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.
Schlüsselwörter
Handkraft - Muskelfunktion - Ernährungsintervention - Mangelernährung
Keywords
muscle function - hand grip strength - nutritional intervention - malnutrition
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Dr. Kristina Norman
Medizinische Klinik und Poliklinik, Charité – Universitätsmedizin Berlin
Charitéplatz 1
10117 Berlin
Telefon: +49-30-450-514139
Fax: +49-30-450-514901
eMail: kristina.norman@charite.de
