Hand Grip Strength

Hand Grip Strength

1.        Handgrip strength: an indicator of nutritional state and the mix of postoperative complications in patients with oral and maxillofacial cancers

a.       British Journal of Oral and Maxillofacial surgery, 1996

b.      Estimated that 36% of patients who present with oral and maxillofacial cancers are malnourished at the time of diagnosis

c.       Results in reduced immunocompetence, impaired wound healing, reduced tolerance to chemotherapy, XRT and surgery

d.      Nutritional state closely correlated with morbidity and mortality

e.      Skeletal muscle is important reserve of amino acids which may be mobilized at times of stress or starvation.  Functional state reflects the body’s nutritional state.

f.        Hand grip strength as indicator of nutritional state

                                                               i.      Non dominant arm

                                                             ii.      Patients with hand grip strength of less than 85% of control were considered to be malnourished

g.       Other measures of skeletal muscle mass/nutritional state

                                                               i.      Midarm muscle circumference

                                                             ii.      Creatinine height index – a measure of the actual 24-hr urinary creatinine excretion compared to predicted calculated from ideal body weight and height.

2.       Is grip strength a useful single marker of frailty

a.       Age and Ageing 2003, British Geriatrics Society

b.      Grip strength is a powerful predictor of disability, morbidity and mortality

c.       Loss of grip strength strongly associated with increasing chronological age.

d.      Lower grip strength suggests loss of muscle mass and muscle strength can lead to physical disability.  Higher muscle strength related to increased bone mass and lower risk of fracture

e.      Grip strength in midlife and later years predicts long-term survival

3.       Muscle Strength and Body Mass Index as Long-Term Predictors of Mmortality in Initially Healthy Men

a.       Journal of Gerontology, 2000

b.      In middle-aged people, poor muscle strength associated with lower body weight, presence of chronic disease, physical inactivity and lower education.

                                                               i.      All known factors of increased mortality

c.       Among geriatric patients, poor muscle strength found to predict increased mortality during acute illness.

d.      Body size major determinant of muscle strength.  Thinner people more often have poorer strength and more illness and have greater mortality than those with normal body weight.

e.      Heavier people are stronger but also have higher mortality.  ?low strength relative to body size

f.        Hand grip strength is independent of BMI in predicting risk of mortality

g.       ? poor strength may precede the development of insulin resistance and predict diabetes.

h.      Osteoarthritis – causes pain and disability; disability a known risk factor for mortality.

i.         Grip strength associated with upper arm lean mass, may indicate a reserve of muscle mass important in cases of trauma

j.        Strength associated with physical activity which in itself predicts better survival.

4.       Race and Sex Effects on the Association Between Muscle Strength, Soft Tissue and Bone Mineral Density in healthy Elders:  The Health, Aging, and Body Composition Study

a.       Journal of Bone and Mineral Research, 2001

b.      Two factors that influence bone density are body composition and muscle strength.

c.       Males have greater bone mass and lower risk for fracture than females.

d.      African Americans have greater bone mass and lower risk for fracture.

e.      Muscle strength a predictor of bone density independent of body weight in women

5.       Hand grip strength is a simple and effective outcome predictor in esophageal cancer following esophagectomy with reconstruction : A prospective Study.

a.       J Cardiothoracic Surgery 2011

b.      Surgery for esophageal cancer usually carries considerable complication and mortality rate.  Preoperative nutrition state plays important role in postoperative recovery.

c.       Patients with esophageal cancer often present with dysphagia and generalized weakness.

d.      For advanced disease, life expectance is often less than 12 months.

e.      Hand grip strength is a proper predictor of immune system, nutrition, aging process, bone density, overall body strength – especially in old age group

f.        Both weak hand grip strength and diabetes were associated with more likelihood of complication.  Abnormally elevated MCV has borderline significance.

g.       Weak grip associated with longer hospital stay.  Also with delayed oral intake.

h.      Retrospectively, hand grip strength less than 25kg is weak and predicts morbidity and mortality.

6.       Grip Strength, Body composition and Mortality

a.       Oxford Journals, 2006 on behalf of the International Epidemiological Association

b.      Poor grip strength associated with increased mortality from all-causes – esp cancer in men