Handgrip strength as a hospital admission nutritional risk screening method.

OBJECTIVE

To investigate if handgrip strength (HGS) could be used as a single screening procedure in identifying patients who are classified as being undernourished or nutritionally-at-risk at hospital admission.

DESIGN

Cross-sectional study. In the second day of hospital admission, HGS was evaluated and results were compared with Nutritional Risk Screening (NRS-2002).

SETTING

Two public hospitals in Porto, Portugal, a university and a district one.

SUBJECTS

A probabilistic sample of 50% in-patients from each hospital of 314 patients (age range of 18-96) was studied. Patients were considered eligible if they were >or=18 years old and able to give informed consent. Hand pain, upper limb deformities, incapacity to perform muscle strength measurements and pregnancy were considered further exclusion criteria.

RESULTS

Patients identified as undernourished by NRS-2002 (37.9%) were older, shorter and lighter, with a lower functional capacity, a longer length of stay and a lower HGS (P<0.001). When comparing patients with lower HGS (first quartile) with those with the highest HGS (fourth quartile), this parameter revealed good sensitivity (86.7%) and specificity (70.2%) and a k=0.56. Multivariate analysis showed that patients with higher HGS had an independent decreased risk of being at nutritional risk (P for trend <0.001) odds ratio=0.19 (95% confidence interval=0.08-0.48). Our entire sample of hospitalized patients was -1.96 Z-score below the HGS cutoff of distribution data for healthy individuals.

CONCLUSIONS

HGS identifies a high proportion of nutritionally-at-risk patients and can be a reliable first screening tool for nutritional risk in hospitals.