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Maria Gonzalez

Universidad de Deusto, Facultad Ciencias Sociales y Humanas, Non-Academic

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Papers by Maria Gonzalez

Is adductor pollicis muscle thickness a good predictor of lean mass in adults?

Clinical Nutrition, 2016

Background & aims: Lean mass (LM) is an important parameter in clinical outcomes, which highlight... more Background & aims: Lean mass (LM) is an important parameter in clinical outcomes, which highlights the necessity of reliable tools for its estimation. The adductor pollicis muscle thickness (APMT) is easily accessible and suffers minimal interference from the adjacent subcutaneous fat tissue. Objective: To assess the relationship between the APMT and LM in a sample of Southern Brazilian adults. Methods: Participants were adults from the 1982 Pelotas (Brazil) Birth Cohort. LM was measured by dual energy X-ray absorptiometry (DXA). LM and lean mass index (LMI e LM divided by the square of height e kg/m 2) were the outcomes. APMT was measured using a skinfold caliper. The mean of three measurements in the non-dominant hand was used in the analyses. APMT was described according to sociodemographic characteristics and nutritional status. The relationship between APMT and both LM and LMI was evaluated by correlation coefficient and linear regression using APMT as a single anthropometric parameter and also in addition to BMI. Results: APMT was assessed in 3485 participants. APMT was higher in males, non-whites, less-schooled and obese individuals. APMT was moderately correlated to LM and LMI (ranged from 0.44 to 0.57). Correlation coefficients were higher for LMI as outcome and in females (LM: 0.51 and LMI: 0.57). APMT explained 19% and 26% of the variance in LM in males and females, respectively, whereas it explained 26% and 33% of the variance in LMI. APMT increased the prediction for LM in 3 and 4 percentage points in males and females, in comparison to explained by BMI. BMI explained 48% and 59% of the variance of LMI in males and females whereas APMT increased it to 51% and 62% for both sexes, respectively. Conclusions: Results were not good enough to promote the APMT as a single predictor of LM or LMI in epidemiological studies. APMT has a little predictive capacity in estimating LM or LMI when BMI is also considered.

Comparative Transcriptome Analysis of the Cosmopolitan Marine Fungus Corollospora maritima Under Two Physiological Conditions

G3 (Bethesda, Md.), Jan 26, 2015

Marine sandy beaches represent dynamic environments often subject to harsh conditions and climate... more Marine sandy beaches represent dynamic environments often subject to harsh conditions and climate fluctuations, where natural and anthropogenic inputs of freshwater from fluvial and pluvial source alter salinity, which has been recognized as a key variable affecting the distribution of aquatic organisms and influencing critical physiological processes. The marine arenicolous fungus Corollospora maritima is a worldwide-distributed saprobe that has been reported to present tolerance to freshwater. Here, we present a transcriptome analysis that will provide the first insight of the genomic content for this fungus and a gene expression comparison between two different salinity conditions. We also identified genes that are candidates for being differentially expressed in response to environmental variations on salinity during the fungal growth. The de novo reconstruction of C. maritima transcriptome Illumina sequencing provided a total of 14,530 transcripts (16 Megabases). The comparison...

A prospective study on the radiation therapy associated changes in body weight and bioelectrical standardized phase angle

