Can calf circumference be a viable option for nutritional assessment in the PICU?

Association between muscular strength and sleep quality in older adults undergoing hemodialysis: a cross-sectional study

PURPOSE

Older adults undergoing hemodialysis experience improved survival rates but often suffer from sleep disorders, resulting in adverse health outcomes. This study aims to assess the association between handgrip strength (HGS), a key indicator of muscular strength, and sleep quality in older adults undergoing hemodialysis.

METHODS

This cross-sectional and analytical study assessed 150 older adults undergoing hemodialysis selected by simple randomization. Data on demographics, clinical parameters, HGS, and sleep quality (PSQI) were collected and analyzed using descriptive and inferential statistics with SPSS version 20.

RESULTS

The mean age of the participants was 65.61 ± 4.07 years. Mean mid-upper arm circumference (MUAC) and calf circumference (CC) were 29.59 cm and 36.96 cm, respectively. The mean HGS was 28.7 ± 8.55 kg, with males exhibiting higher HGS (37.72 ± 6.17 kg) than females (23.55 ± 5.38 kg). The mean PSQI score was 6.71, with 54.1% reporting poor sleep quality. Sleep quality was significantly associated with income source, underlying diseases, Charlson Comorbidity Index (CCI), BMI, MUAC, CC, HGS, and blood levels of potassium and creatinine. A moderate negative correlation (r = - 0.438, p < 0.001) was observed between HGS and PSQI scores, indicating better sleep quality with greater muscular strength. Elevated potassium levels increase the risk of poor sleep.

CONCLUSIONS

Older adults undergoing hemodialysis frequently experience poor sleep quality, which is associated with lower muscular strength. These findings highlight the importance of implementing targeted interventions, such as strength-training programs, to improve muscular strength and, consequently, sleep quality in this vulnerable population.

The Predictive and Prognostic Value of Percentage Change in Calf Circumference in Infants and Children During the First Week of Admission in the Pediatric Intensive Care Unit: A Prospective Cohort Study

Calf circumference (CC) is an easy measure of muscle loss; yet, there are limited studies in children. We aimed to assess the viability of the first-week percent change in CC as a prognostic nutritional marker. Two MUAC (mid-upper arm circumference), CC, and weight measurements were carried out: one on the first day of admission and another on the seventh day. The differences and correlations between their percent changes were examined. The possible association between CC percent change and prolonged length of hospital stay (PLOS) and in-hospital mortality was assessed. Seventy participants were enrolled with a median age of 19.5 months. The median (interquartile range [IQR]) of CC percent change was 0.54 (5.5) with significant correlations between it and each of MUAC and weight percent change (ρ = 0.928, P = .001), (ρ = 0.902, P = .001), respectively. Calf circumference percent changes were significantly more negative in children with PLOS; (P = .004). These changes seem to be viable measures of nutritional status.

Sarcopenia in long-term survivors of cancer in childhood and adolescence: A cross-sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle-bone unit

BACKGROUND

Sarcopenia, a loss of systemic skeletal muscle mass (SMM), is prevalent in childhood cancer survivors and often accompanied by increased fat mass (sarcopenic obesity [SO]). We examined whether calf muscle cross-sectional area (CSA), measured by peripheral quantitative computed tomography (pQCT), can identify sarcopenia and SO in long-term survivors of pediatric acute lymphoblastic leukemia (ALL), and explored its relationship with adjacent bone geometry.

PROCEDURES

Calf muscle CSA and CSA Z scores at the 38% tibia in 70 subjects (median survival 15 years) were compared between sexes and ALL risk group, and their association with sarcopenia and SO evaluated. Relationships between bone strength and muscle mass were assessed further using linear regression and methods described by Schoenau et al. for evaluation of a functional muscle-bone unit.

