Handgrip strength is associated with 12‐month survival in male patients suffering with advanced chronic liver disease

• Published in: Journal of human nutrition and dietetics Vol. 36; no. 4; pp. 1170 - 1178
• Main Authors: Côrtes, Daniela M., Boulhosa, Ramona S. da S. B., L. da S. L. Paz, Cláudio, Cunha, Carla de M., Oliveira, Lucivalda P. M., Lyra, André C., Bueno, Allain A., Jesus, Rosângela P.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-08-2023
• Subjects: 12‐month survival; Adolescent; Adult; Adults; advanced chronic liver disease; Age; Age groups; Aged; Ascites; Child–Pugh; Clinical outcomes; cut‐off values; Edema; Hand Strength - physiology; handgrip strength; Humans; Liver; Liver Diseases; Male; Males; Malnutrition - etiology; Middle Aged; Mortality; Muscle Strength; Nutrition Assessment; Nutrition therapy; Nutritional status; Observational studies; Older people; Parameters; Patients; subjective global assessment; Survival; Young Adult; Child-Pugh; advanced chronic liver disease; subjective global assessment; cut-off values; handgrip strength; 12-month survival
• ISSN: 0952-3871; 1365-277X
• DOI: 10.1111/jhn.13160

Background
Advanced chronic liver disease (ACLD) patients are usually malnourished, and both conditions in combination increase the likelihood of unfavourable clinical outcomes. Handgrip strength (HGS) has been suggested as a relevant parameter for nutritional assessment and predictor of adverse clinical outcomes in ACLD. However, the HGS cut‐off values for ACLD patients have not yet been reliably established. The aims of this study were to preliminarily identify HGS reference values in a sample population of ACLD male patients and to assess their association with survival over a 12‐month follow‐up period.
Methods
This was a prospective observational study with preliminary analysis of outpatients and inpatients. A total of 185 male patients with a medical diagnosis of ACLD met the inclusion criteria and were invited to participate in the study. The physiological variation in muscle strength related to the age of the individuals included in the study was considered to obtain cut‐off values.
Results
After categorising HGS by age group (adults: 18–60 years; elderly: ≥60 years), the reference values obtained were 32.5 kg for the adults and 16.5 kg for the elderly. During the 12‐month follow‐up, 20.5% of the patients died, and 76.3% of those had been identified with reduced HGS.
Conclusions
Patients with adequate HGS showed significantly higher 12‐month survival than those with reduced HGS within the same period. Our findings show that HGS is an important predictive parameter for clinical and nutritional follow‐up in ACLD male patients.
Key points
Strength measurement is an indicator of nutritional status that is not compromised by the presence of oedema and ascites and, therefore, has an advantage over methods traditionally used in clinical practice for advanced chronic liver disease (ACLD) patients.
However, to date, very few studies have presented cut‐off values for ACLD patients. Furthermore, studies that have accounted for variables that directly influence muscle strength, including age group and various levels of severity of liver disease, are scarce.
As dynamometry is a low‐cost method and easily reproducible in clinical practice, handgrip strength (HGS) can be effectively applied for inpatient and outpatient nutritional care. HGS cut‐off values may be used to plan a more tailored nutritional therapy and, most importantly, for the early detection of individuals at greater risk of negative outcomes in ACLD.
The results of this study show that reduced HGS was associated with increased mortality and reduced survival in ACLD male patients.
A multicentre study which presents HGS cut‐off accurate enough to predict mortality in larger populations of ACLD adult and elderly patients of both sexes will bring certainty as to the applicability of our results to larger settings.