Clinical Nutrition, 2015

Standardized phase angle (SPA) is a value derived from bioelectrical impedance phase angle analys... more Standardized phase angle (SPA) is a value derived from bioelectrical impedance phase angle analysis and has been recognized as marker of nutritional risk and clinical status of cancer patients. This study aimed to evaluate the changes in SPA during radiation therapy of cancer patients and identify possible nutritional and clinical determinants of these changes. Nutritional assessment was performed before the initiation and at the end of the radiotherapy. It included anthropometrics and bioelectrical impedance analysis. A generalized linear mixed model was used to evaluate the effects of selected independent variables on the changes in standardized phase angle. A total of 104 patients entered the study and those with complete information were included in the analysis (n = 62). Most patients (61%) were at clinical stage I and II, the most prevalent irradiation site was the pelvis (39%) and 98% were well nourished or overweight. According to the regression analysis, changes in body weight and irradiation at head and neck/upper abdomen and thorax were associated with standardized phase angle modifications during radiotherapy. Clinical stage and radiation dose were not associated with changes in standardized phase angle. Compared to baseline values, for every 1 kg weight reduction during the radiation therapy, the standardized phase angle also decreased by 0.107 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In well nourished or overweight patients, weight loss during radiation therapy is closely associated with decrease in standard phase angle.

La Intermediación Laboral en Andalucía: Análisis De Los Modelos De Búsqueda De Empleo

La descentralización de los Servicios Públicos de Empleo ha culminado su proceso en Andalucía en ... more La descentralización de los Servicios Públicos de Empleo ha culminado su proceso en Andalucía en 2004 con las transferencias de competencias en materia de empleo y posterior puesta en marcha del Servicio Andaluz de Empleo (SAE). Para la Administración Regional supone un reto y la oportunidad de abordar la gestión de las políticas de empleo desde una perspectiva innovadora. En este contexto se ha realizado este estudio con el objetivo de analizar la funcionalidad de los distintos mecanismos de intermediación laboral existentes en Andalucía, con una metodología ecléctica que incluye en su análisis todas las dimensiones tangibles e intangibles, formales e informales, relacionadas con el proceso de búsqueda y acceso al empleo por parte de los ciudadanos en Andalucía. En esta comunicación se presentan la metodología aplicada así como los principales resultados obtenidos de la investigación realizada.

Incidencia y factores prenatales en el embarazo de riesgo

Palabras clave: Embarazo de riesgo. Incidencia. Factores predisponentes. SUMMARY Objective: To kn... more Palabras clave: Embarazo de riesgo. Incidencia. Factores predisponentes. SUMMARY Objective: To know the high risk pregnancy incidence, and the prenatal risk factors in maternal and obstetrical history, and medical and obstetrical pathologies. Method: Observational retrospective epidemiological study of 376 pregnancies over June-October 1999. We used a validated form with scoring technique for risk identification and quantitative calification. Setting: Hospital "Dr.

A first approaching to work with viscosity in college level

Working with the concepts of flow, velocity and emptying time, in containers with different area,... more Working with the concepts of flow, velocity and emptying time, in containers with different area, the research group named Physics and Mathematics in Context from the University of Juarez in Mexico is attempting to experiment with the relationship between the geometry of the containers and their discharge time with different kind of liquids. Thus, we have built two different sets of containers, and use kitchen oil, maple syrup, and car oil. Where the cross area is constant: prisms with bases of different geometries. Thus, in order to achieve a better understanding related to differential equations situations and introduce viscosity.

Standardized phase angle from bioelectrical impedance analysis as prognostic factor for survival in patients with cancer

Supportive Care in Cancer, 2009

Purpose Phase angle (PA), determined by bioelectrical impedance analysis (BIA), has been consider... more Purpose Phase angle (PA), determined by bioelectrical impedance analysis (BIA), has been considered as a prognostic factor in several clinical conditions. The purpose of this study is to investigate PA, after adjusting for sex and age (standardized phase angle; SPA) as a prognostic factor for survival in cancer patients. Methods A prospective study was conducted in 195 patients before the first chemotherapy course. BIA was performed in all patients and SPA was calculated. The Kaplan-Meier method was used to calculate survival. The Cox regression method was used to evaluate the independent prognostic effect of PA after adjustment for other variables. Results Patients with SPA<−1.65 had a smaller survival rate than those with SPA≥−1.65 (p<0.001). Using Cox regression, the mortality rate was higher in patients with SPA< −1.65 (RR 3.12 CI: 2.03-4.79; p<0.001). After multivariate analysis, patients with PA<−1.65 still presented a higher mortality rate (RR 2.35 CI: 1.41-3.90; p=0.001). Conclusions The present study demonstrates that PA, used as SPA, is an independent prognostic indicator in this group of cancer patients receiving chemotherapy treatment even after adjustment for other prognostic variables.

