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Evaluating repeated handgrip strength measurements as predictors of mortality in malnourished hospitalized patients. Secondary analysis of a randomized controlled trial

European Journal of Clinical Nutrition volume 79, pages 897–903 (2025)Cite this article

Subjects

Abstract

Background

Handgrip strength (HGS) is a simple yet effective bed-side tool for assessing muscle strength, which plays an important role in clinical evaluation and monitoring. We hypothesize that repeated measurements of HGS during the hospital stay may serve as a reliable and robust indicator of clinical course and outcomes.

Methods

We re-analyzed data from 565 out of 2028 patients who had repeated handgrip measurement (on admission and on day 7) included in EFFORT, a Swiss-wide multicenter, randomized controlled trial comparing individualized nutritional support with usual care nutrition in medical inpatients. The primary endpoint was 180-day all-cause mortality.

Results

The mean change in HGS from baseline to day 7 was 0.6 kg (SD 4.2) in female and 0.7 kg (SD 3.7) in male patients. Patients with a positive HGS trend had a lower risk of dying within 180 days compared to patients without a positive trend (mortality 11.4% vs. 25.4%, adjusted HR 0.45 [95% CI 0.27 to 0.77], p = 0.003). The change in HGS was also associated with the nutritional intake during the hospitalization in male patients: those who met their energy and protein targets were twice as likely to have an increase in HGS during hospitalization (adjusted OR 2.05 [95% CI 1.23 to 3.42], p = 0.006).

Conclusions

Achieving nutritional targets was associated with a short-term increase in HGS during hospitalization, and a positive HGS trend was associated with a lower risk of mortality after 180 days. These data provide evidence that repeated HGS measurements are a robust bedside tool for assessing and monitoring patients receiving nutritional therapy in the hospital.

Trial Registration

ClinicalTrials.gov Identifier: NCT02517476

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Fig. 1: Kaplan-Meier survival graph for patients with no or negative change in HGS during hospitalization compared to patients with positive HGS trend for 180-d mortality.
Fig. 2

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Data availability

Our data will be made available to others with the publication of this manuscript, as already outlined in the primary EFFORT publication, on receipt of a letter of intention detailing the study hypothesis and statistical analysis plan. A signed data access agreement is required from all applicants. Please send requests to the principal investigator of this trial.

Code availability

Data described in the manuscript, code book, and analytic code will be made available to others with the publication of this manuscript, as already outlined in the primary EFFORT publication, on receipt of a letter of intention detailing the study hypothesis and statistical analysis plan.

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Acknowledgements

We thank all participating patients and the entire EFFORT Team as well as all other hospital staff for their support.

Funding

The original EFFORT trial and this sub-analysis were funded by the Research Council of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) and by grants from the Swiss National Science Foundation (SNSF) (PP00P3_150531 and PP00P3_176972).

Author information

Author notes

  1. These authors contributed equally: Pascal Tribolet, Carla Wunderle, Nina Kaegi-Braun.

Authors and Affiliations

  1. Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland

    Pascal Tribolet, Carla Wunderle, Nina Kaegi-Braun, Lena Buchmueller, Rahel Laager, Beat Mueller & Philipp Schuetz

  2. Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland

    Pascal Tribolet

  3. Faculty of Life Sciences, University of Vienna, Vienna, Austria

    Pascal Tribolet

  4. Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden

    Nina Kaegi-Braun

  5. University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland

    Rahel Laager

  6. Medical Faculty of the University of Basel, 4056, Basel, Switzerland

    Rahel Laager, Beat Mueller & Philipp Schuetz

  7. Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Zeno Stanga

  8. Department of Nutritional Sciences and Research Platform Active Ageing, University of Vienna, Vienna, Austria

    Karl-Heinz Wagner

Authors
  1. Pascal Tribolet
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Contributions

Pascal Tribolet: Conceptualization, data collection, formal analysis, visualization, writing – original draft, writing – review & editing. Carla Wunderle: Conceptualization, formal analysis, investigation, writing – original draft, writing – review & editing. Nina Kaegi-Braun: Conceptualization, formal analysis, investigation, writing – review & editing. Lena Buchmueller: Visualization, writing – original draft, writing – review & editing. Rahel Laager: Formal analysis, Visualization, writing – review & editing. Zeno Stanga: Funding acquisition, investigation, writing – review & editing. Beat Mueller: Funding acquisition, investigation, writing – review & editing. Karl-Heinz Wagner: Investigation, writing – review & editing. Philipp Schuetz: Conceptualization, funding acquisition, investigation, project administration, writing – review & editing.

Corresponding author

Correspondence to Philipp Schuetz.

Ethics declarations

Ethical approval

The study protocol was approved by the Ethics Committee of Northwest and Central Switzerland (EKNZ; 2014_001). All participants provided their written informed consent to participate in this study. The trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02517476). All methods were performed in accordance with the relevant guidelines and regulations.

Competing interests

The Institution of P. Schuetz has previously received unrestricted grant money unrelated to this project from Nestlé Health Science and Abbott Nutrition. The institution of Z. Stanga received speaking honoraria and research support from Nestlé Health Science, Abbott Nutrition, and Fresenius Kabi. All other authors report no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract form.

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Tribolet, P., Wunderle, C., Kaegi-Braun, N. et al. Evaluating repeated handgrip strength measurements as predictors of mortality in malnourished hospitalized patients. Secondary analysis of a randomized controlled trial. Eur J Clin Nutr 79, 897–903 (2025). https://doi.org/10.1038/s41430-025-01618-w

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