Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis

Abstract

Accurate assessments of nutritional status are difficult to obtain in patients with cirrhosis. The aim of this study was to devise and validate a global nutritional assessment scheme for use in this patient population. Measures of body mass index (BMI) and mid-arm muscle circumference (MAMC) were combined with details of dietary intake in a semistructured, algorithmic construct to provide a nutritional assessment scheme for use in patients with cirrhosis; evaluated individuals were classified as adequately nourished, moderately malnourished (or suspected to be), or severely malnourished. There was good interobserver agreement in the nutritional categorization of 50 patients with cirrhosis (34 men, 16 women) using this scheme ( ‫؍‬ 0.79) and significant associations with the contributing objective variables-namely, BMI (Spearman's correlation r ‫؍‬ ؊0.78; P < .001) and relative MAMC (r ‫؍‬ ؊0.69; P < .001)-confirming its internal validity. There was a significant association between nutritional categorization in 20 patients with cirrhosis (10 men, 10 women) and estimates of total body protein obtained using a four-component model (r ‫؍‬ ؊0.45; P ‫؍‬ .046), confirming the external validity of the scheme. Finally, a significant association was found between poor nutritional status in 116 patients with cirrhosis (65 men, 51 women), followed for 14 to 52 months, and shorter subsequent survival (P ‫؍‬ .0005), confirming the scheme's predictive validity. In conclusion, a global assessment scheme has been devised that provides a simple, reproducible, valid, and predictive method of assessing nutritional status in patients with cirrhosis. (HEPATOLOGY 2006;44:823-835.)

Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study

“…Economic outcomes included number and cost of study visits, paracentesis visits, AE related visits and hospitalizations, over 6 months. In the sub-study, nutritional status including BMI, hand grip, mid-arm muscle circumference (MAMC), triceps skin fold thickness (TSF), and the Royal Free Hospital General Assessment (RFH-GA) [17] were measured. Additionally, hemodynamic markers and biomarkers of renal injury including cardiac index, systemic vascular resistance, plasma renin activity, kidney injury molecule-1 (KIM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL) were measured for sub-study patients.…”

Nutrition in the Management of Cirrhosis and its Neurological Complications

“…122,123 Moreover, in a recent prospective study, a range of methods including subjective global assessment, anthropometry, handgrip dynamometry and associated biochemical tests were found to result in a wide variability of results and lack of a clear consensus. 124 In one potentially interesting new development, Morgan et al 125 validated a method whereby BMI and midarm muscle circumference were combined with details of dietary intake in a semi-structured algorithm construct to provide a sensitive and reproducible instrument for nutritional assessment in patients with chronic liver diseases. Use of this method has, however, not gained wide acceptance at this moment in time.…”

Infections in Cirrhotics: Types, Microbiological Spectrum and Risk Factors—5-Year Cohort Study

“…RFH-GA is a recently devised validated method for nutritional assessment in patient with liver cirrhosis. RFH-GA is a simple bedside assessment tool with both subjective and objective components required for nutritional assessment [26]. The subjective part of RFH-GA provides clinical information, dietary intake and physical status whereas objective component includes anthropometric measurements like mid arm muscle circumference (MAMC), body mass index (BMI) and Triceps skin fold thickness (TSF).…”