Adductor pollicis muscle: Reference values of its thickness in a healthy population

Complementarity of nutrition screening with Global Leadership Initiative on Malnutrition criteria for diagnosing malnutrition in critically ill patients: A comparison study of Nutritional Risk Screening 2002 and modified Nutrition Risk in the Critically Ill Score

BACKGROUND AND AIM

Critical illness induces hypermetabolism and hypercatabolism, increasing nutrition risk (NR). Early NR identification is crucial for improving outcomes. We assessed four nutrition screening tools (NSTs) complementarity with the Global Leadership Initiative on Malnutrition (GLIM) criteria in critically ill patients.

METHODS

We conducted a comparative study using data from a cohort involving five intensive care units (ICUs), screening patients for NR using NRS-2002 and modified-NUTRIC tools, with three cutoffs (≥3, ≥4, ≥5), and malnutrition diagnosed by GLIM criteria. Our outcomes of interest included ICU and in-hospital mortality, ICU and hospital length of stay (LOS), and ICU readmission. We examined accuracy metrics and complementarity between NSTs and GLIM criteria about clinical outcomes through logistic regression and Cox regression. We established a four-category independent variable: NR(-)/GLIM(-) as the reference, NR(-)/GLIM(+), NR(+)/GLIM(-), and NR(+)/GLIM(+).

RESULTS

Of the 377 patients analyzed (median age 64 years [interquartile range: 54-71] and 53.8% male), NR prevalence varied from 87% to 40.6%, whereas 64% presented malnutrition (GLIM criteria). NRS-2002 (score ≥4) showed superior accuracy for GLIM-based malnutrition. Multivariate analysis revealed mNUTRIC(+)/GLIM(+) increased >2 times in the likelihood of ICU and in-hospital mortality, ICU and hospital LOS, and ICU readmission compared with the reference group.

CONCLUSION

No NST exhibited satisfactory complementarity to the GLIM criteria in our study, emphasizing the necessity for comprehensive nutrition assessment for all patients, irrespective of NR status. We recommend using mNUTRIC if the ICU team opts for nutrition screening, as it demonstrated superior prognostic value compared with NRS-2002, and applying GLIM criteria in all patients.

Low-cost and fast-performing indicators of muscle mass loss are good predictors of clinical outcomes in hospitalized patients: A longitudinal observational study

BACKGROUND

"Gold standard" methods for muscle mass (MM) assessment are expensive and difficult to use in clinical practice. The present study aimed to evaluate the association between easy-to-apply and low-cost indicators of MM and clinical outcomes in hospitalized patients.

METHODS

In this cohort study, calf circumference [CC], adductor pollicis muscle thickness [APMT], midarm muscle circumference [MAMC], and arm muscle area [AMA] were measured within 48 h of admission to detect MM loss, and it was also evaluated by physical examination. Patients were followed up until discharge for collection of in-hospital death and length of hospital stay (LOS) data, and they were contacted by phone to assess hospital readmission and mortality at 6 months after discharge.

RESULTS

We evaluated 601 patients (55.8 ± 14.8 years). Moderate/severe loss of MM (hazard ratio [HR], 4.12; 95% CI, 1.26-13.49), low CC (HR, 3.67; 95% CI: 1.07-12.55), low MAMC (HR, 5.20; 95% CI, 1.48-18.35), and low AMA (HR, 14.28; 95% CI, 1.80-113.14) were predictors of in-hospital mortality. Moderate/severe loss of MM was a predictor of prolonged LOS (odds ratio [OR], 2.27; 95% CI, 1.53-3.36), hospital readmission (OR, 4.14; 95% CI, 1.26-13.55), and mortality at 6 months (OR, 3.20; 95% CI, 1.71-6.01). Low CC (OR, 2.49; 95% CI, 1.27-4.85) and low APMT (OR, 3.22; 95% CI, 1.56-6.66) were associated with death 6 months after discharge.

CONCLUSION

Easy-to-apply and low-cost indicators of MM were associated with negative clinical outcomes and should be part of nutrition assessment in hospitals.

Metabolic syndrome and unfavorable outcomes on body composition and in visceral adiposities indexes among early breast cancer women post-chemotherapy

PURPOSE

The study objected to investigate potential changes in metabolic, dietary, and nutritional status in women with stages I-III breast cancer exposed to chemotherapy.

