Malnutrition in Relation to Muscle Mass, Muscle Quality, and Muscle Strength in Hospitalized Older Adults

Lingling Xie; Jiaojiao Jiang; Hongbo Fu; Wenyi Zhang; Ling Yang; Ming Yang

doi:10.1016/j.jamda.2021.11.025

Malnutrition in Relation to Muscle Mass, Muscle Quality, and Muscle Strength in Hospitalized Older Adults

J Am Med Dir Assoc. 2022 May;23(5):722-728. doi: 10.1016/j.jamda.2021.11.025. Epub 2021 Dec 23.

Authors

Lingling Xie¹, Jiaojiao Jiang², Hongbo Fu³, Wenyi Zhang³, Ling Yang⁴, Ming Yang⁵

Affiliations

¹ West China School of Nursing/Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
² Rehabilitation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
³ Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁴ Outpatient Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁵ Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: yangmier@gmail.com.

PMID: 34953766
DOI: 10.1016/j.jamda.2021.11.025

Abstract

Objectives: Muscle quality is an essential muscle metric, which can be assessed by measuring intermuscular adipose tissue (IMAT) and skeletal muscle radiodensity (SMD) via computed tomography (CT) images. We aimed to explore the associations of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition with muscle mass, muscle quality, and muscle strength in hospitalized older adults.

Design: A cross-sectional study.

Setting and participants: Hospitalized older patients.

Methods: Malnutrition was defined by the GLIM criteria after screening by the Mini Nutrition Assessment-Short Form (MNA-SF). Chest CT images were used to segment skeletal muscle area (SMA) and IMAT, and to measure SMD. Skeletal muscle index (SMI) was calculated by SMA (cm²)/body height squared (m²). Handgrip strength (HGS) was measured using a digital dynameter. Univariate and multivariate logistic regression models were performed to calculate odds ratios (ORs) and 95% CIs.

Results: We included 1135 patients. The MNA-SF score is positively associated with SMI, SMD, and HGS, but negatively associated with IMAT. Compared to patients with normal nutrition, patients with malnutrition had significantly lower SMD and HGS in both men and women. Women with malnutrition had significantly higher IMAT than women with normal nutrition, whereas men with malnutrition had significantly lower SMI than men with normal nutrition. After adjustment for confounders, SMI (adjusted OR 0.95, 95% CI 0.93, 0.98), SMD (adjusted OR 0.94, 95% CI 0.93, 0.98), and HGS (adjusted OR 0.91, 95% CI 0.89, 0.94) were significantly and negatively associated with malnutrition. IMAT appeared to be positively associated with malnutrition, but the result was not statistically significant (adjusted OR 1.03, 95% CI 1.00, 1.07).

Conclusions and implications: Our study provides new evidence regarding the association between handgrip strength and malnutrition in older inpatients. Moreover, a small association of chest CT--derived muscle quality and mass with malnutrition is identified.

Keywords: Sarcopenia; malnutrition; muscle quality; muscle wasting; myosteatosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cross-Sectional Studies
Female
Hand Strength
Humans
Male
Malnutrition* / diagnosis
Muscle Strength
Muscle, Skeletal / diagnostic imaging
Muscle, Skeletal / pathology
Nutrition Assessment
Sarcopenia* / diagnostic imaging