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9/18/2017
Getting a Grip!
Handgrip Strength Examination for Malnourished Populations
DPG Spotlight
www.cnmdpg.org
Barbara Lusk, MFCS. RD, LDN, FAND
Chair 2017-2018
Disclosures Disclosures
Julie McGuire, MS, RDN, LD Terese Scollard, MBA, RDN, LD, FAND
Clinical Nutrition Management Dietetic Practice Group Spotlight Clinical Nutrition Management Dietetic Practice Group Spotlight
• Instructor & Master’s Program Coordinator • Regional Clinical Nutrition Manager
⎻ Graduate Programs in Human Nutrition at OHSU ⎻ Providence Health and Services, Oregon
• Nutrition-Focused Physical Exam Trainer • Chair-Elect
⎻ Academy of Nutrition and Dietetics ⎻ Clinical Nutrition Management Dietetic Practice Group of the Academy of
Nutrition and Dietetics
• Speaker has no relationship to manufacturer or vendor of dynamometry equipment • Owner
⎻ MySurgeryPlate LLC
• Consultant
⎻ Nasco
• Author
⎻ Nutrition Dimension
• Speaker Bureau
⎻ Nestle Health Science
⎻ Nutricia North America, Inc.
• Speaker has no relationship to manufacturer or vendor of dynamometry equipment
Learning Outcomes Agenda
• Gain insight into the history and applications of handgrip Handgrip strength, muscle
strength measurement as both a clinical and research function and malnutrition
instrument, which supplies relevant clinical information and
brings value in evaluation of individuals and populations at risk
of malnutrition and sarcopenia. Applications in practice
• Apply handgrip strength examination methodology and including methodology
assessment in clinical practice as a functional measurement of a
nutrition diagnosis of protein-calorie malnutrition and of
sarcopenia.
• Learn the correct methodology, patient and examiner positions, Demonstration and practice
practice basics as seated and documentation of results; provide
access to resources that support such competency training to
other RDNs at their own worksites. Resources and questions
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9/18/2017
Muscle Muscle
Function Mass
Handgrip strength BIA
How do dietitians assess muscle mass and Knee flexion/extension DEXA
function? And why is it important? Peak expiratory flow CT
Gait speed MRI
Timed get-up-and-go test MUAC
Stair climb power test Palpation
Short physical Visual inspection
performance battery
Russell Nutr Clin Pract 2015 30 211-218
Choi Korean J Intern Med 2016 31 1054-1060
Peterson and Braunschweig Nutr Clin Pract 2016 31 40-48
Prado et al. Clin Nutr 2012 31 583-601
• Frequent
Clinical readmissions
Outcomes • Longer lengths of stay
• Increased morbidity
• Increased mortality
ass
M • Risk of falls
escl Physical • Fractures
uM Dysfunction • Disability Handgrip Strength
• Loss of independence
When & Why
Immune • Risk of infection
Dysfunction • More complications
Bigaard 2004 Obesity Research 12 1042-1048
Prado et al. 2012 Clin Nutr 31 583-601
Peterson and Braunschweig 2016 Nutrition in Clinical Practice 31 40-48
Prado et al. 2016 Proc Nutr Soc 75 188-198
Dynamometers
Upper limb
impairment
Evaluation Work
of other capacity
impairments after injury
Handgrip
Strength
Assessment
Overall Efficacy of
fitness treatments
assessment
Functional
status
Innes 1999 Aust Occup Ther J 46 120-140
Roberts et al. 2011 Age Ageing 40 423-429
Russell 2015 Nutr Clin Pract 30 211-218 Roberts et al. 2011 Age Ageing 40 423-429
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9/18/2017
Age
Handedness
Gender
Illness
Innes Aust Occup Ther J 1999 46 120-140
Nicolay and Walker International Journal of Industrial Ergonomics 2005 35 605-618
Norman et al. Clin Nutr 2010 29 586-91
Russell Nutr Clin Pract 2015 30 211-842 Image: 2011 Pearson Education; accessed at https://classconnection.s3.amazonaws.com/754/flashcards/566754/png/50.291320964532138.png
Type I fibers Type II fibers
Normal mosaic of type I Atrophy of type II fibers
and type II muscle fibers
Norman 2011 Clin Nutr 30 135-142 Russell et al. 1984 Am J Clin Nutr 39 503-513
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figid=at:
Z disc degeneration 95971627 Review of the Research
Accessed:
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17, 2017
Oumi 2001 Ultrastruc Pathol 25 431-436
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9/18/2017
At Look at the Research
• Mendes et al 2014 Length of stay
• Vaz et al 1996
• Turnbull et al 2002
• Matos et al 2007
• Norman et al 2010 Nutrition status
• Norman et al 2011
• Garcia et al 2013
• Guerra et al 2013
• Flood et al 2014
• Norman et al 2010
• Jakobsen et al 2010 Quality of life
• Kilgour et al 2013
• Klidjian et al 1980
• Webb et al 1989
• Mahalakshmi et al 2004 Post-op complications
• Alvares-da-Silva et al 2005
• Norman et al 2011
• Norman et al 2011 Disability
• Peterson et al 2017
Image accessed at https://s-media-cache-ak0.pinimg.com/originals/7a/44/c6/7a44c6d66c1d8f3ca7c5f8bafdf06f4b.jpg
Handgrip Strength
Characteristic of Malnutrition
White et al. J Acad Nutr Diet 2012 112 730-8
Characteristics of Malnutrition Handgrip Strength as a Characteristic of
Malnutrition
Loss of muscle Loss of
mass subcutaneous Malnutrition in the Malnutrition in the Malnutrition in the
fat Context of Acute Context of Chronic Context of Social or
Illness or Injury Illness Environmental
Inadequate Fluid Circumstances
energy intake accumulation Non-severe Severe Non-severe Severe Non-severe Severe
(moderate) malnutrition (moderate) malnutrition (moderate) malnutrition
malnutrition malnutrition malnutrition
Reduced N/A Measurably N/A Measurably N/A Measurably
grip reduced reduced reduced
Reduced strength
Weight loss Malnutrition handgrip
strength
White et al. J Acad Nutr Diet 2012 112 730-8 White et al. J Acad Nutr Diet 2012 112 730-8
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