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DOI: 10.1055/s-0029-1223344
© Georg Thieme Verlag KG Stuttgart · New York
Messung der Muskelkraft als ernährungsmedizinische Zielgröße
Measurement of Hand Grip Strength as Nutritional Outcome ParameterPublication History
Publication Date:
13 November 2009 (online)
![](https://www.thieme-connect.de/media/akternmed/200906/lookinside/thumbnails/10.1055-s-0029-1223344-1.jpg)
Zusammenfassung
Die Muskelfunktion hat in den letzten Jahrzehnten als dynamischer Parameter des funktionellen Zustands und des Ernährungszustands an Bedeutung gewonnen. Bei krankheitsbedingter Mangelernährung kommt es zu einer typischen Beeinträchtigung der Muskelfunktion. Allerdings sind Veränderungen der Muskelkraft früher zu beobachten als ein messbarer Verlust der Muskelmasse, was darauf schließen lässt, dass die Muskelfunktion von weiteren Parametern abhängig ist, wie die Verringerung energiereicher Phosphate oder Veränderungen im Elektrolythaushalt. Dadurch kennzeichnet sich die Messung der Muskelkraft und insbesondere die der Handkraft durch eine hohe prognostische Bedeutung in Bezug auf Morbidität und Mortalität im akuten Krankheitsverlauf als auch im langfristigen Zeitrahmen. Die Messung der willkürlichen Handkraft mit einem Dynamometer ermöglicht eine praktikable Erfassung der Muskelfunktion und hat damit im klinischen und ambulanten Bereich Eingang gefunden. Die Handkraft ist in zahlreichen Studien auch als ernährungsmedizinische Zielvariable eingesetzt worden. Aufgrund der sensiblen Reaktionsfähigkeit ist eine Verringerung der Muskelfunktion nicht nur ein früher Indikator einer Mangelernährung, sondern reagiert rascher als Parameter der Körperzusammensetzung auf eine Ernährungstherapie. Mit der Einschränkung für geriatrische Patienten, wo die Handkraft nur bedingt durch eine Ernährungsintervention zu steigern ist, eignet sich die Handkraft als einfacher klinischer Verlaufsparameter zur unterstützenden Beurteilung einer Ernährungsintervention. Es bedarf dafür allerdings einer standardisierten systematischen Durchführung der Messung. Zur Beurteilung einzelner Werte ist die Verwendung von alters- und geschlechtsspezifischen Referenzwerten notwendig.
Abstract
Muscle function has gained attention as an indicator of functional as well as nutritional status. Loss of muscle strength is a key phenomenon in disease related malnutrition. However, the decrease in muscle function frequently precedes alterations of body composition. Therefore, muscle function is likely related to further factors than pure muscle mass, such as electrolytes, energy rich phosphates and membrane potential. This sensitivity might account for the prognostic power of muscle function – and hand grip strength in particular – in regard to morbidity and mortality in both acute and long-term settings. The assessment of voluntary hand grip strength with a dynamometer is a feasible and reliable bed side method suitable for the clinical and ambulatory setting. Hand grip strength has been investigated in numerous nutrition intervention studies. Muscle function responds earlier to nutritional deprivation and restoration, and is therefore an early marker of malnutrition as well as a useful tool for monitoring nutritional intervention in adult patients. In the elderly, however, nutritional intervention is not always successful in improving hand grip strength. A systematic and standardized measurement of hand grip strength is necessary in order to obtain valid results. For the evaluation of baseline grip strength values, age and gender specific reference data must be considered.
