Hand Grip Force-Time Curve Indicators Evaluated by Dynamometer: A Systematic Review.

BACKGROUND: Handgrip strength (HGS) is an indicator of muscular strength, used in the diagnosis of sarcopenia, undernutrition, and physical frailty as well as recovery. Typically, the maximum HGS value is used; however, recent evidence suggests the exploration of new indicators provided based on the force-time curve to achieve a more comprehensive assessment of muscle function. Therefore, the objective was to identify indicators of the HGS profile beyond maximum HGS, based on force-time curves, and to systematize knowledge about their applications to various types of samples, health issues, and physical performance. METHODS: A systematic review was performed including studies whose participants' HGS was assessed with a digital or adapted dynamometer. The outcome measures were HGS profile indicators calculated from the force-time curve. RESULTS: a total of 15 studies were included, and the following indicators were identified: grip fatigue, fatigability index, fatigue rate, fatigue resistance, time to 80% maximal voluntary contraction, plateau coefficient of variability, time to maximum value, T-90%, release rate, power factor, grip work, average integrated area, endurance, cycle duration, time between cycles, maximum and minimum force-velocity, rate of grip force, final force, inflection point, integrated area, submaximal control, and response time. CONCLUSIONS: Various indicators based on the force-time curve can be assessed through digital or adapted dynamometers. Future research should analyze these indicators to understand their implications for muscle function assessment, to standardize evaluation procedures, to identify clinically relevant measures, and to clarify their implications in clinical practice.

Prediction equations for estimating body weight in older adults.

BACKGROUND: Assessing body weight in older adults may be challenging. Hence, the present study aimed to develop and cross-validate updated and reproducible equations to estimate body weight in a large sample of older adults, namely among the older-old. METHODS: In total, 1456 individuals aged ≥ 65 years, from the Nutrition UP 65 study, were included in the present analysis. The participants were randomly assigned to one of two sub-samples: development (n = 991) and validation samples (n = 465). Prediction equations using height, mid-upper arm circumference (MUAC), waist circumference (WC), calf circumference (CC) and triceps skinfold thickness (TST) were generated for the development sample using multiple regression analysis and then validated using the validation sample. RESULTS: The model with five predictor variables generated the following equations: females 65-79 years: -114.682 + 0.522 × height (cm) + 0.620 × MUAC (cm) + 0.517 × WC (cm) + 0.893 × CC (cm) + 0.111 × TST (mm) (adjusted r2  = 0.883, standard error of the estimate (SEE) = 4.4); females ≥ 80 years: -110.806 + 0.494 × height (cm) + 0.637 × MUAC (cm) + 0.500 × WC (cm) + 0.986 × CC (cm) + 0.021 × TST (mm) (adjusted r2  = 0.890, SEE = 3.9); males 65-79 years: -114.875 + 0.558 × height (cm) + 0.073 × MUAC (cm) + 0.671 × WC (cm) + 0.717 × CC (cm) + 0.182 × TST(mm) (adjusted r2  = 0.820, SEE=5.0); and males ≥ 80 years: -128.789 + 0.546 × height (cm) + 0.202 × MUAC (cm) + 0.612 × WC (cm) + 1.236 × CC (cm) + 0.093 × TST (mm) (adjusted r2  = 0.906, SEE = 3.5). CONCLUSIONS: Body weight can be estimated with good accuracy in older adults using these sex- and age-specific equations generated from regression models using three to five anthropometric predictor variables.

Urinary Sodium Excretion and Adherence to the Mediterranean Diet in Older Adults.

Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 24 h urine sample was collected and analysed for creatinine and sodium. Excessive sodium intake was defined as above 2000 mg/day. The adherence to the MedDiet was assessed by the PREDIMED. A binary logistic regression model was conducted to evaluate the association between urinary sodium excretion and the adherence to the MedDiet. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Excessive sodium excretion was observed in 80.0% of men and 91.5% of women whereas a high adherence to the MedDiet was reported by 42.2% of women and 46.4% of men. After adjusting for confounders, excessive sodium excretion was associated with a high adherence to the MedDiet in men (OR = 1.94; 95% CI: 1.03-3.65) but not in women. These results show that the MedDiet can be an important source of sodium and highlight the need for implementing strategies to reduce sodium intake when following a MedDiet.

