0.45), BMA (r = 0.42) and WC (r = 0.32). * APMT-NDH showed correlations with weight (r = 0.48), BMI (r = 0.31), BC (r = 0.42), BMC (r = 0.40), BMA (r = 0.37) and WC (r = 0.21). * In the multiple linear regression, APMT-DH values were influenced by weight (r = 0.31) and female (r = -0.36); APMT-NDH was influenced only by the female sex (r = -0.42).
Neves et al (2016) ⁽²¹⁾21 Neves AM, Führer CD, Almeida JCD, Hammes TO. Músculo adutor do polegar como ferramenta de avaliação nutricional em pacientes portadores do vírus da imunodeficiência humana. Clin Biomed Res[Internet]. 2016[cited 2017 Dec 12];36(4):214-21. Available from: http://seer.ufrgs.br/index.php/hcpa/article/view/66344 http://seer.ufrgs.br/index.php/hcpa/arti...	APMT-RH = 10.3 ± 4.5 mm. APMT-LH = 9.9 ± 4.2 mm.	APMT-RH = 8.7 ± 4.7 mm. APMT-LH = 8.4 ± 2.4 mm.	APMT-RH = 9.6 ± 4.7 mm. APMT-LH = 8.9 ± 3.5 mm.	* APMT-RH showed correlation with current weight (r = 0.32). * APMT-LH showed correlations with current weight (r = 0.37), BMI (r = 0.32), BC (r = 0.45), BMC (r = 0.41) and BMA (r = 0.41 ). APMT values of well-nourished patients (GSA-A = 10.5 ± 3.6 mm) were higher than those at risk of malnutrition or malnourishment (GSA-B + GSA-C = 8.2 ± 3.2 mm ). APMT-RH did not differ between GSA-A (11.7 ± 6.2 mm), GSA-B (8.6 ± 3.3 mm) and GSA-C (7.9 ± 2.1 mm).
Valente et al (2016) ⁽²²⁾22 Valente KP, Silva NMF, Faioli AB, Barreto MA, Moraes RAG, Guandalini VR. Espessura do músculo adutor do polegar na avaliação nutricional de pacientes cirúrgicos. Einstein[Internet]. 2016[cited 2017 Dec 12];14(1):18-24. Available from: www.scielo.br/pdf/eins/v14n1/pt_1679-4508-eins-14-1-0018.pdf www.scielo.br/pdf/eins/v14n1/pt_1679-450...	27.4% presented the APMT-DH <13.1 mm (cut-off point for malnutrition)	56.0% presented the APMT-DH <13.1 mm (cut-off point for malnutrition).	40% presented the APMT-DH <13.1 mm (cut-off point for malnutrition).	* The nutritional status defined by APMT was associated with BMI, GSA and nutritional risk. * The APMT showed correlations with BMI (r = 0.29), BMC (r = 0.33), CBMA (r = 0.37) and CC (r = 0.32). * The variables gender, BMI, BMC and CBMA remained in the final multiple linear regression model, which explained 24.0% of the APMT value (R² = 0.238). * BMC was the variable that most influenced APMT, even after adjusting for sex, BMI and CBMA, with a reduction of 0.392 mm.
Ghorabi et al (2016) ⁽²³⁾23 Ghorabi S, Ardehali H, Amiri Z, Shariatpanahi ZV. Association of the adductor pollicis muscle thickness with clinical outcomes in intensive care unit patients. Nutr Clin Pract[Internet]. 2016[cited 2017 Dec 12];31(4):523-6. Available from: https://doi.org/10.1177/0884533615621547 https://doi.org/10.1177/0884533615621547...	NR	NR	APMT-DH = 14.5 ± 3.6 mm. APMT-NDH = 13.4 ± 3.6 mm.	APMT-DH and APMT-NDH showed correlations with BC (r = 0.62 and r = 0.59, respectively), BMC (r = 0.68 and r = 0.66, respectively) and BMA (r = 0.44 in both).