METHODS

Women who were starting chemotherapy with no previous treatment were recruited. Anthropometrics, bioelectrical impedance analysis, handgrip strength, blood pressure and blood sample were collected. Visceral adiposity index and lipid accumulation product were calculated. Dietary intake was evaluated, and the multiple source methods program was applied. Metabolic syndrome (MetS) was assessed following the NCEP-ATP III criteria (defined as 3 of 5 components of MetS). All data were collected at 2-time points: diagnosis (T0) and after 1 month of completion of therapy (T1). Mean, standard deviation, percentage, and ANOVA in SAS Studio® were used to explore the results.

RESULTS

61 women were included. We did not find any changes in anthropometrics and body composition. However, phase angle, extracellular water (EX) and ratio EX to total body water had expressive changes (p < 0.001). The results showed changes in lipid profile (p < 0.001), and greater unfavorable outcomes on adiposities index (p < 0.001). At the end of the study, 68,8% (N = 42) of the women developed MetS post-chemotherapy.

CONCLUSION

We have found supporting evidence for chemotherapy treatment resulting in worsening of nutritional markers, lipid profile and adiposity markers. After chemotherapy part of the sample developed MetS, even without changes in body weight, fat mass, and food intake. Breast cancer patients may benefit from targeted interventions before starting chemotherapy to prevent MetS post-treatment, and therefore reduce the risk of cardiovascular disease. Further investigation into this theme is needed.

Accuracy of three tools for malnutrition diagnosis in hospitalised patients: Comparison to subjective global assessment

BACKGROUND

Malnutrition is prevalent in hospital, and the Subjective Global Assessment (SGA) has been widely used for its identification. However, in the last decade, new tools were proposed by the Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition (AND-ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM). The diagnostic test accuracy of these tools has been scarcely investigated. Thus, we aimed to compare the accuracy of AND-ASPEN, ESPEN and GLIM for malnutrition diagnosis in hospitalised patients.

METHODS

A cross-sectional study was conducted with hospitalised patients aged ≥ 18 years from a five-unit complex hospital. Malnutrition was diagnosed within 48 h of admission using SGA, AND-ASPEN, ESPEN and GLIM. The accuracy of these tools was evaluated by the area under the receiver operating characteristic (AUROC) curve, considering SGA as reference, which was compared by the DeLong test.

RESULTS

Six hundred patients (55.7 ± 14.8 years, 51.3% male) were evaluated. AND-ASPEN [AUROC 0.846; 95% confidence interval (CI) = 0.810-0.883] and GLIM presented a satisfactory accuracy (AUROC 0.842; 95% CI, 0.807-0.877), whereas ESPEN had a substantially lower accuracy (AUROC, 0.572; 95% CI, 0.522-0.622). The AUROC of AND-ASPEN and GLIM were not different from each other (p = 0.785) and both had significantly higher accuracy than ESPEN (p < 0.001). AND-ASPEN and GLIM presented sensitivity, specificity and negative predictive value > 80%, whereas ESPEN sensitivity was < 20%.

CONCLUSIONS

AND-ASPEN and GLIM were accurate methods for diagnosing malnutrition and could be applied in hospitalised patients. By contrast, the ESPEN criteria had unsatisfactory accuracy.

GLIM criteria for malnutrition diagnosis of hospitalized patients presents satisfactory criterion validity: A prospective cohort study

BACKGROUND & AIMS

Malnutrition is prevalent among hospitalized patients, but there is no universally accepted consensus regarding its diagnosis. Recently, the Global Leadership Initiative on Malnutrition (GLIM) proposed a new framework for the malnutrition diagnosis and until this moment there is scarce evidence regarding its validity. This study aimed to evaluate the concurrent and predictive validity of GLIM criteria for malnutrition diagnosis in hospitalized patients.

METHODS

Prospective cohort study involving adult/elderly hospitalized patients. The malnutrition diagnoses according to Subjective Global Assessment (SGA) and GLIM criteria were performed within 48 h of admission. Patients were followed up until hospital discharge to assess the length of hospital stay (LOS) and in-hospital mortality. Six months post discharge; the patients were contacted to collect the outcomes readmission and death. Agreement and accuracy tests, Cox and Logistic regression analysis were performed for testing criterion validity.