Association Between Anthropometric Indicators of Nutrition Status and Length of Hospital Stay in Hospitalized Patients.

BACKGROUND: Undernutrition is associated with increased hospital length of stay (LOS). Anthropometrics is required for undernutrition screening and diagnosis. However, the measurements which are more strongly associated with LOS are to be specified. This study aims to measure the independent association of weight, triceps skinfold thickness (TST), mid-upper arm circumference (MUAC), adductor pollicis muscle thickness (APMT), mid-upper arm muscle area (AMA), mid-upper arm muscle circumference (AMC), and body mass index (BMI) with LOS and investigating whether these indicators had similar validity in predicting LOS. METHODS: Six hundred ninety-five patients participated in a prospective observational study. Participants were dichotomized indicators studied according to the 5th and 25th percentiles described in the literature (for APMT only the 5th percentile was used). Cox regression analysis was used to estimate adjusted hazard ratios (HRs) and corresponding 95% CIs. RESULTS: Patients that presented values <5th percentile for TST (HR, 0.759; 95% CI, 0.579-0.995), MUAC (HR, 0.822; 95% CI, 0.687-0.983), APMT (HR, 0.791; 95% CI, 0.671-0.933), AMA (HR, 0.797, 95% CI, 0.660-0.962), and AMC (HR, 0.746; 95% CI, 0.611-0.911) showed a lower probability of being discharged to usual residence. Patients whose TST values were <25th percentile also presented lower probability of being discharged to usual residence (HR, 0.798; 95% CI, 0.673-0.946). No associations were found between weight and BMI with LOS. CONCLUSION: Depletion of TST, MUAC, APMT, AMA, and AMC was associated with lower probability of being discharged to usual residence. A thicker TST was independently associated with this outcome and thus TST should be considered for undernutrition screening and diagnosis.

Sitting time and associated factors among Portuguese older adults: results from Nutrition UP 65.

Older adults are particularly susceptible to sedentary behaviours. Sitting time has been increasingly referred to as a potentially modifiable risk factor in the prevention of chronic diseases. Identifying factors associated with sitting time, particularly those that are modifiable, will allow for more effective public health strategies. This study aimed to describe sitting time among Portuguese older adults and to evaluate associated factors. A cross-sectional study including 1423 older adults ≥ 65 years old was conducted. Sitting time was assessed with the International Physical Activity Questionnaire. Socio-demographic, health, anthropometric and functional variables were collected. Bivariate and multivariate linear regression models were conducted to study the association between these variables and sitting time. The median of sitting time was 300 min/day (interquartile range = 240 min/day), which is equal to 5 h/day. The following factors were directly associated with longer sitting time: being male, age ≥ 80 years, living in Central or Southern Portugal, being retired from work, as well as presenting low physical activity, obesity or longer time to walk 4.6 metres. On the other hand, being married, having higher education and higher household income were inversely associated with longer sitting time. It can be concluded that Portuguese older adults spend a considerable amount of time sitting per day. Potentially modifiable risk factors associated with longer sitting time in this population were related to nutritional status and functional ability.

Adherence to a Mediterranean Dietary Pattern status and associated factors among Portuguese older adults: Results from the Nutrition UP 65 cross-sectional study.