Bielemann et al (2016) ⁽¹⁶⁾16 Murad MH, Montori VM, Loannidis JPA, Jaeschke R, Devereaux PJ, Prasad K, et al. How to read a systematic review and meta-analysis and apply the results to patient care users guides to the medical literature. JAMA[Internet]. 2014[cited 2017 Dec 12];312(2):171-9. Available from: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2014.5559 https://jamanetwork.com/journals/jama/fu...	APMT-NDH = 24.2 ± 4.2 mm.	APMT-NDH ^a a Statistically significant difference between genders (P <0.05); = 19.4 ± 3.9 mm.	NR	* APMT showed correlations, in men and women, with MM obtained by DEXA (r = 0.44 and r = 0.51, respectively) and MMI (r = 0.51 and r = 0.57, respectively). * The regression coefficients of APMT in the prediction of MM were similar for men (β: 0.7, 95% CI: 0.64-0.78) and women (β: 0.71, 95% CI: 0.65- 0.76). * The APMT, in men and women, respectively, explained 19.0% and 26.0% in the MM variation, and 26.0% and 33.0% in the MMI variation.
Karst et al (2015) ⁽²⁴⁾24 Karst FP, Monteiro R, Vieira SB. Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit. Rev Bras Ter Intensiva[Internet]. 2015[cited 2017 Dec 12];27(4):369-75. Available from: http://www.scielo.br/pdf/rbti/v27n4/en_0103-507X-rbti-27-04-0369.pdf http://www.scielo.br/pdf/rbti/v27n4/en_0...	NR	NR	APMT-RH = 8,0 ± 3,0 mm APMT-LH = 7,3 ± 2,7 mm.	* APMT-RH and APMT-LH showed correlations with BMI (r = 0.45 and r = 0.44, respectively) and CC (r = 0.58 and r = 0.57, respectively). * The area under the ROC curve of the APMT-RH with GSA was 0.82 (95% CI: 0.73-0.91).
Gonzalez et al (2014) ⁽²⁵⁾25 Gonzalez MC, Duarte RRP, Orlandi SP, Bielemann RM, Barbosa-Silva TG. Adductor pollicis muscle: a study about its use as a nutritional parameter in surgical patients. Clin Nutr[Internet]. 2015[cited 2017 Dec 12];34(5):1025-9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(14)00270-2 https://linkinghub.elsevier.com/retrieve...	APMT-DH ^‡ ‡ Variable described by median(interquartile range); : GSA-A 23.0 mm (21.0- 25.0 mm); GSA-B = 18.0 mm (16.0-20.0 mm); GSA-C = 17.0 mm (15.0-18.0 mm). APMT-NDH ^‡ ‡ Variable described by median(interquartile range); : GSA-A = 22.0 mm (20.0-25.0 mm); GSA-B = 18.0 mm (16.0-20.0 mm); GSA-C = 16.0 mm (12.0-18.0 mm).	APMT-DH ^‡ ‡ Variable described by median(interquartile range); : GSA-A 26.0 mm (25.0 - 28.0 mm); GSA-B = 19.5 mm (16.5-22.0 mm); GSA-C = 18.0 mm (15.0-20.0 mm). APMT-NDH ^‡ ‡ Variable described by median(interquartile range); : GSA-A = 25.0 mm (24.0-28.0 mm); GSA-B = 18.0 mm (15.5-20.0 mm); GSA-C = 16.0 mm (15.0-20.0 mm).	NR	* APMT-DH and APMT-NDH showed correlations with age (r = -0.28 in both), weight (r = 0.52 and r = 0.56, respectively), height (r = 0.19 and r = 0.18, respectively ), BMI (r = 0.44 and r = 0.50, respectively) and GSA (r = -0.61 and r = -0.60, respectively).
Ghorabi et al (2014) ⁽²⁶⁾26 Ghorabi S, Vahdat Shariatpanahi Z, Amiri Z. Measurement of adductor pollicis muscle thickness in a healthy population in Iran and its correlation with other anthropometric parameters. Mal J Nutr[Internet]. 2014[cited 2017 Dec 12];20(2):237-43. Available from: https://www.researchgate.net/publication/270566213_Measurement_of_Adductor_Pollicis_Muscle_Thickness_in_a_Healthy_Population_in_Iran_and_Its_Correlation_with_other_Anthropometric_Parameters https://www.researchgate.net/publication...	APMT-DHb = 14.6 ± 3.2 mm. APMT-NDHb = 13.7 ± 3.2 mm.	APMT-DH ^a a Statistically significant difference between genders (P <0.05); ^,b = 11.2 ± 2.4 mm. APMT-NDH ^a a Statistically significant difference between genders (P <0.05); ^,b = 10.2 ± 2.4 mm.	NR	* APMT-DH and APMT-NDH showed correlations with weight (r = 0.60 in both), BMI (r = 0.46 er = 0.45, respectively), BC (r = 0.51 and r = 0.52, respectively), BMC ( r = 0.46 in both), BMA (r = 0.47 in both) and bone complexion (r = 0.57 and r = 0.56 respectively). *The APMT was progressively increased according to bone complexion and presented association with age: the value of APMT increased progressively up to 65 years, followed by a significant reduction above that age.
