ADDUCTOR POLLICIS MUSCLE THICKNESS MEASUREMENT – A RELIABLE METHOD FOR NUTRITIONAL STATUS ASSESSMENT IN CRITICALLY ILL PATIENTS

Abstract

Introduction: Malnutrition in hospital patients is a worldwide problem which leads to increased morbidity and mortality rate. Nutritional assessment carried out immediately after admission of the patient allows to make a plan to start nutritional therapy in order to improve nutritional status and minimize the risk of complications. Among the different methods for nutritional assessment a new technique that enables a measurement of the thickness of adductor pollicis muscle has become popular in the last years. The objective of this study was to determine the validity of the measurement of the thickness of adductor pollicis muscle in correlation to other anthropometric measurements for nutritional status assessment in critically ill patients. Material and Methods: The pilot study included 24 patients treated at the Clinic for Anesthesiology, Reanimation and Intensive Care in the period from April to June 2017. The inclusion criteria were age older than 18 years and hemodynamically stable patients. Exclusion criteria were: pregnancy, current injury or deteriorated mobility from a previous injury, upper limb fracture in the last six months, and degenerative disease. The nutritional status was followed by: Weight and height, Body Mass Index, Mid Arm circumference, Triceps skinfold thickness, Mid Arm Muscle Circumference, Calf circumference, the thickness of Adductor pollicis muscle (TAPM) and Subjective Global Assessment. Results: The mean TAPM measured in mm was 16, 67±2,16 in male and 13,00±1,73 in female patients for dominant hand, and 15,24±2,11 in male and 11,70± 2,54 in female for non-dominant hand. The mean TAPM in patients younger than 45 years was the highest for both the dominant (17, 11±2,47) and the non-dominant hand (15,67 ±2,55). The smallest mean TAPMhand (14,47 ± 2,67). According to the subjective global assessment the mean TAPM was highest in well-nourished patients (16.93 ± 2.16) and smallest in patients with severe malnutrition (12.50 ± 2.56). The correlation between the TAPM and other anthropometric measures showed significance only with Mid Arm Muscle Circumference (p = 0.003) and Calf circumference (p = 0.046) for the dominant hand and with Mid Arm circumference (p = 0.017), Mid Arm Muscle Circumference (p = 0.002) and Calf circumference (p = 0.009) for the non-dominant hand. Conclusion: The measurement of the thickness of adductor pollicis muscle presents a reliable method for nutritional status assessment and it correlates to the other anthropometric measurements used in clinical practice in critically ill patients.