OBJECTIVES: The aim of this study was to evaluate adherence to the Mediterranean dietary pattern (MDP) and its associated factors in older Portuguese adults. METHODS: A cross-sectional observational study was designed. In the context of the Nutrition UP 65 study, a national cluster sample of 1407 Portuguese individuals ≥65 y of age was analyzed. Adherence to the MDP was evaluated with the Portuguese version of the Prevention with Mediterranean Diet tool. The association between an individual's characteristics and adherence to the MDP was analyzed through hierarchical logistic regression analysis. RESULTS: In this study, 43% of participants adhered to the MDP (n = 609). Higher educational level (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.54-3.69), living in the center (OR, 1.35; 95% CI, 1.01-1.79), being married or living in a common-law marriage (OR, 1.54; 95% CI, 1.20-1.97), and body mass index (ORpreobese, 1.52; 95% CI, 1.02-2.25) were related with increased odds of adherence to the MDP. Otherwise, lower adherence to the MDP was found for participants who were ≥80 y of age (OR, 0.70; 95% CI, 0.52-0.94), who lived in Madeira (OR, 0.35; 95% CI, 0.14-0.89) and Azores (OR, 0.28; 95% CI, 0.08-0.99), who rated their health as moderate (OR, 0.65; 95% CI, 0.50-0.84) or as bad or very bad (OR, 0.63; 95% CI, 0.45-0.90), and those who reported six or more comorbidities (OR, 0.62; 95% CI, 0.39-0.97). CONCLUSIONS: Of the sample, 57% did not adhere to the Mediterranean diet. Potentially modifiable factors associated with lower adherence to the MDP were lower educational and health status.

Sodium and potassium urinary excretion and their ratio in the elderly: results from the Nutrition UP 65 study.

BACKGROUND: We aimed to describe urinary sodium and potassium excretion and their ratio in a representative sample of Portuguese elderly population, according to sociodemographic characteristics and weight status. METHODS: A cluster sampling approach was used, representing older Portuguese adults (≥65 years) according to age, sex, education level, and regional area within the Nutrition UP 65 study. This cross-sectional evaluation was conducted in 2015 and 2016. From a sample size of 1,500 participants, 1,318 were eligible for the present analysis, 57.3% were women, and 23.5% were aged ≥80 years. Sodium and potassium consumption was evaluated through one 24 h urinary excretion. Inadequate sodium intake was defined as ≥2,000 mg/day, inadequate potassium intake was considered as <3,510 mg/day, and inadequate sodium-to-potassium ratio was defined as >1, according to the World Health Organization cutoffs. RESULTS: The proportion of the participants with an inadequate intake was 80.0% in women and 91.5% in men (sodium), 96.2% of women and 79.4% of men (potassium), and 98.4% of women and 99.1% of men (sodium-to-potassium ratio). Higher sodium adequacy was observed among the older elderly, unmarried, with lower household income, and underweight/normal weight. Higher potassium adequacy was observed in the younger elderly, married, and with higher income. CONCLUSION: The majority of the Portuguese elderly population was classified as having inadequate sodium, potassium, and sodium-to-potassium ratio urinary excretion. Therefore, strategies for reducing sodium and increasing potassium intake are priorities in the Portuguese elderly population.

A Cross-Sectional Study on the Association between 24-h Urine Osmolality and Weight Status in Older Adults.

Data on the association between hydration and body weight in the elderly are scarce. The objective of this work was to quantify the association between 24-h urine osmolality and weight status in the elderly. A cross-sectional study was conducted within the Nutrition UP 65 study. A quota sampling was implemented to achieve a nationally representative sample of Portuguese older adults (≥65 years) according to age, sex, education and region. From a sample size of 1500 participants, 1315 were eligible for the present analysis, 57.3% were women and 23.5% were aged ≥80 years. Participants were grouped using tertiles of 24-h urine osmolality by sex. World Health Organization cutoffs were used to classify participants according to weight status. Multinomial multivariable logistic regression models were conducted to evaluate the association of tertiles of osmolality with weight status, adjusting for confounders. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Being in the 3rd urine osmolality tertile (highest) was associated with a higher risk of being obese in men, OR = 1.97, 95% CI = 1.06, 3.66. No such association was found in women. These results highlight the need for implementing studies in order to clarify the association between hydration and weight status in the elderly.

Association between serum 25-hidroxyvitamin D concentrations and ultraviolet index in Portuguese older adults: a cross-sectional study.