Schlüsselwörter
Handkraft - Muskelfunktion - Ernährungsintervention - Mangelernährung
Keywords
muscle function - hand grip strength - nutritional intervention - malnutrition
Literatur
- 1 Humphreys J, de la Maza P, Hirsch S. et al . Muscle strength as a predictor of loss of functional status in hospitalized patients. Nutrition. 2002; 18 (7–8) 616-620
- 2 Hunt D R, Rowlands B J, Johnston D. Hand grip strength – a simple prognostic indicator in surgical patients. JPEN J Parenter Enteral Nutr. 1985; 9 (6) 701-704
- 3 Klidjian A M, Foster K J, Kammerling R M. et al . Relation of anthropometric and dynamometric variables to serious postoperative complications. Br Med J. 1980; 281 (6245) 899-901
- 4 Webb A R, Newman L A, Taylor M. et al . Hand grip dynamometry as a predictor of postoperative complications reappraisal using age standardized grip strengths. JPEN J Parenter Enteral Nutr. 1989; 13 (1) 30-33
- 5 Mitsionis G, Pakos E E, Stafilas K S. et al . Normative data on hand grip strength in a Greek adult population. Int Orthop. 2008; 33 713-717
- 6 Lopes J, Russell D M, Whitwell J. et al . Skeletal muscle function in malnutrition. Am J Clin Nutr. 1982; 36 (4) 602-610
- 7 Russell D M, Leiter L A, Whitwell J. et al . Skeletal muscle function during hypocaloric diets and fasting: a comparison with standard nutritional assessment parameters. Am J Clin Nutr. 1983; 37 (1) 133-138
- 8 Mathiowetz V, Weber K, Volland G. et al . Reliability and validity of grip and pinch strength evaluations. J Hand Surg [Am]. 1984; 9 (2) 222-226
- 9 Schmidt R T, Toews J V. Grip strength as measured by the Jamar dynamometer. Arch Phys Med Rehabil. 1970; 51 (6) 321-327
- 10 Fernando M U, Robertson J C. Grip „strength” in the healthy. Rheumatol Rehabil. 1982; 21 (3) 179-181
- 11 BECHTOL CO . Grip test; the use of a dynamometer with adjustable handle spacings. J Bone Joint Surg Am. 1954; 36-A (4) 820-824
- 12 Petersen P, Petrick M, Connor H. et al . Grip strength and hand dominance: challenging the 10 % rule. Am J Occup Ther. 1989; 43 (7) 444-447
- 13 Crosby C A, Wehbe M A, Mawr B. Hand strength: normative values. J Hand Surg [Am]. 1994; 19 (4) 665-670
- 14 Incel N A, Ceceli E, Durukan P B. et al . Grip strength: effect of hand dominance. Singapore Med J. 2002; 43 (5) 234-237
- 15 Hillman T E, Nunes Q M, Hornby S T. et al . A practical posture for hand grip dynamometry in the clinical setting. Clin Nutr. 2005; 24 (2) 224-228
- 16 Tredgett M, Pimble L J, Davis T R. The detection of feigned hand weakness using the five position grip strength test. J Hand Surg [Br]. 1999; 24 (4) 426-428
- 17 Mathiowetz V. Comparison of Rolyan and Jamar dynamometers for measuring grip strength. Occup Ther Int. 2002; 9 (3) 201-209
- 18 Haidar S G, Kumar D, Bassi R S. et al . Average versus maximum grip strength: which is more consistent?. J Hand Surg [Br]. 2004; 29 (1) 82-84
- 19 Anakwe R E, Huntley J S, McEachan J E. Grip strength and forearm circumference in a healthy population. J Hand Surg Eur Vol. 2007; 32 (2) 203-209
- 20 Budziareck M B, Pureza Duarte R R. et al . Reference values and determinants for handgrip strength in healthy subjects. Clin Nutr. 2008; 27 (3) 357-362
- 21 Hanten W P, Chen W Y, Austin A A. et al . Maximum grip strength in normal subjects from 20 to 64 years of age. J Hand Ther. 1999; 12 (3) 193-200
- 22 Luna-Heredia E, Martin-Pena G, Ruiz-Galiana J. Handgrip dynamometry in healthy adults. Clin Nutr. 2005; 24 (2) 250-258
- 23 Massy-Westropp N, Rankin W, Ahern M. et al . Measuring grip strength in normal adults: reference ranges and a comparison of electronic and hydraulic instruments. J Hand Surg [Am]. 2004; 29 (3) 514-519
- 24 Minor M A, Hewett J E. Physical fitness and work capacity in women with rheumatoid arthritis. Arthritis Care Res. 1995; 8 (3) 146-154
- 25 Sayer A A, Syddall H E, Martin H J. et al . Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study. Age Ageing. 2006; 35 (4) 409-415
