| Objectives(1)To explore the relationship between handgrip strength and nutritional status of patients with malignant tumors.(2)To explore the cut-off value of handgrip strength in different genders and age groups when it is used as a nutritional risk screening index for patients with malignant tumors.(3)Based on the judgment of the cut-off value,the effect of handgrip strength in the nutritional risk screening of patients with malignant tumors is tested.Methods(1)The convenience sampling method was used to select 490 patients with malignant tumors who were hospitalized in the Oncology Department of the First Affiliated Hospital of Guangxi Medical University and the Second Affiliated Hospital of Guangxi Medical University from October2019 to January 2020,and the handgrip strength,height and weight of the patients were measured.Anthropometric indicators such as,arm circumference,calf circumference,etc.NRS2002 was used for nutritional risk score,and pearson correlation was used to analyze the correlation between handgrip strength and anthropometric indicators of patients with malignant tumors and nutritional risk status.The nutritional risk status of male patients with malignant tumors and female patients with malignant tumors were used as the dependent variable,and the handgrip strength was used as the independent variable to perform binary logistic regression analysis.Then,the age was adjusted and the regression model was established after diagnosis.Height,weight,BMI,arm circumference,calf circumference)were adjusted to establish a regression model again to explore whether handgrip strength is an influencing factor for the nutritional risk of patients with malignant tumors.Dividing the handgrip strength of male and female patients with malignant tumors into 4 quantile groups,set the highest handgrip strength group 4 as the reference(OR=1),then adjust the age and diagnostic factors and perform binary logistic regression analysis,and then adjust after multiple factors(age,diagnosis,height,weight,BMI,arm circumference,calf circumference),the binary logistic regression analysis was performed again to explore the relationship between handgrip strength and nutritional status;According to whether there is a nutritional risk,a gender-and age-specific receptor work characteristic curve is constructed to evaluate the screening effect of handgrip strength on the nutritional risk of patients with malignant tumors of different genders and ages.And calculated the cut of point of handgrip strength in predicting the nutritional risk of young men,old men,young women,and old women with malignant tumors.(2)The convenience sampling method was adopted to select 339 malignant tumor patients who were hospitalized in the Oncology Department of the First Affiliated Hospital of Guangxi Medical University from May 2020 to July 2020.The handgrip strength of the patients was measured with a grip meter,and NRS2002 was used for nutritional risk screening.At the same time collect the patient’s general information,anthropometric indicators and blood indicators related to nutrition such as hemoglobin,albumin,and prealbumin.Compare the nutritional screening results of handgrip strength and NRS2002,and compare the general condition,anthropometric indicators and nutritional-related blood indicators of patients under different nutritional risk states when using the two screening methods.Kappa consistency test was performed on the nutritional risk screening results of handgrip strength and NRS2002.Results(1)Pearson correlation analysis showed that body mass,body mass index,calf circumference,arm circumference,and handgrip strength were negatively correlated with the nutritional risk status of patients(P<0.001).A binary logistic regression analysis with handgrip strength as the independent variable and nutritional risk status as the dependent variable found that handgrip strength is an influencing factor for the nutritional risk of patients with malignant tumors(P<0.001);A regression model was established by adjusting age and diagnosis.After binary logistic regression analysis,it was found that after adjusting age and diagnosis,handgrip strength is also an influencing factor for the nutritional risk of the patients with malignant tumors(P<0.001);After adjusting for multiple factors such as age,diagnosis,height,body weight,arm circumference,etc.,the binary logistic regression analysis was performed again and found that handgrip strength is still an influencing factor for the nutritional risk of patients with malignant tumors(P<0.001);In male patients,after quartiles of handgrip strength,from low to high,they are divided into low level1 group(<25.5kg),2 group(25.5-31.9kg),3 group(32.0-38.8kg),high level 4groups(>38.8kg)total 4 groups.The results showed