BACKGROUND: The older population is a risk group for hypovitaminosis D. The Ultraviolet Index (UVI) can be an indicator of potential for cutaneous synthesis of vitamin D but physiological and other environmental factors also influence vitamin D synthesis and status. Knowledge about vitamin D status in Portuguese older adults is limited. This study aims to explore the association between Ultraviolet Index and serum 25-hidroxyvitamin D3 [25(OH)D] levels accounting for other potential influential factors. METHODS: A cross-sectional study was conducted between December 2015 and June 2016, in 1497 Portuguese older adults (≥ 65 years) within Nutrition UP 65 project. For each participant, serum 25(OH)D was determined and the mean UVI (mUVI) in the respective residence district was calculated for the previous 30 days. Stepwise linear regression analyses were conducted for the following periods of blood collection: between December and June, December and March and April and June. Standardized regression coefficients (Sß) and 95% confidence intervals were calculated. RESULTS: The median 25(OH)D concentration was 35.9 nmol/L. The UVI was independently and positively associated with 25(OH)D in the models for December-June (Sß = 0.244, 95% CI: 0.198; 0.291, P < 0.001) and April-June (Sß = 0.295, 95% CI: 0.299; 0.362, P < 0.001) and independently and negatively associated in December-March period (Sß = -0.149, 95% CI: -0.211; -0.087, P < 0.001). CONCLUSIONS: In this sample with high vitamin D deficiency frequency, the UVI was a predictor of 25(OH)D levels but the direction of the association varied according to the blood collection period. Our results suggest that accounting for the time of year in future research regarding vitamin status and related public health recommendations may be relevant.

Comparison of Jamar and Bodygrip Dynamometers for Handgrip Strength Measurement.

Guerra, RS, Amaral, TF, Sousa, AS, Fonseca, I, Pichel, F, and Restivo, MT. Comparison of Jamar and Bodygrip dynamometers for handgrip strength measurement. J Strength Cond Res 31(7): 1931-1940, 2017-Studies that compared the agreement between Jamar and other models of dynamometers for handgrip strength (HGS) measurement have exhibited variability in the provided results. The lack of comparability between dynamometers led to the development of the Bodygrip dynamometer. This study aims to examine the reliability of the Bodygrip for HGS measurement, to compare it with the Jamar, and to explore the HGS differences between instruments considering the ergonomic effect of using the Bodygrip with 2 different handles. A cross-sectional study was conducted in free-living (n = 114, 18-89 years) and inpatient (n = 50, 65-93 years) volunteers. Nondominant HGS was tested randomly with the Jamar and Bodygrip, the latter using 2 different handles-curved and straight types. Handgrip strength was obtained for each participant under the same conditions. Each individual performed 2 HGS measurements with each dynamometer, and the maximum HGS value was considered for dynamometers comparison. Differences in the maximum HGS value between the 2 devices (Jamar-Bodygrip), intraclass correlation coefficients (ICCs), Bland and Altman plots, and limits of agreement were obtained. Correlation between the highest HGS measurement obtained for the nondominant hand with the Jamar and with the Bodygrip using each handle was excellent (ICCs: 0.93-0.95). Mean differences of -0.5 (limits of agreement: -4.6; 3.5) kgf with the curved handle and of 1.0 (-7.7; 9.7) kgf with the straight handle for the free-living participants were obtained, whereas for inpatients these values were -1.0 (-3.8; 1.9) kgf and 2.1 (-3.3; 7.5) kgf, respectively, for the curved and straight handles. The Bodygrip is comparable to the Jamar in free-living adults and in hospitalized older adults, exhibiting excellent interinstrument reliability. The Bodygrip with the curved handle produces results closer to the Jamar when compared with Bodygrip with the straight handle, which emphasizes the importance of grip handle ergonomics to measurement reliability.

Vitamin D status and associated factors among Portuguese older adults: results from the Nutrition UP 65 cross-sectional study.

