Hand grip strength as predictor of undernutrition in hospitalized patients with cancer and a proposal of cut-off.

BACKGROUND & AIMS: Hand Grip Strength (HGS) has been proposed as an indicator of nutritional status, being an easy and non-invasive method and presenting high reliability among evaluators. However, there are no cut-off points. To compare HGS with objective methods of nutritional assessment and to propose a cut-off point for its use as a predictor of malnutrition in cancer patients. METHODS: This is a retrospective study with 76 patients (52.6% females, 56.8 ± 16.6 years old) admitted with a diagnosis of cancer in hospitals of Belo Horizonte (MG, Brazil). We evaluated the HGS of the dominant hand, Body Mass Index (BMI), calf circumference (CC), and arm circumference (AC), using the Receiver Operator Characteristic (ROC) curve analysis, being the Patient-Generated Subjective Global Assessment (PG-SGA) the reference method. Statistical tests were performed according to the distribution of the variables, verified by the Shapiro-Wilk test. The level of significance adopted was 5%. RESULTS: The HGS was higher in men (p = 0.001) and adults (p = 0.002). The HGS presented a better performance in the prediction of malnutrition (AUC = 0.766, 95% CI = 0.656-0.936) compared to the anthropometric indicators, with a cut-off point of 32.5 kg (sensitivity of 90.5% and specificity of 61.5%). The prevalence of malnutrition was 82.9% and 81.6% for PG-SGA and proposed cut-off point for HGS, respectively. CONCLUSIONS: The HGS was more sensitive to identify individuals at risk of malnutrition compared to other recognized indicators of nutritional status, indicating its application in a hospital setting with cancer patients.

Nutritional Screening Tools Used and Validated for Cancer Patients: A Systematic Review.

The purpose of this systematic review was to identify validated nutritional screening tools for cancer patients. The research was conducted in the electronic databases Pubmed, Cochrane Library, Scopus, and Biblioteca Virtual de Saúde (BVS), using the descriptors "Nutrition Assessment", "Neoplasms", and "Validation studies". Initially, we identified 168 articles. After assessing eligibility, we included 21 studies. In selected studies, 14 nutritional screening tools were validation objects. The Patient-Generated Subjective Global Assessment (PG-SGA) showed better sensitivity, specificity and positive and negative predictive values (98, 82, 95, and 93%, respectively), as well as predictive of overall survival in cancer patients. In many countries, in addition to PG-SGA, the Nutrition Risk Screen (NRS-2002) is recommended for these patients. We did not identify, however, manuscripts that proposed validation. Validation studies of nutritional screening tools should be performed on patients with cancer, using representative samples of these individuals for better reliability of their results.