March 2016 E-Journal Club

March Weekend Warrior 2016


We hosted a wonderful class of Weekend Warrior participants in March, and discussed a broad range of GI and nutrition support topics. Every time we get to meet such enthusiastic and interested nutrition professionals, I feel encouraged for the future of our field.  Our journal club in March was an article that investigated the link between nutrition status and the mass of an indicator muscle.


March Citation:

Ghorabi S, Ardehali H, Amiri Z, Vahdat Shariatpanahi Z.  Association of the Adductor Pollicis Muscle Thickness With Clinical Outcomes in Intensive Care Unit Patients. Nutr Clin Pract. 2016 Feb 11. [Epub ahead of print]


This was a prospective, observational study that investigated the associations between adductor pollicis muscle thickness (muscle in the web of the hand between the thumb and first finger), nutrition status and clinical outcomes in adult ICU patients.  A total of 127 mixed ICU patients (medical, surgical, trauma) had the adductor pollicis muscle thickness (APMT) measured on the first day of their ICU admission, in addition to triceps skinfold, mid-arm circumference and serum albumin.  Clinical outcomes included ICU length of stay, organ failure (SOFA score) and mortality.

Univariate linear regression analysis was used to measure possible associations between anthropometric parameters, LOS, and SOFA score. Logistic regression analysis was used to measure possible association between anthropometric parameters and mortality.  Multivariate logistic regression analysis adjusted by other risk factors, including APACHE II score, serum albumin, and age, was used to determine if anthropometric parameters was independently associated with the clinical outcomes.

Inclusion and Exclusion Criteria:

Inclusion criteria:

Age ≥ 18 years and admitted to the ICU of the study hospital within the 13 month study period.

Exclusion criteria:

Patients with splints, casts or edema in the upper extremities.

Major Results:

Data from 58 female and 69 male patients were included in the study, with a mean age of 51 ± 20 years.  There were 35.7% medical, 42.8% surgical and 21.4% trauma with a mean APACHE II score of 20.74 ± 7.2.

Dominant and nondominant APMT were lower in patients with serum albumin levels <3 g/dL compared with those with serum albumin levels ≥3 g/dL (11.08 ± 1.9 mm vs 16.07 ± 2.8 mm, P < .001 and 10.12 ± 2.2 mm vs 14.97 ± 2.9 mm, P < .001).

All of the anthropometric measurements were significantly correlated with ICU mortality, ICU LOS and SOFA score. Decreased dominant APMT had the highest correlation with ICU mortality, ICU LOS and SOFA score.

Author’s Conclusions:

“…APMT is a low-cost, reliable, and easy method to assess nutrition status and to predict patients’ outcomes in the ICU.”


This was observational study that investigated associations between ICU outcomes and indicators of muscle mass.  Although the authors described APMT as an indicator of nutrition status, there was no investigation of nutrition intake, weight history, nor any validated indicators of nutrition status (subjective global assessment, nutrition risk score, etc) in this study.  Muscle mass is one facet of nutrition assessment, but various conditions such as chronic illness, age, disuse, corticosteroids, malignancy, etc can all cause loss of muscle mass even when nutritional intake is adequate.

A previous study in surgical patients compared APMT with Subjective Global Assessment and reported that a very low APMT (< 5th percentile) was associated with malnutrition.(1)  However, the study reported that APMT had a low sensitivity for predicting malnutrition, and APMT could not differentiate between moderate and severe malnutrition.(1)

Our Take Home Message(s)

  1. Adductor pollicis muscle thickness is associated with outcomes in adult ICU patients, but this study did not include any measure of nutrition status.
  2. Further research is necessary to understand the potential usefulness of indicator muscles in the assessment of nutrition status in ICU patients.


  1.  Gonzalez MC, Pureza Duarte RR, Orlandi SP, et al.  Adductor pollicis muscle: A study about its use as a nutritional parameter in surgical patients. Clin Nutr. 2015;34(5):1025-1029.

Other News on the UVAHS GI Nutrition Website: (

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Upcoming Webinars 2016:
Tuesday, April 12 at 1:00 PM (ET):  Severe Hypoglycemia After Gastric Bypass Surgery:  A Rare, But Debilitating Problem

Tuesday, May 24 at 1:00 PM (ET):  Meeting Full Calorie Needs in the ICU:  Should We?

June (Date TBA):  Micronutrient Deficiencies after Gastric Bypass Surgery

Latest Practical Gastroenterology article:

Phillips ME. Pancreatic Resection: Nutritional Implications and Long-Term Follow Up.  Practical Gastroenterology 2016;XXXX(3):18.


Joe Krenitsky MS, RDN


PS – Please feel free to forward on to friends and colleagues.