IS CALF CIRCUMFERENCE ASSOCIATED WITH CLINICAL AND NUTRITIONAL OUTCOME IN OLDER PATIENTS?

MAZZINI, Lucas Rosasco; AQUINO, José Luis Braga de; CAMARGO, José Gonzaga Teixeira de; LEANDRO-MERHI, Vania Aparecida

doi:10.1590/0102-672020230055e1773

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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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Original Article • ABCD, arq. bras. cir. dig. 36 • 2023 • https://doi.org/10.1590/0102-672020230055e1773 copy

IS CALF CIRCUMFERENCE ASSOCIATED WITH CLINICAL AND NUTRITIONAL OUTCOME IN OLDER PATIENTS?

A CIRCUNFERÊNCIA DA PANTURRILHA ESTÁ ASSOCIADA AO DESFECHO CLÍNICO E NUTRICIONAL EM PACIENTES IDOSOS?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Previous studies have shown a relationship between calf circumference (CC) and outcomes in hospitalized patients.

AIMS:

To investigate the relationship between CC and clinical and nutritional outcomes in older in-patients (OiP) in a surgery ward.

METHODS:

This was a cross-sectional study with 417 OiP in a surgery ward. Clinical variables, anthropometry, and nutritional screening instruments such as subjective global assessment (SGA), mini nutritional assessment (MNA), and nutritional risk screening (NRS) were used in the investigation. The tests Pearson’s chi-square, Mann-Whitney, Kruskal-Wallis, and Spearman’s coefficient, and multiple linear regression analyses were used to review the factors associated with CC.

RESULTS:

Lower CC values were found in the age group 80 years and over (p<0.0001), presence of complications (p=0.0269), NRS (p<0.0001), SGA (p<0.0001), and MNA (p<0.0001). Gender (p=0.0011; partial R²=0.01151), age (p=0.0002; partial R²=0.06032), body mass index (p≤0.0001; partial R²=0.40820), and arm circumference (p≤0.0001; partial R²=0.11890) are variables that together were associated with CC. There was also a relationship between SGA (p=0.0166; partial R²=0.00605) and absence of complications during hospitalization (p=0.0047; R²=0.01154) with CC.

CONCLUSIONS:

Gender, age, body mass index, and arm circumference were jointly associated with CC, in addition to SGA and absence of complications. The CC is a relevant indicator for OiP in the clinical practice.

HEADINGS
Nutritional status; Anthropometry; Inpatients; Aged

Variables	Category	n	%
Age group (years)	65–79	308	73.9
Age group (years)	≥80	109	26.1
Gender	Female	149	35.7
Gender	Male	268	64.3
Reason for hospitalization	Digestive tract disease	52	12.5
	Kidney disease	42	10.1
	Respiratory disease	19	4.6
	Vascular disease	68	16.3
	Oncological digestive disease	151	36.2
	Orthopedic disease	28	6.7
	Thoracic disease	57	13.7
Body mass index	Overweight	131	34.2
	Adequate	152	39.7
	Low weight	100	26.1
Comorbidity	Yes	309	98.1
Comorbidity	No	6	1.9
Mini nutritional assessment	Malnourished	61	14.6
	Eutrophic	148	35.5
	Malnutrition risk	208	49.9
Subjective global assessment	Well nourished	318	76.3
Subjective global assessment	Malnourished	99	23.7
Nutritional risk screening	At risk	202	48.4
Nutritional risk screening	Without risk	215	51.6
Death	No	401	96.2
Death	Yes	16	3.8
Complications	No	357	85.6
Complications	Yes	60	14.4
Surgery	No	137	32.9
Surgery	Yes	280	67.1

Variables	Measure	Mean±SD	Median
Age	years	73.99±6.92	72.0
Length of hospital stay	days	8.94±8.11	6.0
Body mass index	kg/m²	25.28±5.19	24.90
Arm circumference	cm	27.77±4.41	27.50
Calf circumference	cm	32.49±4.36	32.10
Triceps skinfold	mm	16.70±8.15	15.00
Lymphocytes	cel/mm³	1,519.33±948.70	1,355.00
Arm muscle circumference	cm	225.72±34.52	224.35

Variables	Coefficient (r)^* * Spearman correlation coefficient; †p<0.05.	p-value^† * Spearman correlation coefficient; †p<0.05.
Calf circumference vs age	-0.24848	<0.0001
Calf circumference vs length of hospital stay	-0.02028	0.6797
Calf circumference vs body mass index	0.66943	<0.0001
Calf circumference vs arm circumference	0.70746	<0.0001
Calf circumference vs triceps skinfold	0.38119	<0.0001
Calf circumference vs arm muscle circumference	0.59757	<0.0001
Calf circumference vs lymphocytes	0.10103	0.0827

Variables	Mean ± SD	Median	p-value
Age group (years)
65–79 (n=308)	33.13±4.19	33.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
≥80 (n=109)	30.69±4.35	30.50
Total (n=417)	32.49±4.36	32.10
Gender
Female (n=149)	31.97±4.73	32.00	0.0689^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Male (n=268)	32.78±4.12	32.50
Total (n=417)	32.49±4.36	32.10
Diseases
Digestive (n=52)	33.43±5.04	32.15	0.4076^† * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Renal (n=42)	32.66±4.21	32.75
Respiratory (n=19)	30.45±4.10	31.50
Vascular (n=68)	32.27±4.45	32.25
Digestive neoplasms (n=151)	32.32±4.37	32.50
Orthopedics (n=28)	32.79±4.70	33.50
Thoracic (n=57)	32.78±3.42	32.00
Surgery
No (n=137)	32.37±4.14	32.00	0.5406^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Yes (n=280)	32.56±4.47	32.50
Complications
No (n=357)	32.66±4.45	33.00	0.0269^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Yes (n=60)	31.47±3.66	31.50
SGA
Well nourished (n=318)	33.15±4.10	33.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Malnourished (n=99)	30.38±4.52	30.00
NRS
At risk (n=202)	31.21±4.36	31.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Without risk (n=215)	33.70±4.01	34.00
MNA
M+MR (n=269)	31.49±4.44	31.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Eutrophic (n=148)	34.32±3.56	34.00
Death
No (n=401)	32.52±4.36	32.30	0.4377^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Yes (n=16)	31.83±4.40	30.50

Variable	Estimated parameter^* R2 model = 0.6165. *Estimated value; R2: coefficient of determination: partial; R2: proportion of response variability explained exclusively by the variable in question; R2 model: proportion of explanation of the dependent variable by the variation of the independent variables that remained in the model. Stepwise criterion used for selecting variables; AC: arm circumference; BMI: body mass index; M: male; F: female.	p-value	Partial R²
Age	-0.13231	0.0002	0.06032	age ¯calf circumference
Body mass index	0.27155	<0.0001	0.40820	BMI calf circumference
Arm circumference	0.52190	<0.0001	0.11890	AC calf circumference
Gender (M vs F)	27.20215	0.0011	0.01151	male calf circumference
Complications (no vs yes)	32.64815	0.0047	0.01154	uncomplicated calf circumference
Subjective global assessment (well-nourished vs malnourished)	23.41684	0.0166	0.00605	Well-nourished calf circumference

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[1] Correspondence: Vania Aparecida Leandro-Merhi. E-mail: vapaleme@gmail.com; valm@puc-campinas.edu.br