PhilSPEN Online Journal of Parenteral and Enteral Nutrition

(Article 132 | POJ_0124)

Original Clinical Investigation

Local Study on Hand Grip Measurements of Patients Referred to the Clinical Nutrition Service of St. Luke’s Medical Center, Quezon City, Philippines

Abstract | Introduction | Methodology | Results | Discussion | Conclusion | References | Back to Total Name and Codes page2

Submitted: | Posted:

Authors:

    1. Precious Gem Calamba, MD; Clinical Nutrition Service, St. Luke's Medical Center, Quezon City, Philippines
    2. Luisito O. Llido, MD; Clinical Nutrition Service, St. Luke’s Medical Center, Quezon City, Philippines
    Corresponding Author: Dr. Precious Gem Calamba

Institution where research was conducted

Clinical Nutrition Sevice, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, Metro-Manila, Philippines

ABSTRACT: | Back

Background:

To perform a study on the use of hand held grip measurements for use as an indicator of nutritional status.

Objective:

To measure the relationship of objective hand grip strength using a calibrated dynamometer among population on varying ages, sexes, nutritional and functional status among well and sick patients.

Methodology:

Hand grip measurement is done one the following people.

  1. To know the normal values of hand grip strengths of healthy Filipinos in varying age groups, gender, and Body Mass Index,
  2. To know the hand grip strengths of Sick Filipinos in varying age groups, gender, and Body Mass Index,
  3. To determine if there is significant difference on the values of hand grip strength among healthy and sick Filipino patients in terms of age group, gender, and BMI.

Results:

There were 86 males and 207 females with a 1:2 male to female ratio (Total = 293). There was a 40.98 well males versus a a 23.96 sick males with a difference of 13.02 strengths and a 24.75 well females and a 17.54 sick females with a difference of 7.21 strengths. All showed a distinct difference between well versus sick patients hence showing a difference between strength and nutritional status between them. It also showed that there is a gender difference between males and females, but not a difference in BMI.

Conclusion:

Hand grip strength monitoring is a valuable tool for measuring nutritional status especially in forearm measurements.

 

KEYWORDS: Hand Grip Dynamometry, forearm, clinical nutrition service

INTRODUCTION | Back

Muscle strength is an important aspect of physical fitness and health status, and a decrease in muscle strength may cause significant functional limitations (1). There are many methods to measure muscle strength but are expensive and time consuming.  According to Vogt, et al, (2) hand grip strength has (HGS) is a validated method to assess nutritional status. It is safe, fast, non–invasive, radiation –free, and low cost, and shows inter- rater reliability and maybe useful as an early indication of malnutrition. (3)  A study by Wind, et al (4) on grip strength as predictor of total muscle strength among young adults showed positive correlation between hand grip strength and total muscle strength. The measurement of Hand-grip strength is a useful predictor of health status, muscular status, nutritional status, and disability. (5)

In hospital setting and in clinical practice, nutrition risk assessment (NRS), Subjective Global Assessment (SGA), and Body mass Index (BMI) were often used as a nutrition indicator. We seldom use Handgrip Strength as indicator for functional capacity. This pilot study has aimed to determine the relationship of objective hand grip strength using calibrated dynamometer among population on varying ages, sexes, nutritional and functional status (well and sick) and BMI. These are the objectives of the study: 1) To know the normal values of hand grip strengths of healthy Filipinos in varying age groups, gender, and Body Mass Index, 2) To know the hand grip strengths of Sick Filipinos in varying age groups, gender, and Body Mass Index, 3) To determine if there is significant difference on the values of hand grip strength among healthy and sick Filipino patients in terms of age group, gender, and BMI.

METHODOLOGY | Back

This is a retrospective, descriptive pilot study. All adult patients referred to clinical nutrition service during the nutrition fair and out-patient consultation were included in the study. Participants who did not undergo hand grip strength measurements were excluded. Anthropometric measurement were taken during nutritional assessment, including body weight, height, and calculated BMI.

Handgrip strength were measured using a calibrated digital grip strength dynamometer (CAMRY) which measures between 5.0 to 100 kg force and has adjustable grip span (appendix 1) .  Patients were instructed to self-adjust the dynamometer and hold the grip with maximum force via voice instructions with arm extended facing away from the body in 5 seconds. Up to 3 measurements were performed at 30 second interval and the maximum value were considered for the study. Descriptive statistics were generated for all variables. For numerical data, mean and standard deviations were used and T-test used for comparing differences of values from samples.

RESULTS | Back

Table 1. Demographic Profiles of the Study Population (n=293)
Variables
Male
Female
Mean age in years (SD)
53.16 (80.3)
42.14 (14.87)
Number
86
207
Male to Female ratio
1:2

In table 1 it shows that majority of the study population are females with 1:2 male to female ratio. Study population age were highly variable in males with mean of 53.16 years old and standard deviation of 80.3 and less variable in females with mean age of 42.14 years old and standard deviation of 14.87.

