Evaluation of hand grip strength in 3-17 years old patients with acute and chroni̇c malnutrition

Introduction: Malnutrition is a nutritional disorder that causes adverse effects on body mass and functions and may cause more serious health problems in children than in adults. In malnutrition, whole body protein concentrations and cell mass decrease, and protein synthesis decreases as proteolytic mechanisms are stimulated. Muscle function is associated with whole body protein, body cell mass, upper middle arm circumference (MWC), which is an indicator of arm muscle mass, and body mass index. Hand grip strength (ECG) is a standard method for measuring a patient's functional ability affected by protein-energy malnutrition and can be used as an objective marker for detecting malnutrition. Objective: Early diagnosis of pediatric malnutrition has a positive effect on treatment and many accompanying morbidities. In this study, it was aimed to evaluate the usability of hand grip and pinch grip strength in defining pediatric malnutrition and to evaluate the measurability of response to treatment in the short and medium-long term in patients who underwent nutritional regulation for malnutrition. In addition, we aimed to define the relationship between hand grip strength and pinch grip strength with anthropometric measurements and laboratory markers of nutrition. Material and Methods: Patients aged 3-17 years with malnutrition who applied to Pamukkale University Pediatric Gastroenterology outpatient clinic and Pediatric Health and Diseases polyclinics and control group of the same age were evaluated prospectively. Anthropometric measurements of patients and health control group (height, body weight, body mass index (BMI), weight for height, middle arm circumference, triceps skin height measurement (TSF)) and 3 measurements for dominant hand and non-dominant hand. strength measurements (according to the NHANES protocol), finger web strength measurements, and blood and urine tests were taken. Hand grip strenght and finger pinch strength measurements were taken at the 2nd and 8th weeks of the group with malnutrition, which was carried out in terms of appropriate and adequate enteral nutrition. Anthropometric measurements and laboratory tests were repeated in the eighth week. Results: 55 malnourished children and 50 healthy control groups were included in our study. Body weight, BMI, BMI SDS, upper middle arm circumference and triceps skinfold thickness measurements were significantly lower in the patient group than in the control group (p<0.05). The mean ECG values in the dominant hand of the patient group were 13.52 ± 7.71 kg, and 16.92 ± 8.48 kg in the control group. The mean ECG values in the non-dominant hand of the patient group were 12.51 ± 7.11 kg, and 16.75 ± 8.63 kg in the control group. The mean values of pinch grip strength measurement in the non-dominant hand of the patient group were found to be 3.26 ± 1.49 kg, and 3.96 ± 1.56 kg in the control group. There was a statistically significant difference between the groups in these measurements. In laboratory examinations, albumin, triglyceride, VLDL, 25hydroxy vitamin D3 and ribonuclease activity levels were found to be low in the patient group, and high fibronectin levels (p<0.05). In the malnutrition group, a statistically significant difference was found between the baseline values and the repeated anthropometric and muscle strength measurements after an average of 16.8±5.43 days and 80.63±33.94 days after the first measurements of the patients whose nutrition was regulated.Conclusion: We think that the use of hand dynamometer and pinchmeter will be beneficial in the diagnosis of malnutrition in children and in monitoring the adequacy of nutrition regulation in the early period.