Skip to main content

Advertisement

SpringerLink
Log in

Hand-grip strength as a screening tool for sarcopenia in males with decompensated cirrhosis

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Skeletal muscle index (SMI), the gold standard for sarcopenia, cannot measure muscle strength and requires specialized software and training. Hand-grip strength (HGS) measurement is cheap, requires minimal training and directly reflects muscle strength. We assessed the performance of HGS as a screening tool for sarcopenia in male patients with decompensated cirrhosis (DC).

Methods

Consecutive male DC patients (n=155) were enrolled. Baseline liver functions, etiologic work-up and anthropometric measurements were done. SMI was determined from computed tomography (CT) images at L3 level using ImageJ software. Sarcopenia was diagnosed using SMI cut-off <42 cm2/m2 as suggested by the Indian National Association for Study of the Liver. HGS was assessed using a hand-grip dynamometer. Diagnostic performance of HGS for discriminating sarcopenia was described using receiver operating characteristic (ROC) analysis. Diagnostic performance of different HGS cut-offs was assessed. Findings were internally validated using bootstrapping.

Results

Mean HGS and SMI were 25.73 ± 5.94 kg and 47.72 ± 8.71 cm2/m2, respectively. HGS showed modest correlation with SMI (tau: 0.31, p <0.001). Sarcopenia was seen in 41 (26.5%) patients. Age and HGS were independent predictors of sarcopenia on multivariate analysis. Area under the ROC curve (AUROC) of HGS for detecting sarcopenia was 0.73 (p<0.001). Optimal cut-off for using HGS as a screening tool was ≤31 kg (sensitivity: 37/41 [90.2%]; specificity: 29/114 [25.4%]; positive predictive value [PPV] : 37/122 [30.3%]; and negative predictive value [NPV]: 29/33 [87.9%]).

Conclusion

Prevalence of sarcopenia in Indian male patients with DC is 26.5%. HGS is an independent predictor of sarcopenia and can be used as a screening tool to stratify the need for confirmatory CT-based assessment of sarcopenia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. 2019;70:172–93.

  2. Tandon P, Ney M, Irwin I, et al.. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012;18:1209–16.

  3. Montano-Loza AJ, Meza-Junco J, Baracos VE, et al. Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transpl. 2014;20:640–8.

  4. Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol. 2014;20:8061–71.

    Article  Google Scholar 

  5. Montano–Loza AJ, Meza–Junco J, Prado CMM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10:166–73.e1.

  6. Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, et al. Inclusion of sarcopenia within MELD (MELD-sarcopenia) and the prediction of mortality in patients with cirrhosis. Clin Transl Gastroenterol. 2015;6:e102–2.

  7. DiMartini A, Cruz RJ, Dew MA, et al. Muscle mass predicts outcomes following liver transplantation. Liver Transpl. 2013;19:1172–80.

  8. Englesbe MJ, Patel SP, He K, et al. Sarcopenia and mortality after liver transplantation. J Am Coll Surg. 2010;211:271–8.

  9. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–23.

  10. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.

  11. Puri P, Dhiman RK, Taneja S, et al. Nutrition in chronic liver disease: consensus statement of the Indian National Association for Study of the Liver. J Clin Exp Hepatol. 2021;11:97–143.

  12. Tandon P, Low G, Mourtzakis M, et al. A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol. 2016;14:1473–80.e3.

  13. Gomez-Perez SL, Haus JM, Sheean P, et al. Measuring abdominal circumference and skeletal muscle from a single cross-sectional computed tomography image: a step-by-step guide for clinicians using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr. 2016;40:308–18.

  14. Mani P, Sethupathy K, Francis AAK. Test-retest reliability of electronic hand dynamometer in healthy adults. Int J Adv Res. 2019;7:325–31.

    Article  Google Scholar 

  15. Ahn R, Yoo CI, Lee H, et al. Normative data for neuromuscular assessment of the hand-arm vibration syndrome and its retrospective applications in Korean male workers. Int Arch Occup Environ Health. 2013;86:837–44.

  16. Díaz-Muñoz GA, Calvera-Millán SJ. Comparing the Camry dynamometer to the Jamar dynamometer for use in healthy Colombian adults. Revista Salud Bosque. 2019;9:21–9.

  17. Marques LP, Confortin SC, Ono LM, et al. Quality of life associated with handgrip strength and sarcopenia: EpiFloripa Aging Study. Arch Gerontol Geriatr. 2019;81:234–9.

  18. Elkholy S, Mogawer S, Mansour M, Elmessiery R, Elmeligui A. Hand grip strength as a nutritional assessment tool in patients with liver cirrhosis. Int J Adv Res. 2016;4:1183–91.

  19. Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age Ageing. 2011;40:423–9.

