Handgrip strength as an instrument for assessing the risk of malnutrition and inflammation in hemodialysis patients

Abstract Indroduction: Establishing which parameters to use for diagnosing malnutrition in hemodialysis patients is a challenge in clinical practice. The handgrip strength (HGS) has stood out as a method of assessing nutritional status. Thus, the aim of this study was to determine the cut-off point for HGS in the assessment of the risk of malnutrition and inflammation in HD patients, and its association with other parameters. Methods: Study carried out in hemodialysis units in the city of Curitiba, Brazil. We obtained the cut-off point of the HGS through the ROC curve, using the malnutrition and inflammation score (MIS) as a reference. We checked the relationship (Odds ratio) between the variables “MIS” and “HGS” with the other study variables using the multivariate analysis (logistic regression). Results: We assessed 238 patients (132 men), between 18 and 87 years of age (median = 59). The HGS cut-off point for diagnosing malnutrition and inflammation according to the reference used was <14.5 kg for women, and <23.5 kg for men. According to the HGS criteria, malnourished patients were older (OR = 0.958), with lower arm circumference (OR = 1.328) and higher scores in the malnutrition and inflammation score (OR = 0.85). Conclusion: HGS was significantly correlated with other nutritional assessment parameters. These results suggest that HGS is a valid screening tool to identify the risk of malnutrition and inflammation in hemodialysis patients.

研究背景与摘要：确定用于诊断血液透析患者营养不良的适宜参数是临床实践中的一项挑战。握力（handgrip strength, HGS）已成为评估营养状况的常用检测手段。本研究旨在确定握力在评估血液透析患者营养不良与炎症风险中的截断值，并分析其与其他临床参数的关联。

方法：本研究在巴西库里蒂巴市的血液透析中心开展。以营养不良炎症评分（malnutrition and inflammation score, MIS）作为参照标准，通过受试者工作特征曲线（ROC curve）确定握力的截断值。采用多因素logistic回归分析，检验变量「营养不良炎症评分」与「握力」同其他研究变量之间的关联（优势比，Odds ratio, OR）。

结果：本研究共纳入238例患者（其中男性132例），年龄介于18至87岁之间，中位年龄为59岁。以营养不良炎症评分为参照标准时，用于诊断营养不良与炎症的握力截断值为：女性<14.5 kg，男性<23.5 kg。根据握力判定标准，营养不良患者年龄更大（优势比OR=0.958）、前臂围度更低（OR=1.328）且营养不良炎症评分更高（OR=0.85）。

结论：握力与其他营养评估参数存在显著相关性。上述结果表明，握力可作为有效的筛查工具，用于识别血液透析患者的营养不良与炎症风险。