Nina Kaegi-Braun1,2,3, Pascal Tribolet1, Annic Baumgartner1, Rebecca Fehr1, Valerie Baechli1, Martina Geiser1, Manuela Deiss1,4, Filomena Gomes1,5, Alexander Kutz6, Claus Hoess6, Vojtech Pavlicek6, Sarah Schmid7, Stefan Bilz7, Sarah Sigrist7, Michael Brändle7, Carmen Benz8, Christoph Henzen9, Robert Thomann10, Jonas Rutishauser10, Drahomir Aujesky11,12, Nicolas Rodondi11,13, Jacques Donzé14, Zeno Stanga1,5, Beat Mueller1,5, Philipp Schuetz1,5. 1. Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland. 2. Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland. 3. Faculty of Life Sciences, University of Vienna, Vienna, Austria. 4. The New York Academy of Sciences, New York City, NY, USA. 5. Medical Faculty of the University of Basel, Basel, Switzerland. 6. Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland. 7. Internal Medicine & Endocrinology/Diabetes, Kantonsspital St. Gallen, St. Gallen, Switzerland. 8. Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland. 9. Internal Medicine, Buergerspital Solothurn, Solothurn, Switzerland. 10. Internal Medicine, Kantonsspital Baselland, Baselland, Switzerland. 11. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 12. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. 13. Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. 14. Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND: Disease-related malnutrition is associated with loss of muscle mass and impaired functional status. Handgrip strength (HGS) has been proposed as an easy-to-use tool to assess muscle strength in clinical practice. OBJECTIVES: We investigated the prognostic implications of HGS in patients at nutritional risk with regard to clinical outcomes and response to nutritional support. METHODS: This was a secondary analysis of the randomized controlled, multicenter, Effect of Early Nutritional Support on Frailty, Functional Outcome, and Recovery of Malnourished Medical Inpatients Trial, which compared the effects of individualized nutritional support with usual hospital food in medical inpatients at nutritional risk. Our primary endpoint was 30-d all-cause mortality. The association between sex-specific HGS and clinical outcomes was investigated using multivariable regression analyses, adjusted for randomization, age, weight, height, nutritional risk, admission diagnosis, comorbidities, interaction terms, and study center. We used interaction terms to investigate possible effect modification regarding the nutritional support intervention. RESULTS:Mean ± SD HGS in the 1809 patients with available handgrip measurement was 17.0 ± 7.1 kg for females and 28.9 ± 11.3 kg for males. Each decrease of 10 kg in HGS was associated with increased risk of 30-d mortality (female: adjusted OR: 2.11; 95% CI: 1.23, 3.62, P = 0.007; male: adjusted OR: 1.44; 95% CI: 1.07, 1.93, P = 0.015) and 180-d mortality (female: adjusted OR: 1.45; 95% CI: 1.0, 2.10, P = 0.048; male: adjusted OR: 1.55; 95% CI: 1.28, 1.89, P < 0.001). Individualized nutritional support was most effective in reducing mortality in patients with low HGS (adjusted OR: 0.29; 95% CI: 0.10, 0.82 in patients in the ≤10th percentile compared with OR: 0.98; 95% CI: 0.66, 1.48 in patients in the >10th percentile; P for interaction = 0.026). CONCLUSIONS: In medical inpatients at nutritional risk, HGS provided significant prognostic information about expected mortality and complication risks and helps to identify which patients benefit most from nutritional support. HGS may thus improve individualization of nutritional therapy.This trial was registered at clinicaltrials.gov as NCT02517476.
RCT Entities:
BACKGROUND: Disease-related malnutrition is associated with loss of muscle mass and impaired functional status. Handgrip strength (HGS) has been proposed as an easy-to-use tool to assess muscle strength in clinical practice. OBJECTIVES: We investigated the prognostic implications of HGS in patients at nutritional risk with regard to clinical outcomes and response to nutritional support. METHODS: This was a secondary analysis of the randomized controlled, multicenter, Effect of Early Nutritional Support on Frailty, Functional Outcome, and Recovery of Malnourished Medical Inpatients Trial, which compared the effects of individualized nutritional support with usual hospital food in medical inpatients at nutritional risk. Our primary endpoint was 30-d all-cause mortality. The association between sex-specific HGS and clinical outcomes was investigated using multivariable regression analyses, adjusted for randomization, age, weight, height, nutritional risk, admission diagnosis, comorbidities, interaction terms, and study center. We used interaction terms to investigate possible effect modification regarding the nutritional support intervention. RESULTS: Mean ± SD HGS in the 1809 patients with available handgrip measurement was 17.0 ± 7.1 kg for females and 28.9 ± 11.3 kg for males. Each decrease of 10 kg in HGS was associated with increased risk of 30-d mortality (female: adjusted OR: 2.11; 95% CI: 1.23, 3.62, P = 0.007; male: adjusted OR: 1.44; 95% CI: 1.07, 1.93, P = 0.015) and 180-d mortality (female: adjusted OR: 1.45; 95% CI: 1.0, 2.10, P = 0.048; male: adjusted OR: 1.55; 95% CI: 1.28, 1.89, P < 0.001). Individualized nutritional support was most effective in reducing mortality in patients with low HGS (adjusted OR: 0.29; 95% CI: 0.10, 0.82 in patients in the ≤10th percentile compared with OR: 0.98; 95% CI: 0.66, 1.48 in patients in the >10th percentile; P for interaction = 0.026). CONCLUSIONS: In medical inpatients at nutritional risk, HGS provided significant prognostic information about expected mortality and complication risks and helps to identify which patients benefit most from nutritional support. HGS may thus improve individualization of nutritional therapy.This trial was registered at clinicaltrials.gov as NCT02517476.
Authors: Céline Bretschera; Fabienne Boesiger; Nina Kaegi-Braun; Lara Hersberger; Dileep N Lobo; David C Evans; Pascal Tribolet; Filomena Gomes; Claus Hoess; Vojtech Pavlicek; Stefan Bilz; Sarah Sigrist; Michael Brändle; Christoph Henzen; Robert Thomann; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller; Philipp Schuetz Journal: EClinicalMedicine Date: 2022-02-11