RESULTS

601 patients (55.7 ± 14.8 years, 51.3% men) were evaluated. Malnutrition was diagnosed in 33.9% and 41.6% of patients, by SGA and GLIM criteria, respectively. GLIM criteria presented a satisfactory accuracy, (AUC = 0.842; CI95% 0.807-0.877) with a sensitivity of 86.6%, and a specificity of 81.6%. The presence of malnutrition by GLIM criteria increased the chance of prolonged hospitalization by 1.76 (CI95% 1.23-2.52) times, and the risk of in-hospital deaths by 5.1 (CI95% 1.14-23.14) times. It was also associated with death within six months (RR = 3.96, CI95% 1.49-10.53).

CONCLUSION

GLIM criteria for malnutrition diagnosis presented satisfactory criterion validity and should be applied during clinical practice.

Low Muscle Mass Is a Predictor of Malnutrition and Prolonged Hospital Stay in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Longitudinal Study

BACKGROUND

Malnutrition in chronic obstructive pulmonary disease (COPD) patients is more prevalent during times of exacerbation. Fat-free mass index (FFMI), calf circumference (CC), and adductor muscle pollicis thickness (AMPT) can be used to identify reduced muscle mass and have been found to be good predictors of clinical outcomes in other conditions, but they have not been investigated in COPD. Therefore, this study evaluated low muscle mass as predictor of malnutrition, prolonged length of stay (LOS), and in-hospital death in COPD patients.

METHODS

This prospective cohort study was carried out in hospitalized patients with COPD exacerbation. Malnutrition diagnosis was performed by Subjective Global Assessment, and muscle mass was assessed by FFMI, calculated using fat-free mass from bioelectrical impedance, CC, and AMPT. Clinical outcomes (LOS and in-hospital death) were collected from records.

RESULTS

One hundred seventy-six patients were included (68.2 ± 10.4 years old, 56.2% women); 74.2% were classified as Global Initiative of Chronic Obstructive Lung Disease 2 or 3 and 58.2% as malnourished. The median LOS was 11 (7-19) days, and the incidence of death was 9.1%. Low FFMI and CC predicted malnutrition (low CC: odds ratio [OR], 4.6; 95% CI, 2.2-9.7 and low FFMI: OR, 8.8; 95% CI, 3.7-20.8) and were associated with prolonged LOS (low CC: OR, 2.3; 95% CI, 1.1-4.6 and low FFMI: OR, 2.5; 95% CI, 1.3-4.8).

CONCLUSION

Simple, inexpensive, and noninvasive parameters of muscle mass-FFMI and CC-are good predictors of malnutrition and prolonged LOS in COPD patients experiencing exacerbation.

Ultrasonography and Other Nutrition Assessment Methods to Monitor the Nutrition Status of Critically Ill Patients

BACKGROUND

This study aims to evaluate the use of ultrasonography (US) as an instrument to assess the quadriceps muscles in patients admitted to intensive care units (ICUs), comparing the evolution of US-assessed mass muscle to other nutrition methods.

METHODS

We conducted a prospective observational study of adult patients aged ≥18 years admitted to an ICU of the Hospital das Clínicas in Brazil. Quadriceps muscle measurements were performed by US, and adductor pollicis muscle thickness and arm, calf, and thigh circumferences were measured at admission and every 2 days within the first week. Nutrition status was assessed at baseline by using the Subjective Global Assessment and the Global Leadership Initiative on Malnutrition criteria. Mechanical ventilation time, length of hospital and ICU stay, and mortality were recorded.

RESULTS

Sixty patients were included. Reductions in quadriceps thickness and rectus femoris cross-sectional area were observed at landmarks two-thirds reduction of both measurements from days 1 and 3 to days 5 and 7 (P = .017 and P = .000, respectively). The mid arm circumference (MAC) was reduced. Malnourished patients had lower initial muscle mass. However, muscle mass loss was similar between nourished and malnourished individuals (P > .005). Clinical outcomes were not impacted by muscle loss.

CONCLUSIONS

US muscle mass assessment was able to detect short-term changes in critically ill patients but must be used with caution. MAC was also identified as a useful follow-up tool.

Nutritional diagnosis of patients with hepatocellular carcinoma: what is the best method?