OBJECTIVES: To evaluate vitamin D status and its associated factors in Portuguese older adults from the Nutrition UP 65 study. DESIGN: Cross-sectional observational study. PARTICIPANTS AND METHODS: Nationwide cluster sample of 1500 Portuguese subjects ≥65 years old. Participants were classified, according to US Institute of Medicine cut-offs, as presenting normal 25-hydroxyvitamin D (25(OH)D) levels (≥50.0 nmol/L), at risk of inadequacy (30.0-49.9 nmol/L) or at risk of deficiency (<30 nmol/L). The association between individuals' characteristics and 25(OH)D levels was analysed through multinomial logistic regression analysis. RESULTS: Median 25(OH)D serum value was 36.1 (interquartile range (IQR): 35.5) nmol/L. According to the used cut-offs, 39.6% of participants were at risk of 25(OH)D deficiency and 29.4% were at risk of 25(OH)D inadequacy. In the adjusted model, having higher skin pigmentation and waist circumference >88 cm for women and >102 cm for men were associated with higher odds of 25(OH)D deficiency. Otherwise, living in Lisbon Metropolitan Area and in Madeira, 1-12 years of schooling, being married or in a common-law marriage, monthly income ≥€1000, alcohol consumption, medication or supplements with vitamin D supplement use, and blood samples collected in spring or summer were associated with lower odds of being at risk of 25(OH)D deficiency. In this model, season of blood sample collection, medication or supplements use, and waist circumference were the factors more strongly associated with 25(OH)D levels. CONCLUSIONS: Despite using the conservative Institute of Medicine cut-offs, over two-thirds of these study participants presented inadequate 25(OH)D levels, warranting the implementation of corrective measures. Potentially modifiable factors were strongly associated with 25(OH)D levels in this study. These findings may be particularly relevant to the development of public health policies in southern European countries.

ESPEN diagnostic criteria for malnutrition - A validation study in hospitalized patients.

BACKGROUND & AIMS: The European Society for Clinical Nutrition and Metabolism (ESPEN) released a consensus statement for undernutrition diagnosis: ESPEN diagnostic criteria for malnutrition (EDC). The EDC lacks validation and therefore, the present study aims to assess the concurrent and predictive validity of this tool in a cohort of inpatients. METHODS: A prospective observational study took place in a university hospital. Concurrent validity of EDC was evaluated using the Patient Generated Subjective Global Assessment (PG-SGA) nutrition status classification as the reference method. Sensitivity, specificity, positive and negative predictive values were determined. The EDC predictive validity was assessed by its independent association with length of hospital stay (LOS), applying Cox proportional hazards ratio method. RESULTS: Of the 632 included patients, 455 participants (72%) were nutritionally-at-risk (Nutritional Risk Screening initial screening). For those that had screened positive, 260 (57.1%) and 55 participants (12.1%) were undernourished according to PG-SGA and to EDC, respectively. Compared to PG-SGA, the EDC revealed a sensitivity of 17.1% and a specificity of 98.3%. Positive and negative predictive values were respectively 89.1% and 58.9%. Undernutrition evaluated by EDC was independently associated with lower hazard ratio for being discharged home over time, 0.695 (95% confidence interval: 0.509; 0.950). CONCLUSIONS: The EDC could be used in clinical settings to confirm undernutrition suggested by other methods. The independent association of undernutrition by EDC with LOS shows this method is of clinical relevance.

Nutritional Strategies Facing an Older Demographic: The Nutrition UP 65 Study Protocol.

BACKGROUND: The population of Portugal is aging. The lack of data on older adults' nutritional status and the lack of nutrition knowledge amongst health professionals, caregivers, and older adults themselves, remains a challenge. OBJECTIVE: The Nutrition UP 65 study aims to reduce nutritional inequalities in the older Portuguese adult population and improve knowledge regarding older Portuguese adults' nutritional status, specifically relating to undernutrition, obesity, sarcopenia, frailty, hydration, sodium, and vitamin D statuses. METHODS: A representative sample of older Portuguese adults was selected. Sociodemographic, lifestyle, anthropometric, functional, and clinical data were collected. Sodium excretion, hydration, and vitamin D statuses were assessed. RESULTS: Data collection (n=1500) took place between December, 2015 and June, 2016. Results will be disseminated in national and international scientific journals, and via Portuguese media. CONCLUSIONS: Nutrition UP 65 results will provide evidence for the design and implementation of effective preventive public health strategies regarding the elderly. These insights may represent relevant health gains and costs savings.

Sarcopenia among hospitalized patients - A cross-sectional study.