RESULTS

A calf muscle CSA Z score of less than or equal to zero is 73.81% sensitive and 84.62% specific for detecting sarcopenia defined by height-adjusted appendicular lean mass measured by dual-energy x-ray absorptiometry. No significant difference in CSA Z scores was noted between sexes or ALL risk groups; however, Z scores were markedly higher in those without SO (adjusted odds ratio 0.529, 95% confidence interval [CI]: 0.340-0.824). Ratios of calf muscle mass to height and total bone mineral content at the 38% tibia are "sufficient" and consistent with estimated reference ranges for a healthy population.

CONCLUSIONS

CSA Z scores may represent a useful clinical measure of SMM and are predictive of SO in this population. Our results are supportive of a functional muscle-bone unit in long-term survivors of pediatric ALL.

Body composition in pediatric patients

Undernutrition is highly prevalent in children who are critically ill and is associated with increased morbidity and mortality, including a higher risk of infection due to transitory immunological disorders, inadequate wound healing, reduced gut function, longer dependency on mechanical ventilation, and longer hospital stays compared with eutrophic children who are critically ill. Nutrition care studies have proposed that early interventions targeting nutrition assessment can prevent or minimize the complications of undernutrition. Stress promotes an acute inflammatory response mediated by cytokines, resulting in increased basal metabolism and nitrogen excretion and leading to muscle loss and changes in body composition. Therefore, the inclusion of body composition assessment is important in the evaluation of these patients because, in addition to the nutrition aspect, body composition seems to predict clinical prognosis. Several techniques can be used to assess body composition, such as arm measurements, calf circumference, grip strength, bioelectrical impedance analysis, and imaging examinations, including computed tomography and dual-energy x-ray absorptiometry. This review of available evidence suggests that arm measurements seem to be well-established in assessing body composition in children who are critically ill, and that bioelectrical impedance analysis with phase angle, handgrip strength, calf circumference and ultrasound seem to be promising in this evaluation. However, further robust studies based on scientific evidence are necessary.

Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review

BACKGROUND AND AIM

Undernutrition (UN) may negatively impact clinical outcomes for hospitalized patients. The relationship between UN status at pediatric intensive care unit (PICU) admission and clinical outcomes is still not well-reported. This systematic meta-analysis review evaluated the impact of UN at admission to PICU on clinical outcomes, including mortality incidence, length of stay (LOS), and the need for and length of time on mechanical ventilation (MV).

METHODS

A search was conducted using relevant and multi-medical databases from inception until January 2022. We considered studies that examined the link between UN at PICU admission and clinical outcomes in patients aged 18 years or younger. Pooled risk difference estimates for the PICU outcomes were calculated using a random-effects model.

RESULT

There were a total of 10,638 patients included in 17 observational studies; 8,044 (75.61%) and 2,594 (24.38%) patients, respectively, were normal-nourished (NN) and undernourished (UN). In comparison to NN patients, UN patients had a slightly higher risk of mortality (RD = 0.02, P = 0.05), MV usage (RD = 0.05, P = 0.02), and PICU LOS (RD = 0.07, P = 0.007). While the duration of MV was significantly longer in UN than in NN (RD = 0.13, P < 0.0001). Sensitivity analysis of UN classification cohorts with a z-score < -2 or in the 5%, patetints age up to 18 years, and mixed diagnose for PICU admission demonstrated a 6-fold increase in the probability of PICU LOS in UN patients compared to NN patients (RD = 0.06, 95% CI = 0.01, 0.12). UN patients have a higher risk of MV usage RD = 0.07, 95% CI = 0.00, 0.14) in studies involving cohorts with a mixed primary diagnosis for PICU admission.

CONCLUSION

In PICU, UN is linked to mortality incidence, longer PICU stay, MV usage, and duration on MV. The primary diagnosis for PICU admission may also influence clinical outcomes. Determining the prevalence of UN in hospitalized patients, as well as the subgroups of patients diagnosed at the time of admission, requires more research. This may help explain the relationship between nutritional status and clinical outcomes in PICU patients.