Ozturk Yelda, Deniz Olgun, Coteli Suheyla, Unsal Pelin, Dikmeer Ayse, Burkuk Suna, Koca Meltem, Cavusoglu Cagatay, Dogu Burcu Balam, Cankurtaran Mustafa, Halil Meltem
Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
JPEN J Parenter Enteral Nutr. 2022 May;46(4):936-945. doi: 10.1002/jpen.2230. Epub 2021 Aug 13.
The aim of this study is to identify cutoff values for muscle ultrasound (US) to be used in Global Leadership Initiative on Malnutrition (GLIM) criteria, and to define the effect of reduced muscle mass assessment on malnutrition prevalence at hospital admission.
A total of 118 inpatients were enrolled in this cross-sectional study. Six different muscles were evaluated by US. Following defining thresholds for muscle US to predict low muscle mass measured by bioelectrical impedance analysis, malnutrition was diagnosed by GLIM criteria with seven approaches, including calf circumference, mid-upper arm circumference (MAC), handgrip strength (HGS), skeletal muscle index (SMI), rectus femoris (RF) muscle thickness, and cross-sectional area (CSA) in addition to without using the reduced muscle mass criterion.
The median age of patients was 64 (18-93) years, 55.9% were female. RF muscle thickness had moderate positive correlations with both HGS (r = 0.572) and SMI (r = 0.405). RF CSA had moderate correlation with HGS (r = 0.567) and low correlation with SMI (r = 0.389). The cutoff thresholds were 11.3 mm (area under the curve [AUC] = 0.835) and 17 mm (AUC = 0.737) for RF muscle thickness and 4 cm² (AUC = 0.937) and 7.2 cm² (AUC = 0.755) for RF CSA in females and males, respectively. Without using the reduced muscle mass criterion, malnutrition prevalence was 46.6%; otherwise, it ranged from 47.5% (using MAC) to 65.2% (using HGS).
Muscle US may be used in GLIM criteria. However, muscle US needs a standard measurement technique and specific cutoff values in future studies.
本研究旨在确定用于全球营养不良领导倡议（GLIM）标准的肌肉超声（US）临界值，并确定入院时肌肉量评估降低对营养不良患病率的影响。
本横断面研究共纳入118名住院患者。通过超声评估六种不同的肌肉。在确定肌肉超声预测通过生物电阻抗分析测量的低肌肉量的阈值后，采用包括小腿围、上臂中部周长（MAC）、握力（HGS）、骨骼肌指数（SMI）、股直肌（RF）肌肉厚度和横截面积（CSA）在内的七种方法，以及不使用降低肌肉量标准的情况下，根据GLIM标准诊断营养不良。
患者的中位年龄为64（18 - 93）岁，55.9%为女性。RF肌肉厚度与HGS（r = 0.572）和SMI（r = 0.405）均呈中度正相关。RF CSA与HGS呈中度相关（r = 0.567），与SMI呈低度相关（r = 0.389）。女性和男性的RF肌肉厚度的临界阈值分别为11.3 mm（曲线下面积[AUC] = 0.835）和17 mm（AUC = 0.737），RF CSA的临界阈值分别为4 cm²（AUC = 0.937）和7.2 cm²（AUC = 0.755）。不使用降低肌肉量标准时，营养不良患病率为46.6%；否则，患病率范围为47.5%（使用MAC）至65.2%（使用HGS）。
肌肉超声可用于GLIM标准。然而，在未来的研究中，肌肉超声需要标准的测量技术和特定的临界值。
