Xie Lingling, Jiang Jiaojiao, Fu Hongbo, Zhang Wenyi, Yang Ling, Yang Ming
West China School of Nursing/Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Rehabilitation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
J Am Med Dir Assoc. 2022 May;23(5):722-728. doi: 10.1016/j.jamda.2021.11.025. Epub 2021 Dec 23.
Muscle quality is an essential muscle metric, which can be assessed by measuring intermuscular adipose tissue (IMAT) and skeletal muscle radiodensity (SMD) via computed tomography (CT) images. We aimed to explore the associations of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition with muscle mass, muscle quality, and muscle strength in hospitalized older adults.
A cross-sectional study.
Hospitalized older patients.
Malnutrition was defined by the GLIM criteria after screening by the Mini Nutrition Assessment-Short Form (MNA-SF). Chest CT images were used to segment skeletal muscle area (SMA) and IMAT, and to measure SMD. Skeletal muscle index (SMI) was calculated by SMA (cm)/body height squared (m). Handgrip strength (HGS) was measured using a digital dynameter. Univariate and multivariate logistic regression models were performed to calculate odds ratios (ORs) and 95% CIs.
We included 1135 patients. The MNA-SF score is positively associated with SMI, SMD, and HGS, but negatively associated with IMAT. Compared to patients with normal nutrition, patients with malnutrition had significantly lower SMD and HGS in both men and women. Women with malnutrition had significantly higher IMAT than women with normal nutrition, whereas men with malnutrition had significantly lower SMI than men with normal nutrition. After adjustment for confounders, SMI (adjusted OR 0.95, 95% CI 0.93, 0.98), SMD (adjusted OR 0.94, 95% CI 0.93, 0.98), and HGS (adjusted OR 0.91, 95% CI 0.89, 0.94) were significantly and negatively associated with malnutrition. IMAT appeared to be positively associated with malnutrition, but the result was not statistically significant (adjusted OR 1.03, 95% CI 1.00, 1.07).
Our study provides new evidence regarding the association between handgrip strength and malnutrition in older inpatients. Moreover, a small association of chest CT--derived muscle quality and mass with malnutrition is identified.
肌肉质量是一项重要的肌肉指标，可通过计算机断层扫描（CT）图像测量肌间脂肪组织（IMAT）和骨骼肌放射密度（SMD）来进行评估。我们旨在探讨全球营养不良领导倡议（GLIM）定义的营养不良与住院老年患者肌肉质量、肌肉质量和肌肉力量之间的关联。
一项横断面研究。
住院老年患者。
通过简易营养评估简表（MNA-SF）筛查后，根据GLIM标准定义营养不良。胸部CT图像用于分割骨骼肌面积（SMA）和IMAT，并测量SMD。骨骼肌指数（SMI）通过SMA（cm）/身高平方（m）计算得出。使用数字测力计测量握力（HGS）。进行单变量和多变量逻辑回归模型以计算比值比（OR）和95%置信区间（CI）。
我们纳入了1135例患者。MNA-SF评分与SMI、SMD和HGS呈正相关，但与IMAT呈负相关。与营养正常的患者相比，营养不良的患者无论男性还是女性，其SMD和HGS均显著降低。营养不良的女性IMAT显著高于营养正常的女性，而营养不良的男性SMI显著低于营养正常的男性。在调整混杂因素后，SMI（调整后OR 0.95，95% CI 0.93，0.98）、SMD（调整后OR 0.94，95% CI 0.93，0.98）和HGS（调整后OR 0.91，95% CI 0.89，0.94）与营养不良显著负相关。IMAT似乎与营养不良呈正相关，但结果无统计学意义（调整后OR 1.03，95% CI 1.00，1.07）。
我们的研究提供了关于住院老年患者握力与营养不良之间关联的新证据。此外，还确定了胸部CT衍生的肌肉质量和质量与营养不良之间存在小的关联。