Body weight and fat-free mass changes in a cohort of patients receiving chemotherapy

Supportive Care in Cancer, 2009

Purpose Malnutrition is prevalent in cancer patients and it can become even greater during its tr... more Purpose Malnutrition is prevalent in cancer patients and it can become even greater during its treatment. The purpose of the present study is to verify changes in the fat-free mass (FFM) and body weight (BW) in cancer patients during chemotherapy treatment and to identify their significant determinants. Methods In a longitudinal study of 174 patients starting a chemotherapy protocol, bioelectrical impedance analysis (BIA) was used to estimate FFM and the nutritional assessment by patient-generated subjective global assessment. BW and FFM changes have been calculated and their significant determinants were identified after a multivariate analysis. Results Malnutrition was found in 23% of the patients at the admission. After a multivariate analysis, a significant BW change was found during the treatment in patients submitted to previous/adjuvant and palliative chemotherapy (weight gain of 4.15% and 2.23%, respectively, p=0.05) and a significant FFM loss (7.61%, p<0.01) in patients with severe malnutrition at admission. Conclusions Only the chemotherapy protocol and initial nutritional state had a significant influence in BW and FFM changes during the chemotherapy. BIA may contribute to other methods of nutritional assessment, in order to detect modifications in body composition even in the absence of BW changes.

Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients

Nutrition, 2010

Objective: International nutritional screening tools are recommended for screening hospitalized p... more Objective: International nutritional screening tools are recommended for screening hospitalized patients for nutritional risk, but no tool has been specifically evaluated in the Brazilian population. The aim of this study was to identify the most appropriate nutritional screening tool for predicting unfavorable clinical outcomes in patients admitted to a Brazilian public university hospital. Methods: The Nutritional Risk Screening 2002 (NRS 2002), Mini-Nutritional Assessment-Short Form (MNA-SF), and Malnutrition Universal Screening Tool (MUST) were administered to 705 patients within 48 h of hospital admission. Tool performance in predicting complications, hospital stay time, and death was analyzed using receiver operating characteristic curves. Results: The NRS 2002, MUST, and MNA-SF identified nutritional risk in 27.9%, 39.6%, and 73.2% of patients, respectively. The NRS 2002 had the largest area under the receiver operating characteristic curve for predicting clinical outcomes (complications 0.6531, very long hospital stay 0.6508, death 0.7948) compared with the MNA-SF (complications 0.3505, very long hospital stay 0.3802, death 0.2417) and MUST (complications 0.6036, very long hospital stay 0.6109, death 0.6363). For elderly patients, the NRS 2002 performed better than the MNA-SF for predicting clinical outcomes (complications 0.6500 versus 0.3440, very long hospital stay 0.6317 versus 0.3552, death 0.7932 versus 0.1617). Conclusion: The NRS 2002 was the best nutritional screening tool for predicting clinical outcomes in a Brazilian public university hospital.

Phenotypic characterization of a Candida albicans strain deficient in its major exoglucanase

Microbiology, 1997

Summary: Both alleles of theXOG1gene ofCandida albicans, which encodes a protein with exoglucanas... more Summary: Both alleles of theXOG1gene ofCandida albicans, which encodes a protein with exoglucanase activity, were sequentially disrupted. Enzymic analysis of either cell extracts or culture supernatants of disrupted strains revealed that this gene is responsible for the major exoglucanase activity inC. albicans, although residual exoglucanase activity could still be detected.xog1null mutants showed similar growth rates in both rich and minimal liquid medium as compared to the wild-type strain, indicating that the enzyme is not essential forC. albicansgrowth. In addition, no differences were observed between wild-type andxog1null mutants with respect to their ability to undergo dimorphic transition. However, small but repeatable differences were found between the wild-type and the null mutant with respect to susceptibility to chitin and glucan synthesis inhibitors. Using a murine model of experimental infection, no significant differences in virulence were observed. Thexog1null strai...

