Hu Yule, Zhang Chen, Zou Changhong, Yang Haojie, Chen Yingdi, Liang Tao
School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.9 Dong Dan San Tiao, 100730, Beijing, China.
Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100045, Beijing, China.
Nutr Metab Cardiovasc Dis. 2023 Dec;33(12):2419-2427. doi: 10.1016/j.numecd.2023.07.034. Epub 2023 Jul 29.
The assessment of muscle mass using technology-based methods is less commonly performed when applying the Global Leadership Initiative on Malnutrition (GLIM) criteria due to the lack of skilled clinical nutrition practitioners and/or equipment. Based on the predictive validity of poor health outcomes and feasibility in clinical practice, this study aimed to analyze whether the measurement of calf circumference (CC), mid-upper arm circumference (MAC), and the physical examination could be used as substitutes for muscle mass assessment, as well as handgrip strength (HGS) used as a substitution when applying the GLIM criteria in hospitalized HF patients.
From June 2022 to January 2023, a single-center prospective study including 216 patients was performed. Additionally, covariates were identified by a directed acyclic graph. The multivariate logistic regression analysis was also used to analyze and compare the association between poor health outcomes and malnutrition (based on 5 types of GLIM criteria). Cohen-kappa coefficient and TELOS-feasibility score were calculated. The prevalence of malnutrition ranged from 35.2% to 42.6%, depending on the tool used. After adjusting for covariates, malnutrition assessed using CC, MAC, or physical examination within the GLIM criteria was independently associated with poor clinical outcomes (90-day HF-related readmission or all-cause mortality and prolonged hospital stay) but not with HGS.
CC, MAC and results from physical examination but not HGS may serve as a substitutive metric of muscle mass contained in the GLIM criteria to diagnose malnutrition and predict poor clinical outcomes among HF patients.
This study was registered at Chinese Clinical Trial Registry. (ChiCTR2200057876) on 20 Mar. 2022.
在应用营养不良全球领导倡议（GLIM）标准时，由于缺乏技术熟练的临床营养从业者和/或设备，使用基于技术的方法评估肌肉质量的情况较少见。基于健康不良后果的预测效度以及临床实践中的可行性，本研究旨在分析小腿围（CC）、上臂中段围（MAC）的测量以及体格检查是否可作为肌肉质量评估的替代方法，以及握力（HGS）在对住院心力衰竭（HF）患者应用GLIM标准时能否作为替代指标。
2022年6月至2023年1月，进行了一项纳入216例患者的单中心前瞻性研究。此外，通过有向无环图确定协变量。还使用多变量逻辑回归分析来分析和比较健康不良后果与营养不良（基于5种GLIM标准）之间的关联。计算了科恩kappa系数和TELOS可行性评分。根据所使用的工具不同，营养不良的患病率在35.2%至42.6%之间。在对协变量进行调整后，在GLIM标准内使用CC、MAC或体格检查评估的营养不良与不良临床结局（90天HF相关再入院或全因死亡率以及住院时间延长）独立相关，但与HGS无关。
CC、MAC和体格检查结果而非HGS可作为GLIM标准中所含肌肉质量的替代指标，用于诊断HF患者的营养不良并预测不良临床结局。
本研究于2022年3月20日在中国临床试验注册中心注册。（ChiCTR2200057876）
