Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation

Abstract

PURPOSE: Malnutrition is prevalent in patients with advanced liver disease (LD) related to multifactorial causes. Fluid retention can underestimate the nutritional status based on anthropometric measures. We evaluated nutritional indicators and body composition (BC) in patients with liver cirrhosis and correlated them with LD severity. METHODS:Forty three patients with LD enrolled for liver transplantation were evaluated by Anthropometric measures, subjective evaluation (Global Assessment of Nutritional Status -SGA) and biochemical indicators. Single-frequency electrical bioimpedance (SFE-BIA) was used to evaluate body composition (BC). It measured resistance (R), reactance (Xc) and the phase angle (PA). LD severity was estimated by Child-Pugh and Meld criteria (Model for End-Stage Liver Disease). RESULTS:Child-Pugh index between patients was 7.11±1.70 and Meld was 12.23±4.22. Arm Circumference, Arm Muscle Circumference and Arm Muscle Area, SGA, hemoglobin, hematocrit and albumin showed better correlation with disease severity. Xc and PA showed correlation both with Meld and Child-Pugh score when BC were evaluated. PA was depleted in 55.8% of the patients. CONCLUSIONS:Diagnosis of malnutrition varied according to the method. Global assessment of nutritional status showed better correlation with disease severity than with objective methods. Single-frequency electrical bioimpedance for body composition analysis in cirrhotic patients must be cautiously used; however, primary vectors seems to be valid and promising in clinical practice.

Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables

“…Both MAMA and corrected MAMA are associated with clinical risk, including a prediction of the length of hospital stay in surgical patients (Almeida et al ., ) and an increased risk of mortality in the elderly and those with chronic obstructive pulmonary disease (Miller et al ., ; Soler‐Cataluña et al ., ; Enoki et al ., ). Although MAMA has been described as preferable to MAMC on the basis of correlation with creatinine/height index (Trowbridge et al ., ; Gibson, ), the advantages are small and there is little evidence that it is a better predictor of body composition or health risk in adults (Scalfi et al ., ; Vulcano et al ., ). Therefore, because MAMC is marginally easier to calculate, it is reasonable to use this in nutritional assessment.…”

Creatinine height index as a predictor of nutritional status among patients with liver cirrhosis

“…In this study, adopting SGA as a tool to diagnose malnutrition revealed that 92.2% of patients were Medhat et al 227 malnourished, 50.5% of them were severely malnourished, and 41.7% of them were moderately malnourished, this percentage is higher than that found by Vulcano et al (2013), where they found that 46.5% of the cirrhotic patients suffering from different degree of malnutrition according to SGA (Vulcano et al, 2013). Also this study results were higher than that of Teiusanue et al (2012), where 76% of the patients were well nourished, 15% of the patients were mild to moderately malnourished and 9% only were severely malnourished (Teiusanue et al, 2012).…”

“…Furthermore, protein calorie malnutrition (PCM) itself may accelerate deterioration of liver functions and adversely affects its clinical outcome (Plauth et al, 2000). PCM considered a major risk factor for morbidity and mortality before and after transplantation as well as in abdominal surgery (Vulcano et al, 2013).…”

A Comprehensive Review of Bioelectrical Impedance Analysis and Other Methods in the Assessment of Nutritional Status in Patients with Liver Cirrhosis

“…Segmental BIA is also used to overcome fluid retention in patients. As opposed to MF-BIA, single-frequency BIA (SI-BIA) might cause the underestimation of body composition [76]. It is usually performed with four electrodes.…”