Response to pegylated interferon plus ribavirin in HIV‐infected patients with chronic hepatitis C due to genotype 4

Journal of Viral Hepatitis, 2008

Summary. Hepatitis C virus (HCV) genotypes 1 and 4 respond less well to pegylated interferon (pe... more Summary. Hepatitis C virus (HCV) genotypes 1 and 4 respond less well to pegylated interferon (pegIFN) plus ribavirin (RBV) therapy. For this reason most studies merge these two genotypes when assessing virological response. However, in most trials the HCV genotype 4 population is rather small, and conclusions are mainly derived from what occurs in HCV‐1 patients. All HCV‐4 patients coinfected with HIV who received pegIFN plus RBV in two different multicentre studies, PRESCO and ROMANCE, conducted respectively in Spain and Italy, were retrospectively analyzed. Baseline plasma HCV‐RNA, proportion of patients with HCV‐RNA <10 IU / mL at week 4 (rapid virological response), and HCV‐RNA declines >2 logs at week 12 (early virological response, EVR) were all assessed as predictors of sustained virological response (SVR). Overall, 75 patients (60 men) were evaluated. Median age was 40 years and median CD4 count 598 cells / mm3; 49% had plasma HIV‐RNA <50 copies / mL; 71% had ele...

Dynamics of HIV tropism under suppressive antiretroviral therapy: implications for tropism testing in subjects with undetectable viraemia

Journal of Antimicrobial Chemotherapy, 2010

The use of maraviroc as part of a simplification of antiretroviral therapy (ART) is hampered by t... more The use of maraviroc as part of a simplification of antiretroviral therapy (ART) is hampered by the difficulty of assessing viral tropism in patients with undetectable viraemia. In this context, information on tropism might be obtained from testing either older stored viraemic sera collected before initiation of ART or current proviral DNA in peripheral blood cells. Methods: HIV-1-infected individuals who had initiated ART and had undetectable viraemia for .2 years were identified. V3 genotyping was performed in parallel from plasma HIV-RNA and proviral DNA before starting ART and from proviral DNA while on suppressive ART. Viral tropism was interpreted using geno2pheno (false positive rate ¼ 10%) and an optimized version of position specific scoring matrices (PSSM) with a greater sensitivity to detect X4 variants (PSSM X4/R5-8). Results: A total of 78 HIV-1 infected individuals were examined. Mean time under suppressive ART was 3.5 years (interquartile range: 2.3-4.4). The rate of X4 variants in plasma and proviral DNA samples at baseline was 32.8% and 34.0%, respectively. It was 33.9% after .2 years of suppressive ART in DNA samples. Paired RNA/DNA tropism results at baseline could be obtained for 38 patients, with an overall 82% concordance. After .2 years of suppressed plasma viraemia, HIV tropism was reassessed in proviral DNA; tropism switches were uncommon, especially comparing baseline and most recent DNA longitudinal specimens (12%). Conclusions: HIV tropism switches over time under suppressive ART are rare. There is a relatively good correlation between RNA and DNA tropism estimations using genotypic tests. Thus, HIV-1 tropism might confidently be examined either in older stored viraemic plasma specimens or in current proviral DNA samples.