that taking the high-level handgrip strength group 4 as the reference(OR=1),after adjusting for the effects of age and diagnosis,the nutritional risk ORs of the 3 groups,2 groups,and 1group were 2.06,8.42,and 51.06,respectively.It could be seen that compared with the patients in the highest handgrip strength group,the nutritional risks of the other three groups are increasing;After adjusting for multiple factors(age,diagnosis,height,body weight,BMI,arm circumference,calf circumference),it was found that the nutritional risk ORs of patients in groups 3,2,and 1 were1.20,4.93,and 30.56,respectively,with P for trend<0.001;In female patients,after quartiles of handgrip strength,from low to high,they were divided into low level group 1(<17.7kg),group 2(17.7-21.2kg),group 3(21.3-25.5kg),high level 4 groups(>25.5kg),a total of 4 groups.The 4 groups of high-level handgrip strength were set as the reference(OR=1).The results showed that after adjusting for the effects of age and diagnosis,the nutritional risk ratio ORs of the 3 group,2 group,and 1 group were 7.90,46.13,and 138.60,respectively.It could be seen that compared with the patients in the highest handgrip strength group,the nutritional risks of the other three groups are increasing;After adjusting for multiple factors(age,diagnosis,height,weight,BMI,arm circumference,calf circumference),it was found that the nutrition of the 3 group,2 group,and 1 group of patients,the risk ratio OR was 5.78,30.68,95.42,and P for trend<0.001;The area under the ROC curve(AUC)of handgrip strength predicting the nutritional risk of young male patients is 0.859(>0.5),the sensitivity is 81.1%,and the specificity is 79.4%;The area under the ROC curve(AUC)of handgrip strength predicting the nutritional risk of male elderly patients is 0.800(>0.5),the sensitivity is 80.6%,and the specificity is 69.2%;The area under the ROC curve(AUC)of handgrip strength predicting the nutritional risk of young female patients is 0.867(>0.5),the sensitivity is 84.4%,and the specificity is 75.3%;The area under the ROC curve(AUC)of handgrip strength predicting the nutritional risk of female elderly patients is 0.901(>0.5),the sensitivity is 83.3%,and the specificity is 93.35%;When the maximum cut-off point of the Youden index is used as the critical value for judging nutritional risk,the results show that the critical value of handgrip strength predicting the nutritional risk of male youth is 32.2 kg,and the critical value of handgrip strength predicting nutritional risk of male elderly is 26.9 kg.The critical value of nutritional risk for female youth is 21.3 kg,and the critical value of handgrip strength for predicting nutritional risk for female elderly is 20.5 kg.(2)When handgrip strength was used as a nutritional risk screening indicator,44.2% of patients with malignant tumors are at nutritional risk;when NRS2002 was used for nutritional risk screening,38.9% of patients with malignant tumors were at nutritional risk;When handgrip strength was used as a nutrition screening index,the differences in age,height,weight,BMI,arm circumference,calf circumference,hemoglobin,prealbumin,and albumin between the normal nutrition group and the nutrition risk group are statistically significant(P<0.05);When using NRS2002 as a screening tool,the differences in age,body weight,BMI,arm circumference,calf circumference,hemoglobin,prealbumin,and albumin between the normal nutrition group and the nutrition risk group were statistically significant(P<0.05);There was a statistically significant difference between the results of the two screening methods of handgrip strength and NRS2002(P<0.05),and the Kappa value was 0.576.Conclusions(1)Handgrip strength is an influencing factor for the nutritional risk of patients with malignant tumors;From the high-level handgrip strength group to the low-level handgrip strength group,as the handgrip strength level decreases,the nutritional risk of patients with malignant tumors is on the rise;When the handgrip strength of male youth is less than 32.2 kg,the handgrip strength of male elderly is less than 26.9 kg,the handgrip strength of female youth is less than 21.3 kg,and the handgrip strength of female elderly is less than 20.5 kg,it can be preliminarily judged that there is a nutritional risk.(2)When handgrip strength is used as a nutritional risk screening index,the detection rate of nutritional risk is higher than that of NRS2002;Handgrip strength and NRS2002 two nutritional risk screening results are moderately consistent;Handgrip strength measurement can be combined with NRS2002 as a tool for nutritional risk screening for patients with malignant tumors,thereby improving the breadth and accuracy of nutritional risk screening. |
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