Introduction

Introduction: malnutrition is a frequent finding among cancer patients. Despite its prognostic significance, there are still few studies evaluating the nutritional status of patients with hepatocellular carcinoma (HCC). Objectives: to evaluate the nutritional status of patients with HCC by different methods. Methods: patients with HCC were evaluated in an outpatient clinic at the Hospital Santa Casa de Misericórdia de Porto Alegre. The methods used for the nutritional assessment were body mass index (BMI), tricipital skinfold (TSF), arm circumference (AC), arm muscle circumference (AMC), hand grip strength (HGS), adductor pollicis muscle (APM), patient-generated subjective global assessment (PG-SGA) and phase angle (PA). Results: forty-three patients with HCC were evaluated; all of them were cirrhotic. The mean age was 64.0 ± 5.8 years and the prevalent gender was male (72.1%). APM, PA, PG-SGA and AMC were the most sensitive methods for the diagnosis of malnutrition. There was a negative correlation between TSF and Child-Pugh score (p = 0.004) and a positive correlation between APM and BCLC stage (Barcelona Clinic Liver Cancer Group) (p = 0.006). Conclusions: there was high variation in the diagnosis of malnutrition among the methods studied. APM, AMC, PA and PG-SGA can be indicated as tools of choice in the nutritional assessment of the HCC patient because they were the most sensitive methods in the diagnosis of malnutrition. TSF and APM correlate with disease severity.

Association of Adductor Pollicis Muscle Thickness and Handgrip Strength with nutritional status in cancer patients

BACKGROUND AND AIM

Malnutrition is common in patients with cancer, and its early diagnosis can reduce or prevent further complications and improve the clinical and nutritional prognosis. Adductor Pollicis Muscle Thickness (APMT) and Handgrip Strength have been explored in this population to identify a reduction in strength and muscle mass prior to the use of conventional methods. We aimed to correlate APMT and Handgrip Strength with conventional anthropometric variables in cancer patients and verify their association with nutritional status as determined by the Patient-Generated Subjective Global Assessment (PG-SGA).

METHODS

A cross-sectional study was conducted with 80 patients diagnosed with cancer who were candidates for surgery. Nutritional status was obtained from the PG-SGA. Conventional anthropometric measurements were taken, as well as APMT and Handgrip Strength. Pearson's correlation analysis and multivariate linear regression were applied to detect the influence of variables on APMT and HGS. A significance level of 5.0% was considered.

RESULTS

A high prevalence of malnutrition and the need for dietotherapic intervention was found, identified by the PG-SGA. Correlations between APMT and Handgrip Strength with anthropometric variables and with the PG-SGA score were observed. After regression adjustments, the variables that interacted with APMT were TSF and AC, and the PG-SGA score, corrected Muscle Arm Area (CAMA), and age interacted with Handgrip Strength.

CONCLUSION

Correlations between anthropometric measurements and the PG-SGA score with APMT and Handgrip Strength were observed, even after adjusting for age and sex. These associations demonstrate that APMT and Handgrip Strength can be used with criterion in patients with cancer as complementary methods to evaluate nutritional risk and the need for nutritional intervention.

Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment

INTRODUCTION

Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index.

RESULTS

We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively.

CONCLUSION

TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.

Adductor Pollicis Muscle Thickness for nutritional assessment: a systematic review

OBJECTIVE

The aim of this study is to systematically review the scientific findings about the efficacy of the measure of the Adductor Pollicis Muscle Thickness for nutritional assessment of individuals in various clinical conditions.

METHOD

Systematic review study performed according to the methodology Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

13 original articles published between 2004 and 2016 were included. The measure was associated/correlated to parameters of nutritional status (such as weight, body mass index and Global Subjective Assessment) and muscle mass markers (such as circumference brachial muscle circumference, brachial muscle area, calf circumference, and muscle mass). All these correlations were weak or moderate.

CONCLUSION

The measurement can be used in different populations, being able to estimate nutritional status and muscle mass. However, it is suggested that it be used in a complementary way to the nutritional evaluation, not constituting a single diagnostic/monitoring parameter.

Use of adductor pollicis muscle thickness in hospitalized or ambulatory patients: a systematic review

Objective:

to analyze the use of the Adductor Pollicis Muscle Thickness (APMT) as an anthropometric parameter and prognostic indicator in hospitalized or ambulatory patients.

Method:

systematic review carried out the Web of Science, SCOPUS and Lilacs databases.

Results:

Twenty-three studies were performed on critical, surgical, oncological, nephropathic and hepatopathic patients, collecting data on bibliographic reference, study site, objectives, number of patients, age group, methodology, main results and conclusion. APMT proved to be a good anthropometric parameter for evaluation of nutritional status in critical patients without edema, and surgical, oncological and nephropathic patients, but presented poor performance for diagnosis of malnutrition in hepatopathic patients. It was a good prognostic indicator for mortality in critical, nephropathic and oncological patients, and also a good predictor of hospitalization in nephropathic patients. There was an association with neurological complications in Hepatic Encephalopathy (HE) in the case of hepatophatic patients, but it was not a predictor of postoperative complications in surgical patients.