High sensitivity of specific genotypic tools for detection of X4 variants in antiretroviral-experienced patients suitable to be treated with CCR5 antagonists

Journal of Antimicrobial Chemotherapy, 2010

Evaluation of the reliability of several V3-based genotypic predictors to infer viral tropism in ... more Evaluation of the reliability of several V3-based genotypic predictors to infer viral tropism in patients infected with B and non-B strains of HIV-1. Methods: Several genotypic tropism predictors were evaluated in plasma (RNA) samples from 198 HIV-1-infected patients, taking as gold standard the results of the phenotypic recombinant virus assay Phenoscript w. In addition, for 37 B subtype HIV-1 patients the phenotypic results from plasma samples were also compared with tropism predictions based on V3 amplification from paired peripheral blood mononuclear cells (PBMCs). Results: A total of 150 paired genotypic/phenotypic results were obtained from plasma specimens. Concordance values ranged from 63% to 85%, depending on the genotypic algorithm used. The best predictors in terms of sensitivity/specificity to detect X4 variants were WebPSSM X4/R5 (77%/87%), Geno2pheno FPR ¼ 5% (80%/77%) and an algorithm combining the '11/25' and 'Net charge' rules, termed Garrido's rule (80%/79%). The performance of genotypic predictors was better testing B than non-B clades. The overall sensitivity ranged from 28% to 94%, reaching 100% in subtype B antiretroviral-experienced patients using WebPSSM SI/NSI , Geno2pheno FPR ≥ 5% and Garrido's rule. Conversely, the sensitivity when testing non-B subtypes was poorer, ranging from 17% to 67%. Interestingly, the correlation between genotypic and phenotypic results was better when testing PBMCs than plasma using all genotypic predictors. Conclusions: Genotypic tools based on V3 sequences may provide reliable information on HIV-1 tropism when testing clade B viruses, especially in antiretroviral-experienced patients. The sensitivity to detect X4 variants using genotypic tools may improve by testing proviral DNA instead of plasma RNA.

Impact of antiretroviral therapy on viral tropism in HIV-infected patients followed longitudinally for over 5 years

Journal of Antimicrobial Chemotherapy, 2007

Background: Viral tropism plays a major role in HIV pathogenesis and may influence the activity o... more Background: Viral tropism plays a major role in HIV pathogenesis and may influence the activity of entry inhibitors. The impact of antiretroviral therapy use on the dynamics of viral tropism over time is still poorly understood. Patients and methods: HIV co-receptor usage was determined longitudinally for over 5 years in 237 plasma specimens collected from 73 distinct HIV-1-infected drug-naive individuals, 42 of whom initiated antiretroviral therapy thereafter and 31 who remained untreated. Viral tropism was estimated genotypically using the phenotype predictor software webPSSM, considering as X4 virus populations those with pure X4 and dual/mixed X4/R5 variants. Results: At baseline, the prevalence of X4 viruses was 3.2% and 14.6% in patients who remained untreated and in those who initiated antiretroviral therapy, respectively (P 5 0.112). Mean plasma HIV-RNA was lower in the former compared with the latter (3.8 + + + + + 0.9 versus 4.5 + + + + + 0.9 log; P < 0.004), while conversely the mean CD4 count was greater in untreated than in those who had begun therapy (536 + + + + + 191 versus 278 + + + + + 192 cells/mm 3 ; P < 0.001). During follow-up, switch in co-receptor use occurred overall in 26% of the study population, with no significant differences between the groups. Emergence of X4 viruses was significantly associated with lower CD4 counts regardless of antiretroviral treatment exposure. Conclusions: The use of antiretroviral therapy does not seem to influence the selection of X4 viruses, which mainly occur in patients with low CD4 counts.

Design and validation of new genotypic tools for easy and reliable estimation of HIV tropism before using CCR5 antagonists

