Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Centro Universitário Ritter dos Reis (UniRitter), Porto Alegre, RS, Brazil.
Institute of Education Research and Health Managment (iPGS), Porto Alegre, RS, Brazil.
Clin Nutr. 2019 Apr;38(2):891-896. doi: 10.1016/j.clnu.2018.02.010. Epub 2018 Feb 16.
BACKGROUND & AIMS: The adductor pollicis muscle thickness (APMT) is a promising method for evaluation of muscle loss and, consequently, malnutrition in adult and elderly patients. However, to date, there have been no studies of its applicability to the pediatric population. Within this context, we sought to evaluate the association of APMT with anthropometric variables, body mass index (BMI), pediatric Subjective Global Assessment (SGA) of nutrition, nutritional screening, and clinical outcomes in hospitalized pediatric patients.
This was a cross-sectional study of inpatients aged 4-8.9 years, recruited via convenience sampling from a pediatric hospital in Porto Alegre, Rio Grande do Sul, Brazil. Data collection took place between December 2014 and February 2016. Patients admitted to the intensive care unit, those unable to feed orally, and those with cerebral palsy or Down syndrome were excluded from the study. General and socioeconomic information was collected and the SGA Ped and STRONGkids were administered at hospital admission. Clinical data were collected from the electronic medical record. Anthropometric parameters and APMT were measured by properly calibrated examiners. Data analysis was carried out in SPSS version 21.0. The significance level was set at 5%.
The sample consisted of 447 patients. Most (55.9%) were male; the mean age was 6.2 ± 1.4 years. Low APMT was significantly associated with underweight, short stature, low body fat percentage, and poor muscle reserve (p < 0.001). There were also significant associations of moderate and severe malnutrition (assessed by the SGA Ped) and high nutritional risk (assessed by the STRONGkids instrument) with reduced APMT (p < 0.001). Regarding clinical outcomes, a longer hospital stay was observed in patients with reduced APMT (p = 0.001). A receiver operating characteristic (ROC) curve, plotted considering the SGA Ped as the gold standard, suggested APMT cutoff points of 10.2 mm for boys and 9.5 mm for girls. Stratification by age yielded APMT cutoff points of 9.8 mm for boys younger than 6 years and 10.2 mm for those older than 6 years, and 9.2 mm and 9.8 mm for girls younger and older than 6 years, respectively.
The APMT is an efficient parameter for the detection of malnutrition in hospitalized pediatric patients.
内收拇指肌厚度（APMT）是评估肌肉减少和营养不良的一种很有前途的方法，适用于成人和老年患者。然而，迄今为止，尚无研究表明其可应用于儿科人群。在此背景下，我们旨在评估 APMT 与人体测量学变量、体重指数（BMI）、儿科主观综合营养评估（SGA）、营养筛查以及住院儿科患者临床结局的相关性。
这是一项横断面研究，纳入了年龄在 4-8.9 岁的住院患儿，通过便利抽样法从巴西阿雷格里港的一家儿科医院招募。数据收集于 2014 年 12 月至 2016 年 2 月期间进行。研究排除了入住重症监护病房、无法经口喂养以及患有脑瘫或唐氏综合征的患儿。入院时收集了一般和社会经济信息，并进行了 SGA Ped 和 STRONGkids 评估。临床数据从电子病历中获取。由经过适当校准的检查者测量人体测量学参数和 APMT。使用 SPSS 21.0 版进行数据分析。显著性水平设为 5%。
本研究纳入了 447 名患儿。其中大多数（55.9%）为男性，平均年龄为 6.2±1.4 岁。低 APMT 与体重不足、身材矮小、体脂百分比低以及肌肉储备不良显著相关（p<0.001）。中重度营养不良（通过 SGA Ped 评估）和高营养风险（通过 STRONGkids 评估）与 APMT 降低也存在显著相关性（p<0.001）。在临床结局方面，APMT 降低的患者住院时间较长（p=0.001）。考虑到 SGA Ped 作为金标准，绘制的接收者操作特征（ROC）曲线提示男孩 APMT 的截断点为 10.2mm，女孩为 9.5mm。按年龄分层，得出男孩年龄小于 6 岁时的 APMT 截断点为 9.8mm，大于 6 岁时为 10.2mm，女孩年龄小于 6 岁时为 9.2mm，年龄大于 6 岁时为 9.8mm。
APMT 是一种检测住院儿科患者营养不良的有效参数。
