Adductor muscle thickness of the thumb: A new and reliable parameter for nutritional assessment of pediatric inpatients

Abstract

The adductor pollicis muscle thickness (APMT) is a promising method for evaluation of muscle loss and, consequently, malnutrition in adult and elderly patients. However, to date, there have been no studies of its applicability to the pediatric population. Within this context, we sought to evaluate the association of APMT with anthropometric variables, body mass index (BMI), pediatric Subjective Global Assessment (SGA) of nutrition, nutritional screening, and clinical outcomes in hospitalized pediatric patients. This was a cross-sectional study of inpatients aged 4-8.9 years, recruited via convenience sampling from a pediatric hospital in Porto Alegre, Rio Grande do Sul, Brazil. Data collection took place between December 2014 and February 2016. Patients admitted to the intensive care unit, those unable to feed orally, and those with cerebral palsy or Down syndrome were excluded from the study. General and socioeconomic information was collected and the SGA Ped and STRONGkids were administered at hospital admission. Clinical data were collected from the electronic medical record. Anthropometric parameters and APMT were measured by properly calibrated examiners. Data analysis was carried out in SPSS version 21.0. The significance level was set at 5%. The sample consisted of 447 patients. Most (55.9%) were male; the mean age was 6.2±1.4 years. Low APMT was significantly associated with underweight, short stature, low body fat percentage, and poor muscle reserve (p<0.001). There were also significant associations of moderate and severe malnutrition (assessed by the SGA Ped) and high nutritional risk (assessed by the STRONGkids instrument) with reduced APMT (p<0.001). Regarding clinical outcomes, a longer hospital stay was observed in patients with reduced APMT (p=0.001). A receiver operating characteristic (ROC) curve, plotted considering the SGA Ped as the gold standard, suggested APMT cutoff points of 10.2mm for boys and 9.5mm for girls. Stratification by age yielded APMT cutoff points of 9.8mm for boys younger than 6 years and 10.2mm for those older than 6 years, and 9.2mm and 9.8mm for girls younger and older than 6 years, respectively. The APMT is an efficient parameter for the detection of malnutrition in hospitalized pediatric patients.