Table 2. Comparison of Mean Hand Grip Strength and Mean BMI among Study Population in Terms of Gender and Health Status
Variables
mean hand grip strength
mean BMI (SD)
p value difference
All males
34.54 (10.87)
24.64 (5.10)
All females
21.94 (6.77)
24.69 (5.8)
Males -well
40.98 (5.99)
26.6 (4.17)
p value < 0.001
Males - sick
23.65 (8.25)
20.87 (4.64)
Females - well
24.75 (4.32)
24.66 (4.5)
p value < 0.001
Females - sick
17.54 (7.55)
24.75 (7.62)

Table 2 shows the mean handgrip strength and BMI among female and male, sick and healthy population. The mean hand grip for males = 34.54 (10.87) kg; for females = 21.94 (6.77) kg. The male population were stronger with higher handgrip strength than that of the female population. However, there is nearly 50% drop in hand strength grip when males become sick, about 30% drop among females (refer to Figures 1 and 2). There were significant differences in terms of hand grip strength among sick and well population in both male and female group. In terms of BMI, males and female population were comparable. However, there is significant drop of BMI among male-sick population, but no significant difference in the mean BMI of female-sick population. This result is similar to the study by Kun-His Liao, et al. that sex was the most significant affecting handgrip strength. (6)

Figure 1. Handgrip Strength  Difference  Among Males
                 (Group 1 = Sick Patients; Group 2 = Well Patients)

strength1

Figure 2. Handgrip Strength  Difference  Among Females
                 (Group 1 = Sick Patients; Group 2 = Well Patients)

strength2

Figure 3, 4 and 5 elucidates that hand grip strengths decreases among male and female study population as their ages advances from 20 years old onwards. These trends were more pronounced among population with ages advancing to more than 40 years of age. This result is consistent with the study by Kortebein, et. al. (7) that loss of muscle mass and strengths were greater in older population than that of the younger population since older persons possess lesser muscle reserve capacity.

Figure 3. Relationship of Hand Grip Strengths in Male Population (20 years old above).

strentgh3

Figure 4. Relationship of Hand Grip Strengths in Female Population (20 years old above).

 strength5

  Figure 5.  Relationship Between Hand Grip Strength, BMI and Age

strength4astrength4b

Age versus the Hydrogrip Test (first image); BMI versus Hydrogrip Test (second image)

In the first image BMI decreases as age increases. The second figure showed that BMI has direct proportional relationship with hand grip strength as strength increased from low to high strength. It is consistent with the study by Kun His ,et al 6 showing positive correlation of  handgrip strength and BMI.

DISCUSSION: | Back

Majority of the study population are females with 1:2 male to female ratio. Study population age were highly variable in males and less variable in females. The mean hand grip for males = 34.54 (10.87); for females = 21.94 (6.77) kg.

The male population were stronger with higher handgrip strength than that of the female population. However, there is nearly 50% drop in hand strength grip when males become sick, about 30% drop among females. There were significant differences in terms of hand grip strength among sick and well population in both males and female group. As age advances to more than 40 years old, hand grip strength continuously decreases.  Also,  BMI has directly proportional relationship with hand grip strength as results of this study reveal that increasing BMI yielded to increasing hand grip strength. Thus, as age increases hand grip strength decreases and as BMI increases hand grip strength increases.

There were highly significant differences in hand grip strength among sick and well population in both male and female population.  Hand grip strength of well subjects are stronger compared to sick subjects. Hand grip strength weakens when patients develop illness. Future researches may need to investigate whether hand grip strength increases when sick patient recover from illness.

CONCLUSION: | Back

Hand grip strength is a good indicator of patient health and protein mass/function. Therefore, with hand grip strength predictive validity, affordability, safety and simplicity, this technique should be considered a part of a routine nutritional assessment.

REFERENCES: | Back

  1. Avares da silva (2005) Comparison of hand-grip strength, subjective global assessment, and nutrition risk screening in in predicting clinical outcome in cirrhotic patients nutrition (113-117)
  2. Barbara Vogt, Mariana Borges, Handgrip strength is an independent predictor of all-cause mortality in maintainance dialysis patient, Clinical Nutrition 35(2016) 1429
  3. Flood A, Chung. The use of handgrip strength as a predictor of nutrition status in hospital patients. Clinical nutrition 2014(33:106-14)
  4. Anne Wind, Tim Takken , (march 2009) Is grip Strength predictor of muscle strength among young adults (5-6)
  5. Bohannon RW. Muscle strength : clinical and prognostic value of hand grip dynamometry: clinical opinion in clinical nutrition and metabolic care 2015;18(5)
  6. Kun-His Liao. Handgrip strength in Low, Medium, and High body mass index males and females; Rehabilitation health 2016 (3:1)
  7. Kortebein P: Rehabilitation for hospital associated deconditioning, Am J Phys Med 2009; 88:66

 

Abstract | Introduction | Methodology | Results | Discussion | References | Back to Total Name and Codes page2