Pereira et al (2013) ⁽²⁷⁾27 Pereira RA, Caetano AL, Cuppari L, Kamimura MA. Adductor pollicis muscle thickness as a predictor of handgrip strength in hemodialysis patients. J Bras Nefrol[Internet]. 2013[cited 2017 Dec 12];35(3):177-84. Available from: http://www.scielo.br/pdf/jbn/v35n3/en_v35n3a03.pdf http://www.scielo.br/pdf/jbn/v35n3/en_v3...	APMT ^† † the APMT measurement was performed on the arm without vascular access; = 10.8 ± 4.9 mm.	APMT ^† † the APMT measurement was performed on the arm without vascular access; = 9.0 ± 3.7 mm.	APMT ^† † the APMT measurement was performed on the arm without vascular access; = 10.0 ± 4.5 mm.	* The APMT showed correlations with age (r = -0.32), hand grip strength (r = 0.40), serum albumin (r = 0.27), cell mass (r = 0.40), reactance (r = 0.27) and phase angle (r = 0.38). * There were no correlations with GSA,, weight, BMI, BC, BMC, BMA, MM and serum creatinine. * In the linear regression analysis adjusted for sex, age and time on hemodialysis, APMT was a predictor of manual grip strength (r = 0.59).
Cobero et al (2012)(28)	NR	NR	APMT-DH = 12,4 ± 5,1 mm.	* The APMT showed correlations with current weight (r = 0.24), BMI (r = 0.20), TSF (r = 0.24), CB (r = 0.22) and CC (r = 0.26).
Oliveira et al (2012)(18)	APMT ^† † the APMT measurement was performed on the arm without vascular access; = 12.3 ± 1.5 mm.	APMT ^† † the APMT measurement was performed on the arm without vascular access; ^a a Statistically significant difference between genders (P <0.05); = 11.2 ± 1.5 mm.	APMT ^† † the APMT measurement was performed on the arm without vascular access; = 11.9 ± 1.6 mm.	* The APMT showed correlations with BMI (r = 0.37), BC (r = 0.44), BMC (r = 0.49), BMA (r = 0.45), percentage of cell mass (r = 29), phase angle (r = 0.40), resistance (r = -0.403), creatinine (r = 0.23) and albumin (r = 0.21).
Bragagnolo et al (2009)(7)	NR	NR	APMT-DH = 12.6 ± 3.2 mm. APMT-NDH = 12.2 ± 2.9 mm.	* APMT showed correlation with BMI, CB, TSF, and BMC (r values were not reported). * The APMT of the patients classified with GSA-A was higher than those with GSA-B and GSA-C. * In the APMT ROC curves for the identification of protein-energy malnutrition, the sensitivity was 72.4% for the APMT-DH (cu-toff point = 13.4 mm) and 77.3% for the APMT-NDH (cu-toff point = 13, 1 mm); the specificity was 100% for both. *The APMT classification in both hands presented associations with current weight, BMI, BC, TSF and BMC.
Lameu et al (2004)(5)	APMT-DH = 12.5 ± 2.9 mm.	APMT-DH ^a a Statistically significant difference between genders (P <0.05); = 10.5 ± 2.3 mm.	APMT-DH = 11.5 ± 2.8 mm.	* The APMT showed correlations with BMI (r = 0.40), BMC (r = 0.42), BMS (r = 0.40), and CC (r = 0.36) but were not correlated with fat, such as TSF and BFA * APMT presented an association with age: APMT increased progressively to 46-65 years, followed by a significant reduction over 65 years..

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[1] CORRESPONDING AUTHOR: Priscila Moreira de Lima Pereira. E-mail: priscilamlp_jf@hotmail.com