Journal of Antimicrobial Chemotherapy, 2009

Background: Genotypic tools may allow easier and less expensive estimation of HIV tropism before ... more Background: Genotypic tools may allow easier and less expensive estimation of HIV tropism before prescription of CCR5 antagonists compared with the Trofile w assay (Monogram Biosciences, South San Francisco, CA, USA). Methods: Paired genotypic and Trofile w results were compared in plasma samples derived from the maraviroc expanded access programme (EAP) in Europe. A new genotypic approach was built to improve the sensitivity to detect X4 variants based on an optimization of the webPSSM algorithm. Then, the new tool was validated in specimens from patients included in the ALLEGRO trial, a multicentre study conducted in Spain to assess the prevalence of R5 variants in treatment-experienced HIV patients. Results: A total of 266 specimens from the maraviroc EAP were tested. Overall geno/pheno concordance was above 72%. A high specificity was generally seen for the detection of X4 variants using genotypic tools (ranging from 58% to 95%), while sensitivity was low (ranging from 31% to 76%). The PSSM score was then optimized to enhance the sensitivity to detect X4 variants changing the original threshold for R5 categorization. The new PSSM algorithms, PSSM X4R5-8 and PSSM SINSI-6.4 , considered as X4 all V3 scoring values above 28 or 26.4, respectively, increasing the sensitivity to detect X4 variants up to 80%. The new algorithms were then validated in 148 specimens derived from patients included in the ALLEGRO trial. The sensitivity/specificity to detect X4 variants was 93%/69% for PSSM X4R5-8 and 93%/70% for PSSM SINSI-6.4. Conclusions: PSSM X4R5-8 and PSSM SINSI-6.4 may confidently assist therapeutic decisions for using CCR5 antagonists in HIV patients, providing an easier and rapid estimation of tropism in clinical samples.

Spontaneous bacterial peritonitis caused byListeria monocytogenes: Two case reports and literature review

European Journal of Clinical Microbiology & Infectious Diseases, 1992

Two new cases of spontaneous bacterial peritonitis (SBP) caused byListeria monocytogenes are repo... more Two new cases of spontaneous bacterial peritonitis (SBP) caused byListeria monocytogenes are reported.Listeria monocytogenes was recovered from the ascitic fluid but not from the blood cultures of two adult diabetic inpatients with hepatic cirrhosis and SBP that had been treated empirically with cefotaxime. These two cases add to the 17 cases ofListeria monocytogenes SBP reported previously, stressing the relevance of

Hand grip strength: Outcome predictor and marker of nutritional status

Clinical Nutrition, 2011

Background & aims: Among all muscle function tests, measurement of hand grip strength has gained ... more Background & aims: Among all muscle function tests, measurement of hand grip strength has gained attention as a simple, non-invasive marker of muscle strength of upper extremities, well suitable for clinical use. This review outlines the prognostic relevance of grip strength in various clinical and epidemiologic settings and investigates its suitability as marker of nutritional status in cross-sectional as well as intervention studies. Methods: Studies investigating grip strength as prognostic marker or nutritional parameter in crosssectional or intervention studies were summarized. Results and conclusions: Numerous clinical and epidemiological studies have shown the predictive potential of hand grip strength regarding short and long-term mortality and morbidity. In patients, impaired grip strength is an indicator of increased postoperative complications, increased length of hospitalization, higher rehospitalisation rate and decreased physical status. In elderly in particular, loss of grip strength implies loss of independence. Epidemiological studies have moreover demonstrated that low grip strength in healthy adults predicts increased risk of functional limitations and disability in higher age as well as all-cause mortality. As muscle function reacts early to nutritional deprivation, hand grip strength has also become a popular marker of nutritional status and is increasingly being employed as outcome variable in nutritional intervention studies.

Adductor pollicis muscle: Reference values of its thickness in a healthy population

