Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition

Abstract

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). Methods: A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). Results: The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = −0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11–18.47). Conclusions: In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.

Use of Muscle Ultrasonography in Morphofunctional Assessment of Amyotrophic Lateral Sclerosis (ALS)

“…This study showed lower values of muscle quantity (rectus femoris thickness (Y-axis) and quadriceps thickness (RF+VI)) and lower values of muscle quality (Y-X index) without changes in muscle area. The values observed in patients with malnutrition were similar to those parameters of another study of ultrasonography in patients with malnutrition [11].…”

“…Muscle quality parameters have shown similar results, with an increase in admission in lower quartiles and no relation to survival. These data resemble those of patients with disease-related malnutrition and a high X-Y index (instead of the low Y-X index of this study), which demonstrate an increase in the number of deceased patients in the highest quartiles of the X-Y index [11].…”

“…- (cm), transverse diameter of the QRF (X-axis) (cm), and the sum of the anteroposterior diameters of QRF and the vastus intermedius (RF+VI) (cm) [11].…”

“…The grayscale ranges from 0 (black) to 255 (white). The value is shown as a percentage (%) with respect to the maximum (255) [11]. The Image J ® program version 1.54 f (National Institutes of Health NIH, Bethesda, MD, USA) was used to determine echogenicity; this program is a method to treat radiological images developed by the National Health Institute (NIH) [12].…”

Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk

“…Although there are different muscle structures that can be evaluated, many studies focus on the rectus femoris or combinations of various muscle groups involving large muscle bundles with functional importance to patients in terms of gait. Measurement of the rectus femoris of the quadriceps is one of the most referenced measurements due to its correlation with strength and tests of execution or functional performance [ 25 , 26 , 27 , 28 , 29 , 32 ]. The data from our work can be extrapolated only to patients at potential risk of malnutrition when hospitalized and older than 18 years.…”