Conclusion:

APTM was considered a good anthropometric parameter in most clinical conditions, except in patients with liver disease and a good prognostic indicator for mortality in critical, oncological and nephropathic patients, and a predictor of neurological complications in HE. Further prognostic investigation, standardization of cutoff points and evaluation of sensitivity and specificity are required.

ADDUCTOR POLLICIS MUSCLE THICKNESS AND PREDICTION OF POSTOPERATIVE MORTALITY IN PATIENTS WITH STOMACH CANCER

Background:

Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment

Aim:

To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality

Methods:

Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile

Results:

APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007)

Conclusion:

APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

Thickness of the adductor pollicis muscle: Accuracy in predicting malnutrition and length of intensive care unit stay in critically ill surgical patients: Thickness of the adductor pollicis muscle in surgical critically patients

BACKGROUNDS & AIMS

new techniques for assessment of nutritional status of critically ill and surgical patients have been investigated to overcome inherent limitations of conventional method. The current study aimed to evaluate the ability of thickness of the adductor pollicis muscle (TAPM) in detecting malnutrition and predicting morbidity and mortality in critically ill surgical patients.

METHODS

cohort study of adult patients, assessed within the 48 h of admission to the surgical intensive care unit (ICU) of a public hospital. TAPM measurements of the non-dominant hand were performed with patients lying supine. TAPM values lower than the 5th percentile for age and sex were adopted to identify malnutrition. Patients were followed up until discharge for measurement of the following parameters: length of ICU stay, time on mechanical ventilation, length of hospital stay, and hospital mortality.

RESULTS

fifty-nine surgical ICU patients, with mean age of 60.0 ± 17.4 years were included in the current study. There was a positive, weak-to-moderate correlation between TAPM and anthropometric indicators (r = 0.338 to r = 0.579; p < 0.01). The ability of TAPM in identifying patients with malnutrition (diagnosed by global subjective assessment) was assessed by ROC curve analysis, and an area under the ROC curve of 0.611 (95%CI: 0.459-0.762; p = 0.151) was found. TAPM < p5 increased the risk of ICU length of stay >3 days (RR = 2.92; 95%CI 1.09-7.81; p = 0.032). Relative frequencies of malnourished and well-nourished patients according to TAPM were not different between survivors and non-survivors (p = 0.814).

CONCLUSION

TAPM showed unsatisfactory accuracy in predicting malnutrition. Although TAPM was not a good mortality predictor, reduced TAPM (< p5) values increased the risk of a prolonged ICU stay (>3 days).

Thickness of the adductor pollicis muscle in nutritional assessment of surgical patients

Objective

To evaluate the correlation between thickness of the muscle adductor pollicis and anthropometric measurements, body mass index and Subjective Global Assessment in the nutritional assessment of surgical patients.

Methods

The study population comprised patients admitted to the general and reconstructive surgery unit of a university hospital in the city of Vitória (ES), Brazil. The inclusion criteria were patients evaluated in the first 48 hours of admission, aged ≥20 years, hemodynamically stable, with no edema or ascites. Data analysis was performed using the software Statistical Package for Social Science 21.0, significance level of 5%.

Results

The sample consisted of 150 patients that were candidates to surgery, mean age of 42.7±12.0 years. The most common reasons for hospitalization were surgical procedures, gastrintestinal diseases and neoplasm. Significant association was observed between thickness of adductor pollicis muscle and Subjective Global Assessment (p=0.021) and body mass index (p=0.008) for nutritional risk. Significant correlation was found between thickness of adductor pollicis muscle and arm muscle circumference, corrected arm muscle area, calf circumference and body mass index. There were no significant correlations between thickness of adductor pollicis muscle and triceps skinfold and age.

Conclusion

The use of thickness of adductor pollicis muscle proved to be an efficient method to detect malnutrition in surgical patients and it should be added to the screening process of hospitalized patients, since it is easy to perform, inexpensive and noninvasive.

Association between adductor pollicis muscle thickness, anthropometric and immunological parameters in HIV-positive patients

BACKGROUNDS AND AIMS

Involuntary weight loss and muscle mass loss among HIV-positive patients are only detectable in late stages, leading poor life quality. The reduction of adductor pollicis muscle thickness (APMT) can be easily and earlier uncovered in those cases. The purpose was to estimate APMT and compare it with immunological and anthropometric parameters of HIV-infected people.