BACKGROUND & AIMS: Data on the prevalence of sarcopenia among hospitalized older patients are scarce and there is no available information on the burden of sarcopenia among younger patients. The present study aims to increase the knowledge about the frequency of sarcopenia among hospitalized patients and to evaluate the influence of different diagnostic criteria in these estimates. METHODS: A cross-sectional study was conducted in hospitalized adult patients. Sarcopenia was defined, according to the European Working Group on Sarcopenia in Older People (EWGSOP), as the presence of both low muscle mass, assessed by Bioelectrical Impedance Analysis (BIA), adjusted for height, and low muscle function (hand grip strength). Two other criteria were applied, also using hand grip strength for evaluating muscle function, one that also assessed muscle mass by BIA, but adjusted for weight, and another which estimated muscle mass based on mid-arm muscle circumference. Nutritional status was evaluated by Patient-Generated Subjective Global Assessment. The degree of agreement between the different diagnostic criteria was assessed using kappa. Multivariable logistic regression models were used in order to identify factors associated with sarcopenia. RESULTS: 608 hospitalized adult patients aged ≥18 years composed the study sample. According to EWGSOP's criteria, 25.3% patients were sarcopenic. However, depending on age and on the applied criteria, frequency of sarcopenia varied from 5% to 41.1% for men and from 4.9% to 38.3% for women. There was 95.7% (k = 0.89) agreement between criteria that estimated muscle mass by BIA. According to EWGSOP criteria approximately 20% of the non-undernourished patients were sarcopenic. Furthermore, 29.5% of overweight and 18.7% of obese patients were sarcopenic. Factors associated with sarcopenia were male gender, age ≥65 years, moderate or severe dependence, being undernourished and admitted to a medical ward. CONCLUSIONS: Sarcopenia is frequent among hospitalized patients and varies widely depending on the applied diagnostic criteria. Sarcopenia was identified in a considerable proportion of patients aged under ≥65 years and in non-undernourished, namely among overweight and obese.

Usefulness of six diagnostic and screening measures for undernutrition in predicting length of hospital stay: a comparative analysis.

BACKGROUND: Undernutrition has been associated with longer length of hospital stay (LOS). However, an analysis that investigates the association of recommended undernutrition diagnostic and screening indicators with LOS conducted in patients with a varied spectrum of pathologies and considering confounders would help to clarify their clinical value. OBJECTIVE: We aimed to quantify the association of being undernourished as evaluated by different methodologies with LOS and their validity in predicting inpatient LOS. DESIGN: A prospective observational study was conducted. Undernutrition was evaluated by the Academy of Nutrition and Dietetics-American Society for Parental and Enteral Nutrition recommended clinical characteristics of malnutrition (AA-CCM) tool, the Patient-Generated Subjective Global Assessment (PG-SGA), the Nutritional Risk Screening (NRS-2002) tool, and the Malnutrition Universal Screening tool (MUST). Handgrip strength (HGS) quartiles by sex and phase angle (PA) categories were also used as indicators of undernutrition. PARTICIPANTS AND SETTING: Six hundred eighty-two inpatients from a Portuguese university hospital participated between 2011 and 2013. MAIN OUTCOME MEASURES: LOS was determined between the date of hospital admission and discharge. STATISTICAL ANALYSES PERFORMED: Kaplan-Meier and adjusted Cox proportional hazard ratio (HR) methods were applied. RESULTS: Moderate or severe undernutrition by AA-CCM (HR 0.58, 95% CI 0.49 to 0.69), by PG-SGA (moderate or suspected: HR 0.60, 95% CI 0.49 to 0.73 and severe: HR 0.52, 95% CI 0.42 to 0.64), risk of undernutrition assessed by NRS-2002 (HR 0.61, 95% CI 0.52 to 0.73), by MUST (medium: HR 0.75, 95% CI 0.60 to 0.95 and high: HR 0.67, 95% CI 0.55 to 0.81), HGS quartile (second: HR 0.64, 95% CI 0.50 to 0.80 and first [lowest]: HR 0.50, 95% CI 0.39 to 0.64) and nutritional risk defined by low PA (HR 0.62, 95% CI 0.48 to 0.81) were all independently associated with lower probability of being discharged from the hospital. CONCLUSIONS: Despite assessing different dimensions of nutritional status, undernutrition by AA-CCM and PG-SGA, risk of undernutrition assessed by NRS-2002 and MUST, and low HGS and PA independently predict longer LOS in hospitalized patients. All these methodologies share a similar validity in predicting LOS.

