| ObjectiveThe first part:based on measuring the adductor pollicis muscle,we will build the reference value of thickness of adductor pollicis muscle(APMT)for the healthy adult all ages in China and provide clinical nutrition assessment with reference.The second part:by measuring the thickness of adductor pollicis muscle for patients with malignant tumors of digestive system with high incidence of malnutrition.Nutritional status was assessed successively by Patient-Generated Subjective Global Assessment(PG-SGA),anthropometry,body composition analysis and laboratory examination followed by measurement of APMT.Then the correlation analysis about and nutritional evaluation parameters above was performed.In addition,we also obtained the cut-off value of APMT inmalnutrition according to the Receiver Operating Characteristic curve and investigate the clinical value of adductor pollicis muscle thickness(APMT)in nutritional assessment ofpatients with malignant tumor of digestive system.Methods The first part:through literature retrieval and to consult,we find that the reference valueof thickness of adductor pollicis muscle(APMT)for the healthy adult all ages in China have no reference standard,so more than 1000 healthy adults about physical examinees from physical examination center and accompanies from hospital ward and student nurses were extracted by convenient sampling method preliminarily.They were evaluated by Subjective Global Assessment(SGA)and the height and weight were measured and then we calculated the BMI.Finally 859 subjects(435 males and 424 females)who met inclusive criteria in the study were grouped into 10 groups by age and gender:Group M1 has 103 persons(18-30 years)、Group M2 has 69 persons(31-40 years)、Group M3 has 80 persons(41-50 years)、Group M4 has 94 persons(51-60 years)、Group M5 has 89 persons(61-70 years);Group W1 has 85 persons(18-30 years)、Group W2 has 93 persons(31-40 years)、Group W3 has 81persons(41-50 years)、Group W4 has 91 persons(51-60 years)、Group W5 has 74 persons(61-70 years).The skinfold caliper was used in dominant(DAPMT)andnon-dominant(NDAPMT)sides.We compared with the reference values by different ages and genders and analysed its correlation with height,weight and BMI and finally obtained the reference value of adductor pollicis muscle thickness in different age groups.The second part:by convenience sampling,96 patients(55 males and 41 females)with malignant tumor of digestive system treated in Department of hepatobiliary surgery of a hospital were chosen.In the next morning after admission,nutritional status was assessed successively by Patient-Generated Subjective Global Assessment(PG-SGA),anthropometry,body composition analysis and laboratory examination followed by measurement of APMT.According to the results of PG-SGA,they were divided into three groups:A(well nutrition)、B(mild or moderate malnutrition)、C(severe malnutrition)respectively.And we adtained the sensitivity and specificity for predicting malnutrition.Then the correlation analysis about and nutritional evaluation parameters above was performed.In addition,we also obtained the cut-off value of APMT in malnutrition according to the Receiver Operating Characteristic curve.ResultsThe first part:There were 859 subjects and their mean age was 45.30± 14.30years.Adductor pollicis muscle thickness of subjects in dominant(DAPMT)was 21.97±2.55mm in males、18.08±2.42mm in females,whereas non-dominant(NDAPMT)was 20.29±2.54mm in males、16.84 ± 2.3 0mm in females.The value of thickness of the adductor muscle in both sides was always significantly higher in males in the various age groups with statistical meanings(P<0.05).The age group(>40-50 years old、>50-60 years old、>60-70 years old)of APMT and NAPMT were higher than the age group(>18-30 years old、>30-40 years old)(P<0.05).Correlations between DAPMT and NDAPMT and other variables,such as weight,height and BMI were statistically significant(P<0.05).The second part:There were 96 subjects and their average age is 62.25 ±6.66 years.Adductor pollicis muscle thickness of subjects in dominant(DAPMT)was 16.05±310mm,whereas non-dominant(NDAPMT)was 14.39±2.85mm.According to assessment result of PG-SGA,subjects were distributed into the following group:28 patients in A(eutrophic),36 patients in B(moderate or suspected malnourishment)and 32 patients in C(severelymalnourishmented).DAPMT for three groups was 17.76±2.83mm,16.22±3.08mm and 14.37±2.50mm respectively,P<0.05.NDAPMT for three groups was 16.08±2.48mm,14.56±3.03mm and 12.73±1.95mm respectively,P<0.05.The analysis showed that the thickness of adductor pollicis muscle decreased with the increase of PG-SGA score,weight,BMI,AC,TSF,AMC,CC,BCM,BMC,protein mass,skeletal muscle mass,mineralsubstance mass,fat mass,ICW,ECW,albumin,prealbumin,serum creatinine were correlated with APMT.According to our results,patients could be diagnosed with malnutrition,when DAPMT was less than 14.25mm and NDAPMT was less than 13.50mm.The area of the Receiver Operating Characteristic curve was 0.84and 0.75respectively.At this time,APMT measurements presented low specificity(47.10%and 52.90%for DAPMT and NDAPMT,respectively),but a high sensitivity(92.90%for both DAPMT and NDAPMT)ConclusionThe APMT and NAPMT for healthy adults in China was different in different ages or gender.By comparison,It was similar to foreign research.It was proved that the thickness of adductor pollicis muscle could reflect the nutrition of healthy adults in China.We build the reference value of thickness of adductor pollicis muscle for the healthy adult all ages in China and provide clinical nutrition assessment with reference.Thickness of adductor pollicis muscle could be one of the nutritional evaluation indexes for patients with malignant tumors of digestive system in China.It had well predictability and highly sensibility for malnutrition and it was helpful to screen patients with digestive system malignant tumor in time.Clinical workers could combined with other nutritional indexes such as PG-SGA and body weight and BMI with it. |
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