METHODS

A crosssectional study was carried out in an University Hospital including 103 HIV-infected outpatients by subjective global assessment (SGA). Data were compared to APMT for the whole sample and between gender in univariate analysis. Besides that, simple correlation and multiple linear regression were done to check the APMT relation with gender, age, weight body, body mass index, arm circumference, CD4, CD8 and viral load.

RESULTS

The APMT average values of the dominant hand (16.2 ± 4.2 mm) and non-dominant hand (14.8 ± 4.3 mm) were lower than in the healthy population. Through stratified analysis by gender, it was found significant difference in weight, arm muscle circumference, arm muscle area, triceps skinfold thickness and arm fat area (p < 0,01 for each). In any age group, men had significantly higher dominant and non-dominant APMT values than women (p < 0.001). Although the fair correlation among cited variables and APMT of both hands, there were no correlation and no difference between the genders in regards to immunological markers (CD4, CD8 and viral load). In a prediction model to APMT values, gender was determinant in multiple linear regression.

CONCLUSIONS

In a well-nourished HIV sample by SGA with adequate CD4 counts, APMT measures of both hands were lower than in healthy people. In both hands, APMT were positively correlated with weight and male, regardless of other anthropometric data and immunologic factors.

Is adductor pollicis muscle thickness a good predictor of lean mass in adults?

BACKGROUND & AIMS

Lean mass (LM) is an important parameter in clinical outcomes, which highlights the necessity of reliable tools for its estimation. The adductor pollicis muscle thickness (APMT) is easily accessible and suffers minimal interference from the adjacent subcutaneous fat tissue.

OBJECTIVE

To assess the relationship between the APMT and LM in a sample of Southern Brazilian adults.

METHODS

Participants were adults from the 1982 Pelotas (Brazil) Birth Cohort. LM was measured by dual energy X-ray absorptiometry (DXA). LM and lean mass index (LMI - LM divided by the square of height - kg/m(2)) were the outcomes. APMT was measured using a skinfold caliper. The mean of three measurements in the non-dominant hand was used in the analyses. APMT was described according to socio-demographic characteristics and nutritional status. The relationship between APMT and both LM and LMI was evaluated by correlation coefficient and linear regression using APMT as a single anthropometric parameter and also in addition to BMI.

RESULTS

APMT was assessed in 3485 participants. APMT was higher in males, non-whites, less-schooled and obese individuals. APMT was moderately correlated to LM and LMI (ranged from 0.44 to 0.57). Correlation coefficients were higher for LMI as outcome and in females (LM: 0.51 and LMI: 0.57). APMT explained 19% and 26% of the variance in LM in males and females, respectively, whereas it explained 26% and 33% of the variance in LMI. APMT increased the prediction for LM in 3 and 4 percentage points in males and females, in comparison to explained by BMI. BMI explained 48% and 59% of the variance of LMI in males and females whereas APMT increased it to 51% and 62% for both sexes, respectively.

CONCLUSIONS

Results were not good enough to promote the APMT as a single predictor of LM or LMI in epidemiological studies. APMT has a little predictive capacity in estimating LM or LMI when BMI is also considered.

Relationship between adductor pollicis muscle thickness and subjective global assessment in a cardiac intensive care unit

OBJECTIVE

To verify the relationship between the adductor pollicis muscle thickness test and the subjective global assessment and to correlate it with other anthropometric methods.

METHODS

This observational cross-sectional study was conducted in the intensive care unit of a cardiology hospital in the state of Rio Grande do Sul, Brazil. The hospitalized patients underwent subjective global assessment and adductor pollicis muscle thickness tests on both hands, along with measurement of the right calf circumference. Laboratory parameters, length of stay, vital signs and electronic medical record data and tests were all collected.

RESULTS

The study population included 83 patients, of whom 62% were men. The average age was 68.6 ± 12.5 years. The most common reason for hospitalization was acute myocardial infarction (34.9%), and the most common pathology was systolic blood pressure (63.9%), followed by diabetes mellitus (28.9%). According to subjective global assessment classifications, 62.7% of patients presented no nutritional risk, 20.5% were moderately malnourished and 16.9% were severely malnourished. Women had a higher nutritional risk, according to both the subjective global assessment and the adductor pollicis muscle thickness test, the cutoff for which was < 6.5mm (54.8%; p = 0.001). The pathology presenting the greatest nutritional risk was congestive heart failure (p = 0.001). Evaluation of the receiver operating characteristic (ROC) curve between adductor pollicis muscle thickness and subjective global assessment showed the accuracy of the former, with an area of 0.822.