  20. Fess EE. Grip Strength, 2nd edition. Chicago: American Society of Hand Therapists (ASHT) [Internet]. 1992. Available from: https://www.asht.org/practice/clinical-assessment-recommendations

  21. Spijkerman DC, Snijders CJ, Stijnen T, Lankhorst GJ. Standardization of grip strength measurements. Effects on repeatability and peak force. Scand J Rehabil Med. 1991;23:203–6.

    CAS  PubMed  Google Scholar 

  22. Hawass NE. Comparing the sensitivities and specificities of two diagnostic procedures performed on the same group of patients. Br J Radiol. 1997;70:360–6.

  23. Kumar V, Benjamin J, Shasthry V, et al. Sarcopenia in Cirrhosis: Fallout on Liver Transplantation. J Clin Exp Hepatol. 2020;10:467–76.

  24. Anand A, Mohta S, Agarwal S, et al. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria with population-based skeletal muscle index best predicts mortality in Asians with cirrhosis. J Clin Exp Hepatol. 2022;12:52–60.

  25. Plauth M, Cabré E, Riggio O, et al. ESPEN Guidelines on Enteral Nutrition: Liver disease. Clin Nutr. 2006;25:285–94.

  26. Figueiredo FA, Dickson ER, Pasha TM, et al. Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease. Liver Transpl. 2000;6:575–81.

  27. Ciocîrlan M, Cazan AR, Barbu M, et al. Subjective global assessment and handgrip strength as predictive factors in patients with liver cirrhosis. Gastroenterol Res Pract. 2017;2017:4–8.

  28. Daphnee DK, John S, Vaidya A, Khakhar A, Bhuvaneshwari S, Ramamurthy A. Hand grip strength: a reliable, reproducible, cost-effective tool to assess the nutritional status and outcomes of cirrhotics awaiting liver transplant. Clin Nutr ESPEN. 2017;19:49–53.

  29. Alvares-da-Silva MR, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition. 2005;21:113–7.

  30. Tandon P, Tangri N, Thomas L, et al. A rapid bedside screen to predict unplanned hospitalization and death in outpatients with cirrhosis: a prospective evaluation of the clinical frailty scale. Am J Gastroenterol. 2016;111:1759–67.

  31. Wang CW, Feng S, Covinsky KE, et al. A comparison of muscle function, mass, and quality in liver transplant candidates: results from the functional assessment in liver transplantation study. Transplantation. 2016;100:1692–8.

  32. Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2013;35:51–65.

    Article  Google Scholar 

  33. Lauretani F, Russo CR, Bandinelli S, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985). 2003;95:1851–60.

  34. Sinclair M, Chapman B, Hoermann R, et al. Handgrip strength adds more prognostic value to the model for end-stage liver disease score than imaging-based measures of muscle mass in men with cirrhosis. Liver Transpl. 2019;25:1480–7.

  35. Krause KE, McIntosh EI, Vallis LA. Sarcopenia and predictors of the fat free mass index in community-dwelling and assisted-living older men and women. Gait Posture. 2012;35:180–5.

    Article  Google Scholar 

  36. Stoever K, Heber A, Eichberg S, Brixius K. Sarcopenia and predictors of skeletal muscle mass in elderly men with and without obesity. Gerontol Geriatr Med. 2017;3:2333721417713637.

    Article  Google Scholar 

  37. Tachi Y, Kozuka A, Hirai T, et al. Impact of myosteatosis on skeletal muscle volume loss in patients with chronic liver disease. J Gastroenterol Hepatol. 2018;33:1659–66.

Download references

Author information

Authors and Affiliations

  1. Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India

    Arka De, Sunita Kumari, Akash Singh & Virendra Singh

  2. Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India

    Amritjyot Kaur

  3. Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India

    Naveen Kalra

Authors
  1. Arka De
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunita Kumari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amritjyot Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akash Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naveen Kalra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Virendra Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Arka De: design of the study protocol, patient enrolment, data collection and manuscript writing; Sunita Kumari: patient enrolment, data collection and manuscript writing; Amritjyot Kaur: patient enrolment, data collection and analysis; Akash Singh: data collection and analysis; Naveen Kalra: data collection; Virendra Singh: conceived the study, design of the study protocol, patient enrolment, data collection, manuscript writing and critical revision. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Virendra Singh.

Ethics declarations

Conflict of interest

AD, SK, AK, AS, NK, and VS declare no competing interests.

Ethics approval and consent to participate

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. 

Disclaimer

 The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 14 kb)

Supplementary Figure 1:

Flow-diagram of study (PDF 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De, A., Kumari, S., Kaur, A. et al. Hand-grip strength as a screening tool for sarcopenia in males with decompensated cirrhosis. Indian J Gastroenterol 41, 284–291 (2022). https://doi.org/10.1007/s12664-022-01255-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-022-01255-2

Keywords

Search

Navigation