608 the Development and Validation of a Nutritional Prioritising Tool for Use in Patients With Chronic Liver Disease

Arora, Simran; Mattina, Christina; McAnenny, Catherine; O’Sullivan, Niall; McGeeney, Laura; Calder, Nicola; Gatiss, G.A.; Davidson, Brian; Morgan, M.Y.

doi:10.1016/s0168-8278(12)60621-7

Cited by 27 publications

(24 citation statements)

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“…Commentary NRS-2002 and MUST are validated tools to screen hospitalized patients for risk of malnutrition [131,132] and are recommended by ESPEN [133]. The Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT) has been developed as a screening tool for malnutrition in liver disease patients [134,135]. In a head-to-head comparison, the RFH-NPT was more sensitive than the NRS-2002 to identify liver patients at risk for malnutrition [136].…”

Section: Recommendationmentioning

confidence: 99%

ESPEN guideline on clinical nutrition in liver disease

et al. 2019

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This update of evidence-based guidelines (GL) aims to translate current evidence and expert opinion into recommendations for multidisciplinary teams responsible for the optimal nutritional and metabolic management of adult patients with liver disease. The GL was commissioned and financially supported by ESPEN. Members of the guideline group were selected by ESPEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. A total of 85 recommendations were made for the nutritional and metabolic management of patients with acute liver failure, severe alcoholic steatohepatitis, non-alcoholic fatty liver disease, liver cirrhosis, liver surgery and transplantation as well as nutrition associated liver injury distinct from fatty liver disease. The recommendations are preceded by statements covering current knowledge of the underlying pathophysiology and pathobiochemistry as well as pertinent methods for the assessment of nutritional status and body composition.

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Section: Recommendationmentioning

confidence: 99%

ESPEN guideline on clinical nutrition in liver disease

et al. 2019

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“…This schema takes less than 3 minutes to complete and can be used by nonspecialist staff. It has excellent intra‐ and interobserver reproducibility and significant external validity against the RFH‐GA; it has also been validated in a UK multicenter trial 37. However, further, more extensive validation is needed.…”

Section: Nutritional Assessmentmentioning

confidence: 99%

“… RFH‐NPT schema for determining nutritional risk in patients with cirrhosis 37. Nutritional risk is assessed on the summate scores allocated to the assessed variables.…”

Section: Nutritional Assessmentmentioning

confidence: 99%

The nutritional management of hepatic encephalopathy in patients with cirrhosis: International society for hepatic encephalopathy and nitrogen metabolism consensus

Amodio¹,

Bémeur²,

Butterworth³

et al. 2013

Hepatology

338

327

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Nitrogen metabolism plays a major role in the development of hepatic encephalopathy (HE) in patients with cirrhosis. Modulation of this relationship is key to the management of HE, but is not the only nutritional issue that needs to be addressed. The assessment of nutritional status in patients with cirrhosis is problematic. In addition, there are significant sex-related differences in body composition and in the characteristics of tissue loss, which limit the usefulness of techniques based on measures of muscle mass and function in women. Techniques that combine subjective and objective variables provide reasonably accurate information and are recommended. Energy and nitrogen requirements in patients with HE are unlikely to differ substantially from those recommended in patients with cirrhosis per se viz. 35-45 kcal/g and 1.2-1.5g/kg protein daily. Small meals evenly distributed throughout the day and a late-night snack of complex carbohydrates will help minimize protein utilization. Compliance is, however, likely to be a problem. Diets rich in vegetables and dairy protein may be beneficial and are therefore recommended, but tolerance varies considerably in relation to the nature of the staple diet. Branched chain amino acid supplements may be of value in the occasional patient intolerant of dietary protein. Increasing dietary fiber may be of value, but the utility of probiotics is, as yet, unclear. Short-term multivitamin supplementation should be considered in patients admitted with decompensated cirrhosis. Hyponatremia may worsen HE; it should be prevented as far as possible and should always be corrected slowly. Conclusion: Effective management of these patients requires an integrated multidimensional approach. However, further research is needed to fill the gaps in the current evidence base to optimize the nutritional management of patients with cirrhosis and HE. (HEPATOLOGY 2013;58:325-336) M alnutrition and hepatic encephalopathy (HE) are two of the most common complications of cirrhosis and both have detrimental effects on outcome.

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“…Both publications suggest that an initial rapid screening tool should be implemented to all cirrhotic patients, and those identified at risk for malnutrition should be referred for a detailed nutritional assessment. So far, there are only two nutritional screening tools developed especially for liver disease patients, namely the Liver Disease Undernutrition Screening Tool (LDUST) (10) and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) (11) . However, further validation is needed for these two tools in different populations, as acknowledged both by EASL and the European Society for Clinical Nutrition and Metabolism (ESPEN) (9,12) .…”

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confidence: 99%

Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study

et al. 2019

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Malnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5–54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.

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608 the Development and Validation of a Nutritional Prioritising Tool for Use in Patients With Chronic Liver Disease

Cited by 27 publications

References 0 publications

ESPEN guideline on clinical nutrition in liver disease

ESPEN guideline on clinical nutrition in liver disease

The nutritional management of hepatic encephalopathy in patients with cirrhosis: International society for hepatic encephalopathy and nitrogen metabolism consensus

Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study

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