CONCLUSION

Adductor pollicis muscle thickness proved to be a good method for evaluating nutritional risk.

Adductor pollicis muscle as predictor of malnutrition in surgical patients

BACKGROUND

In the compromised nutritional status, there is excessive skeletal muscle loss and decreased inflammatory response, contributing to increased morbidity and mortality and length of stay.

AIM

To estimate the prevalence of malnutrition by measuring adductor pollicis muscle using cutoffs for surgical patients suggested in the literature.

METHODS

Cross-sectional study with 151 patients scheduled for elective surgical procedure. Nutritional assessment was performed by classical anthropometric measurements: arm circumference, triceps skinfold thickness, arm muscle circumference, corrected arm muscle area, BMI and percentage of weight loss and the extent of the adductor pollicis muscle in both hands.

RESULTS

The prevalence of malnutrition in patients was high. A significant association between nutritional diagnosis according to the measures of adductor pollicis muscle and arm circumference, BMI and triceps skinfold thickness but there was no association with arm muscular circumference, arm muscular area or percentage of weight loss.

CONCLUSION

The adductor pollicis muscle has proved to be a good method to diagnose muscle depletion and malnutrition in surgical patients.

Adductor pollicis muscle: A study about its use as a nutritional parameter in surgical patients

BACKGROUND & AIMS

Body composition is important to identify malnutrition, and several anthropometric measurements are used to estimate muscle mass in the clinical practice. This study aimed to assess the adductor pollicis muscle thickness (APMT), its covariates and association with malnutrition in hospitalized surgical patients.

METHODS

APMT was measured in 361 surgical patients in both dominant (DAPMT) and non-dominant (NDAPMT) sides. APMT values below the 5th percentile of reference values provided by a healthy population were considered as malnourished. Nutritional status was assessed by Subjective Global Assessment (SGA). The difference in APMT values among nutritional status categories was evaluated, and the association between malnutrition by SGA and APMT was estimated using multivariate linear regression. Sensitivity, specificity and positive and negative predictive values were also calculated.

RESULTS

Most patients were women (60.4%). APMT values were significantly different among SGA categories. Well-nourished patients had APMT values significantly higher compared to the ones with moderate or severe malnutrition by SGA, with no significant difference between APMT values in moderate or severe malnourished patients. Statistically significant associations between both DAPMT and NDAPMT below the 5th percentile and malnutrition and were found (RR = 3.99, CI 95% = 3.19-5.00; p < 0.001; and RR = 3.92; CI 95% = 3.10-4.96; p < 0.001; respectively). Gender, age, estimated weight and nutritional status were considered associated factors for APMT. APMT showed low sensitivity (DAPMT: 34.9%, NDAPMT: 37.7%) but high specificity (DAPMT: 98.7%, NDAPMT: 97.8%) to identify malnutrition.

CONCLUSIONS

APMT was significantly associated with nutritional status in a sample of surgical patients. The APMT seems to be a simple and useful anthropometric tool to confirm the diagnosis of malnutrition.

Preoperative nutritional assessment and prognosis in patients with foregut tumors

Malnourished patients with gastrointestinal tumours are at risk for postoperative complications and death. The aim of this study was to determine which nutritional assessment method better predicts outcome. Seventy-four patients, 45 men and 29 women; mean (SD) age of 63 (102) yr (range = 34 to 83), undergoing surgical resections for esophageal (n = 19) gastric (n = 43) and pancreatic (n = 12) tumors were preoperatively assessed by Patient Generated Subjective Global Assessment, anthropometry, and by laboratory sampling. Forty-three (58%) of them were unnourished; 25 Subjective Global Assessment (SGA)-A, 34 SGA-B, and 15 SGA-C cases. Mean (SD) of dominant hand adductor pollicis muscle thickness (DAPM) was 13 (3.5) mm and mean (SD) serum albumin was 3.8 (0.5) g/dL. Mean (SD) hospital staying for patients who complicated and died was 34 (29) days and 23 (13) days for survivors (not significant); SGA-B cases were significantly associated with higher mortality (n = 12, P<0.001). Patients with a mean (SD) DAPM below 10.8 (3.7) mm died more frequently than those with a mean (SD) greater than 14 (3) mm (P < 0.001). None of the methods was significantly related to hospital stay, but receiver operating characteristic curves (95% confidence interval) for PG-SGA and DAPM thickness (0.75 and 0.74) reliably predicted mortality (P<0.001) and these methods may be used as preoperative parameter.

