Messung der Muskelkraft als ernährungsmedizinische Zielgröße

 

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Zusammenfassung

Die Muskelfunktion hat in den letzten Jahrzehnten als dynamischer Parameter des funktionellen Zustands und des Ernährungszustands an Bedeutung gewonnen. Bei krankheitsbedingter Mangelernährung kommt es zu einer typischen Beeinträchtigung der Muskelfunktion. Allerdings sind Veränderungen der Muskelkraft früher zu beobachten als ein messbarer Verlust der Muskelmasse, was darauf schließen lässt, dass die Muskelfunktion von weiteren Parametern abhängig ist, wie die Verringerung energiereicher Phosphate oder Veränderungen im Elektrolythaushalt. Dadurch kennzeichnet sich die Messung der Muskelkraft und insbesondere die der Handkraft durch eine hohe prognostische Bedeutung in Bezug auf Morbidität und Mortalität im akuten Krankheitsverlauf als auch im langfristigen Zeitrahmen. Die Messung der willkürlichen Handkraft mit einem Dynamometer ermöglicht eine praktikable Erfassung der Muskelfunktion und hat damit im klinischen und ambulanten Bereich Eingang gefunden. Die Handkraft ist in zahlreichen Studien auch als ernährungsmedizinische Zielvariable eingesetzt worden. Aufgrund der sensiblen Reaktionsfähigkeit ist eine Verringerung der Muskelfunktion nicht nur ein früher Indikator einer Mangelernährung, sondern reagiert rascher als Parameter der Körperzusammensetzung auf eine Ernährungstherapie. Mit der Einschränkung für geriatrische Patienten, wo die Handkraft nur bedingt durch eine Ernährungsintervention zu steigern ist, eignet sich die Handkraft als einfacher klinischer Verlaufsparameter zur unterstützenden Beurteilung einer Ernährungsintervention. Es bedarf dafür allerdings einer standardisierten systematischen Durchführung der Messung. Zur Beurteilung einzelner Werte ist die Verwendung von alters- und geschlechtsspezifischen Referenzwerten notwendig.

Abstract

Muscle function has gained attention as an indicator of functional as well as nutritional status. Loss of muscle strength is a key phenomenon in disease related malnutrition. However, the decrease in muscle function frequently precedes alterations of body composition. Therefore, muscle function is likely related to further factors than pure muscle mass, such as electrolytes, energy rich phosphates and membrane potential. This sensitivity might account for the prognostic power of muscle function – and hand grip strength in particular – in regard to morbidity and mortality in both acute and long-term settings. The assessment of voluntary hand grip strength with a dynamometer is a feasible and reliable bed side method suitable for the clinical and ambulatory setting. Hand grip strength has been investigated in numerous nutrition intervention studies. Muscle function responds earlier to nutritional deprivation and restoration, and is therefore an early marker of malnutrition as well as a useful tool for monitoring nutritional intervention in adult patients. In the elderly, however, nutritional intervention is not always successful in improving hand grip strength. A systematic and standardized measurement of hand grip strength is necessary in order to obtain valid results. For the evaluation of baseline grip strength values, age and gender specific reference data must be considered.

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Dr. Kristina Norman

Medizinische Klinik und Poliklinik, Charité – Universitätsmedizin Berlin

Charitéplatz 1

10117 Berlin

Phone: +49-30-450-514139

Fax: +49-30-450-514901

Email: kristina.norman@charite.de