Handgrip strength and associated factors in hospitalized patients.

BACKGROUND: Handgrip strength (HGS) is a marker of nutrition status. Many factors are associated with HGS. Age, height, body mass index, number of diagnoses, and number and type of drugs have been shown to modify the association between undernutrition and HGS. Nevertheless, other patient characteristics that could modify this association and its joint modifier effect have not been studied yet. OBJECTIVE: To evaluate the association of inpatients' HGS and undernutrition considering the potential modifier effect of cognitive status, functional activity, disease severity, anthropometrics, and other patient characteristics on HGS. METHODS: A cross-sectional study was conducted in a university hospital. Sex, age, abbreviated mental test score, functional activity score, Charlson index, number of drugs, Patient-Generated Subjective Global Assessment (PG-SGA) score, body weight, mid-arm muscle circumference, adductor pollicis muscle thickness, body height, wrist circumference, hand length, and palm width were included in a linear regression model to identify independent factors associated with HGS (dependent variable). RESULTS: The study sample was composed of 688 inpatients (18-91 years old). All variables included in the model were associated with HGS (ß, -0.16 to 0.38; P ≤ .049) and explained 68.5% of HGS. Age, functional activity decline, Charlson index, number of drugs, PG-SGA score, body weight, and wrist circumference had a negative association with HGS. All other studied variables were positively associated with HGS. CONCLUSION: Nutrition status evaluated by PG-SGA was still associated with HGS after considering the joint effect of other patient characteristics, which reinforces the value of HGS as an indicator of undernutrition.

A digital calliper for training and study purposes.

A quick and valid method for evaluating percentage body fat is based on the use of skinfold callipers. However, limitations associated to their use and characteristics led the authors to improve a traditional calliper (Harpenden) and to integrate it with a software application. Such a measuring system, LipoTool, is meant to have better accuracy and reliability, including data processing and digital recording at a very low cost. At first, a sample of 49 older adults was used to evaluate the performance of LipoTool by comparing its results to those obtained with the traditional Harpenden calliper. A strong positive association in %BF was achieved. This digital sensing system was later improved by incorporating wireless communication between the calliper and the software application, adding other functionalities. The software application works in any computer and is flexible to incorporate new coming models, linear regressions or new algorithms. This new system was validated against the standard Dual-Energy X-Ray Absorptiometry system, using a sample of 40 adults with positive results. This solution is a valid and reliable alternative to traditional reference callipers, simplifying the percentage of body fat evaluation and providing a more effective use in daily practice with less expenditure of time and resources. Its implemented guided procedure turns it into a precious training tool based on a non-invasive, portable device, and not requiring special individual preparation. Ongoing activities are focused on the design of a new mechanical structure, with novel functionalities and for exploring other studies.

Accuracy of a digital skinfold system for measuring skinfold thickness and estimating body fat.

The use of skinfold thickness measurements to evaluate the distribution of subcutaneous adipose tissue and to predict body fat has recognised advantages. However, the different types of skinfold calliper available present limitations that make them unattractive and perhaps less used in daily practice. The purpose of the present study was to evaluate the accuracy and functionality of a new digital skinfold system, the Liposoft 2008+Adipsmeter V0 (LA), for measuring skinfold thickness and determining body fat proportion (%BF). Skinfold thickness measurements made by the LA were compared with those obtained with a Harpenden (H) calliper from two samples of adults (n 45) and older adults (n 56) in a university-based cross-sectional study. A comparison was also conducted between estimated %BF from skinfolds and dual-energy X-ray absorptiometry. Bland and Altman plots show that skinfolds measured by the LA and H calliper are in high agreement, with a mean difference of 0·3 (95% CI -3·1, 3·4) mm. In regard to the %BF estimated from LA and H skinfolds measurement, the LA produced a similar approximation to dual-energy X-ray absorptiometry %BF, with a mean difference of 0·2 (95% CI -0·8, 1·2) %, compared with %BF obtained with the H calliper. The LA system is an accurate instrumentation and represents an innovation in the evaluation of skinfold thickness and body composition based on anthropometric measurement.