Handgrip strength as a surrogate marker of lean mass and risk of malnutrition in paediatric patients

Background & aims: The use of handgrip strength (HGS) as a proxy of nutritional status in sick children has not been studied. This study created HGS centile charts in healthy children and explored the utility of HGS z-scores as markers of body composition and screening of malnutrition risk in sick children. Methods: Data from 535 healthy children aged 5-16 years were used for the development of HGS centiles adjusted either for age or height. In 595 sick children, relationships between HGS z-scores with body composition, malnutrition risk (Paediatric Yorkhill Malnutrition Score-PYMS), length of hospital stay (LOS) and biomarkers of disease severity were explored. The use of HGS z-score to identify sick children in need of further dietetic assessment was investigated. Results: Children scoring at high malnutrition risk with PYMS had lower HGS z-scores for age (by 0.51 SD, p < 0.001) and height (by 0.46 SD, p = 0.001) than those who scored low. A HGS z-score at cut-offs of-0.81 SD and-1.2 SD for age and height, respectively, was predictive of need for dietetic intervention in sick children with sensitivity of 79% and 70% and specificity of 56% and 69%, respectively. HGS z-scores were predictive of fat free mass (FFM) in sick and healthy (all p < 0.001) children, while fat mass was not. HGS z-scores were inversely related with plasma CRP (rho, age:-0.21; height:-0.23, both p = 0.001). HGS was not predictive of LOS. Conclusion: HGS is predictive of FFM, could compliment assessment of malnutrition risk, and may help identify children for further dietetic intervention on admission to hospital. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

This study established handgrip strength centile charts in healthy children and explored the utility of handgrip strength z-scores in assessing body composition and screening malnutrition risk in sick children. The results showed that handgrip strength z-scores can help identify sick children in need of further dietetic intervention and are predictive of fat free mass.