Clinical Nutrition, 2010

Background & aims: Adductor pollicis muscle is the only muscle which could be directly assessed, ... more Background & aims: Adductor pollicis muscle is the only muscle which could be directly assessed, and its thickness could be useful in muscle mass assessment. Our objective is to determine values of adductor pollicis muscle thickness (APMT) in healthy subjects. Methods: APMT was obtained using a skinfold caliper in 300 healthy subjects, grouped by age and gender, in dominant (DAPMT) and non-dominant (NDAPMT) sides. All patients were assessed by Subjective Global Assessment (SGA). General characteristics of the subjects were obtained by a questionnaire. Results: One hundred and fifty men and one hundred and fifty women were evaluated. Their mean age was 44.9 AE 18.5 years and they were all well nourished. DAPMT mean values found in men were 26.1 AE 4.4 mm and in women, 19.8 AE 3.3 mm, respectively. NDAPMT mean values found in men and women were 25.1 AE 4.4 mm and 18.7 AE 3.1, respectively. Reference values for each gender and age group were created and values below the 5th percentile were considered as limit of normality. Conclusions: This study presents APMT reference values from a healthy population. New studies may demonstrate its role in the evaluation of muscle mass and its association with nutritional status.

Assessement of resting energy expenditure of obese patients: Comparison of indirect calorimetry with formulae

Clinical Nutrition, 2009

Background & aims: Determining the caloric expenditure of overweight (Body mass index-BMI from 25... more Background & aims: Determining the caloric expenditure of overweight (Body mass index-BMI from 25-29.9 kg/m 2) or obese (BMI ! 30 kg/m 2) patients is a difficult task. The importance of the measurement using indirect calorimetry (IC) is to avoid the administration of an inadequate caloric load, which can increase clinical morbidity. The aim of this study was to compare the resting energy expenditure (REE) obtained by IC with that estimated by the Harris-Benedict (HB) and the Ireton-Jones (IJ) equations and a fixed amount of 21 kcal/kg of body weight, using actual, average and adjusted weights. Methods: A total of 71 IC measurements were prospectively performed in 44 patients using the ''DELTATRAC II Ò '' calorimeter. In 53 of the measurements the patients were on mechanical ventilation and 18 were performed using the canopy, in the fasting state and 24 h after achieving calculated caloric requirements. Results: The best REE prediction value in the fasting state was obtained with the HB equation using the actual body weight (HB/ABW), 1873 AE 484 kcal/day (p ¼ 0.49) when compared to the REE of 1798 AE 495 kcal/day measured by IC. After achieving caloric needs, the best REE prediction values were using the HB/ABW equation, 1873 AE 484 kcal/day (p ¼ 0.56) and the IJ equation with the adjusted body weight, 2103 AE 580 kcal/day (p ¼ 0.19) when compared to 1948 AE 507 kcal/day measured by IC. Although, when the above results were plotted on the Bland and Altman limits of agreement test their average bias were low, but the ranges of their absolute values from the observed average agreement were large, !531 Kcal. Conclusion: From these data we can conclude that even though the average values obtained with the equations utilized to predict the REE for this population, showed good correlation with those by IC, as they had the best comparative absolute results, however they demonstrated an unacceptable variability when matched to the measured REE values.

Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients

Clinical Nutrition, 2011

Background & aims: We evaluated the ability of Nutritional Risk Screening 2002 (NRS 2002) and Sub... more Background & aims: We evaluated the ability of Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) to predict malnutrition related to poor clinical outcomes. Methods: We assessed 705 patients at a public university hospital within 48 h of admission. Logistic regression and number needed to screen (NNS) were calculated to test the complementarity between the tools and their ability to predict very long length of hospital stay (VLLOS), complications, and death. Results: Of the patients screened, 27.9% were at nutritional risk (NRSþ) and 38.9% were malnourished (SGA B or C). Compared to those patients not at nutritional risk, NRSþ, SGA B or C patients were at increased risk for complications (p ¼ 0.03, 0.02, and 0.003, respectively). NRSþ patients had an increased risk of death (p ¼ 0.03), and SGA B and C patients had an increased likelihood of VLLOS (p ¼ 0.008 and p < 0.0001, respectively). Patients who were both NRSþ and SGA C had lower estimates of NNS than patients who were NRSþ or SGA C only, though their confidence intervals did overlap. Conclusions: The concurrent application of SGA in NRSþ patients might enhance the ability to predict poor clinical outcomes in hospitalized patients in Brazil.