- 26 Norman K, Kirchner H, Lochs H. et al . Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol. 2006; 12 (21) 3380-3385
- 27 Goldblatt J, James O F, Jones D E. Grip strength and subjective fatigue in patients with primary biliary cirrhosis. JAMA. 2001; 285 (17) 2196-2197
- 28 Bohannon R W, Maljanian R, Ferullo J. Mortality and readmission of the elderly one year after hospitalization for pneumonia. Aging Clin Exp Res. 2004; 16 (1) 22-25
- 29 Kerr A, Syddall H E, Cooper C. et al . Does admission grip strength predict length of stay in hospitalised older patients?. Age Ageing. 2006; 35 (1) 82-84
- 30 Guo C B, Zhang W, Ma D Q. et al . Hand grip strength: an indicator of nutritional state and the mix of postoperative complications in patients with oral and maxillofacial cancers. Br J Oral Maxillofac Surg. 1996; 34 (4) 325-327
- 31 Rantanen T, Guralnik J M, Foley D. et al . Midlife hand grip strength as a predictor of old age disability. JAMA. 1999; 281 (6) 558-560
- 32 Rantanen T, Harris T, Leveille S G. et al . Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci. 2000; 55 (3) M168-M173
- 33 Sasaki H, Kasagi F, Yamada M. et al . Grip strength predicts cause-specific mortality in middle-aged and elderly persons. Am J Med. 2007; 120 (4) 337-342
- 34 Newman A B, Kupelian V, Visser M. et al . Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci. 2006; 61 (1) 72-77
- 35 Gale C R, Martyn C N, Cooper C. et al . Grip strength, body composition, and mortality. Int J Epidemiol. 2007; 36 (1) 228-235
- 36 Heimburger O, Qureshi A R, Blaner W S. et al . Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy. Am J Kidney Dis. 2000; 36 (6) 1213-1225
- 37 Wang A Y, Sea M M, Ho Z S. et al . Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients. Am J Clin Nutr. 2005; 81 (1) 79-86
- 38 Norman K, Schutz T, Kemps M. et al . The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction. Clin Nutr. 2005; 24 (1) 143-150
- 39 Pham N V, Cox-Reijven P L, Wodzig W K. et al . SGA and measures for muscle mass and strength in surgical Vietnamese patients. Nutrition. 2007; 23 (4) 283-291
- 40 Vaz M, Thangam S, Prabhu A. et al . Maximal voluntary contraction as a functional indicator of adult chronic undernutrition. Br J Nutr. 1996; 76 (1) 9-15
- 41 Christie P M, Hill G L. Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease. Gastroenterology. 1990; 99 (3) 730-736
- 42 Norman K, Kirchner H, Freudenreich M. et al . Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease – a randomized controlled trial. Clin Nutr. 2008; 27 (1) 48-56
- 43 Beattie A H, Prach A T, Baxter J P. et al . A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut. 2000; 46 (6) 813-818
- 44 Paton N I, Chua Y K, Earnest A. et al . Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Am J Clin Nutr. 2004; 80 (2) 460-465
- 45 Price R, Daly F, Pennington C R. et al . Nutritional supplementation of very old people at hospital discharge increases muscle strength: a randomised controlled trial. Gerontology. 2005; 51 (3) 179-185
- 46 Edington J, Barnes R, Bryan F. et al . A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clin Nutr. 2004; 23 (2) 195-204
- 47 Milne A C, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med. 2006; 144 (1) 37-48
- 48 Gunther C M, Burger A, Rickert M. et al . Grip strength in healthy caucasian adults: reference values. J Hand Surg [Am]. 2008; 33 (4) 558-565
- 49 Werle S, Goldhahn J, Drerup S. et al . Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur Vol. 2009; 34 (1) 76-84
- 50 Schlüssel M M, dos Anjos L A, de Vasconcellos M T. et al . Reference values of handgrip dynamometry of healthy adults: a population-based study. Clin Nutr. 2008; 27 (4) 601-607
Dr. Kristina Norman
Medizinische Klinik und Poliklinik, Charité – Universitätsmedizin Berlin
Charitéplatz 1
10117 Berlin
Phone: +49-30-450-514139
Fax: +49-30-450-514901
Email: kristina.norman@charite.de