The study of intramuscular nerve distribution patterns and relative spindle abundance of the thenar and hypothenar muscles in human hand

Background

The intramuscular nerve distribution and relative spindle abundance of the human hand have not been well defined, although this is important in guiding hand surgery.

Methods

Forty human hands were dissected and subjected to modified Sihler’s stain and haematoxylin and eosin stain to investigate intramuscular nerve distribution and relative spindle abundance, respectively.

Results

The flexor pollicis brevis (FPB), adductor pollicis (AP), and abductor digiti minimi (ADM) contain separate nerve compartments. Neural anastomoses were observed in the thenar and hypothenar muscles, including the Y-like, O-like, H-like, and U-like appearance. We found that U-like neural anastomoses may be the characteristic of the opponens muscles. The relative spindle abundance was the greatest in the opponens muscles which may coordinate fine movements.

Conclusion

Except for the two opponens muscles, the rest of the thenar and hypothenar muscles could be used as whole muscle or half-muscle donors for muscle transplant. Our nerve map of the hand offers valuable guidance for hand reconstruction.

Adductor pollicis muscle thickness: a promising anthropometric parameter for patients with chronic renal failure

INTRODUCTION

Protein-calorie malnutrition is a prevalent disorder in chronic renal failure (CRF) and a major risk factor for increased mortality in hemodialysis (HD) patients. Although many methods have been used to assess malnutrition in CRF, the role of adductor pollicis muscle thickness (APMt) is not established yet.

AIMS

This study aimed to analyze the APMt in HD patients and to investigate the correlation between APMt and conventional anthropometric, laboratory, and bioelectrical impedance markers, as well as its association with mortality/morbidity in a period of 12 months of follow-up.

SUBJECTS AND METHODS

The study included 143 HD patients from a single facility. After dialysis, the dry weight, height, mid-arm circumference, triceps skinfold thickness, and APMt were measured. Subsequently, the body mass index, percentage of standard body weight, the mid-arm muscle circumference, and the mid-arm muscle area were calculated. Blood counts were performed for hemoglobin, creatinine, and albumin. Patients were also submitted to a single-frequency tetrapolar bioimpedance test for measuring resistance, reactance, phase angle, and percentage of body cell mass. The correlation between APMt and anthropometric, laboratory, and bioelectrical impedance parameters was calculated using Pearson's linear correlation. Multiple linear regression analysis was used to select independent risk factors to death and hospitalizations in 6 and 12 months of follow-up, among parameters selected by univariate analysis.

RESULTS

Patients were aged 52.2 ± 16.6 years (20 to 83 years) on average, 58% were men, and mean dialysis vintage was 5.27 ± 5.12 years. APMt was 11.85 ± 1.63 mm (men, 12.34 ± 1.53; women, 11.19 ± 1.51; P < .0001). APMt was positively correlated with body mass index (r = 0.37; P < .0001), mid-arm circumference (r = 0.437; P < .0001), mid-arm muscle circumference (r = 0.494; P < .0001), mid-arm muscle area (r = 0.449; P < .0001), percentage of standard body weight (r = 0.355; P = .000), creatinine (r = 0.230; P = .006), albumin (r = 0.207; P = .013), percentage of body cell mass (r = 0.293; P = .000), and phase angle (r = 0.402; P < .0001), and negatively correlated with resistance (r = -0.403; P < .0001). The APMt ≤10.6 mm was associated with a 3.3 times greater risk of hospitalization within 6 months of follow-up (OR = 3.3, 95% CI: 1.13 to 9.66; P = .029) compared with patients with an APMt >10.6 mm. The APMt was not associated with risk of death at 6 and 12 months or hospitalization within 12 months of follow-up.

CONCLUSION

This is the first study testing APMt as an anthropometric marker in HD patients. The parameter is easy to measure and does not seem to be significantly affected by variations in hydration status. The parameter was significantly correlated with markers reflecting the condition of the muscle compartment, but not with parameters estimating the fat mass. The determination of an APMt cutoff point for malnutrition in patients with CRF and its correlation with morbidity and mortality will require further investigation in clinical studies.