Serum albumin, subjective global assessment, body mass index and the bioimpedance analysis in the assessment of malnutrition in patients up to 15 years after liver transplantation

Wagner, Doris; Adunka, C.; Kniepeiss, Daniela; Jakoby, E.; Schaffellner, S.; Kandlbauer, M.; Fahrleitner‐Pammer, Astrid; Roller, Regina E.; Kornprat, Peter; Müller, Heimo; Iberer, F.; Tscheliessnigg, Karlheinz

doi:10.1111/j.1399-0012.2011.01442.x

Cited by 37 publications

(26 citation statements)

References 20 publications

(30 reference statements)

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“…We show this agreement through the results of phase angle, by obtaining the same cutoff point as studies by L. Scheunemann et al (37) and Wagner et al (41) . Given this fact, the phase angle is a strong prognostic marker regardless of the pathology, since this method evaluates cell capacitance, i.e., the integrity and functionality of the individual's cell, unlike other methods routinely used for nutritional diagnosis, which are usually based on the patient's body weight.…”

Section: Discussionsupporting

confidence: 88%

Nutritional assessment in patients with cirrhosis

Fernandes

Bassani

Nunes

et al. 2012

Arq. Gastroenterol.

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-Context -Malnutrition in cirrhotic patients with end-stage disease is common, and the degree of nutritional debilitation can play an important role in the pathogenesis of complications and cause a negative impact on prognosis. However, it involves difficulties and controversies regarding the identification of the best nutritional assessment method. Objective -To identify a method that provides a safe and effective nutritional diagnosis. Methods -Cross-sectional study with 129 cirrhotic patients. Anthropometric measurements, subjective global assessment, hand grip strength and bioelectrical impedance. Results -Through phase angle of bioelectrical impedance analysis (BIA) method, significant associations with Child-Pugh (P = 0.008), age group and gender were observed. The ROC (receiver operator characteristic) curve was generated to determine the best cutoff point of the phase angle of cirrhotic patients, serving as one of the reference parameters for the nutritional assessment with bioimpedance in this study, considering the classification through Child-Pugh score as the reference standard for the clinical conditions of patients with cirrhosis. Conclusions -The assessment through bioelectrical impedance presented a statistically significant correlation with Child-Pugh score. The identification of phase angle of 5.44º is the new parameter suggested for the classification of the nutritional conditions of cirrhotic patients.

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Section: Discussionsupporting

confidence: 88%

Nutritional assessment in patients with cirrhosis

Fernandes

Bassani

Nunes

et al. 2012

Arq. Gastroenterol.

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“…38 Several studies 25,39,40 have demonstrated the association between PhA and markers of nutritional risk. In previous studies, 41 serum albumin was significantly associated with PhA (0.812) in liver transplant patients. Norman et al 42 found that standardized PhA is an independent predictor for nutrition, functional status and survival.…”

Section: Discussionmentioning

confidence: 99%

Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission

2013

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s u m m a r yBackground & aims: This study determined the association between phase angle (PhA), by bioelectrical impedance analysis (BIA) and nutritional risk by Nutritional Risk Screening (NRS-2002), Subjective Global Assessment (SGA), hospital length of stay (LOS) and 30 day non-survival in patients at hospital admission compared to healthy controls. Methods: PhA was determined by BIA in patients (n ¼ 983, 52.7 AE 21.5 yrs, M 520) and compared to healthy age-, sex-and height-matched controls. Low PhA was set at <5.0 (men) and <4.6 (women) as previously determined (Kyle, in press). Results: PhA was lower in patients (men 6.0 AE 1.4, women 5.0 AE 1.3 ) than controls (men 7.1 AE 1.2 , women 6.0 AE 1.2 , un-paired t-test p < 0.001). Patients were more likely to have low PhA than controls: NRS-2002: no risk (relative risk (RR) 1.7, 95th confidence interval (CI) 1.2e2.3), moderate risk (RR 4.5, CI 3.4e5.8) and severe risk (RR 7.5, CI 5.9e9.4); similar results were obtained by SGA; LOS !21 days (RR 6.9, CI 5.1e9.1) and LOS 5e20 days (RR 5.2, CI 3.9e6.9) and non-survivors (RR 3.1, CI 2.1e3.4) compared to survivors. Conclusions: There is a significant association between low PhA and nutritional risk, LOS and nonsurvival. PhA is helpful to identify patients who are at nutritional risk at hospital admission in order to limit the number of in-depth nutritional assessments.

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“…Despite some of the limitations in patients with ascites, BIA is a reliable tool for the determination of BCM in cirrhotic patients with and without ascites (26). Phase angle has been considered to be a prognostic tool in various clinical situations, such as human immuno virus (21), renal disease (27), pulmonary tuberculosis (28), cancer (29), and liver cirrhosis (15,25,30,31).…”

Section: Bioimpedance Analysis (Bia)mentioning

confidence: 99%

Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant

Bakshi

Singh

2016

Hepatobiliary Surg. Nutr.

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Background: Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. Methods:We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Results: Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage , blood loss during the surgery, BIA (fat mass, FFM, muscle mass and body fat%). Conclusions:The different nutrition assessment tools showed great variability of results. SGA showed moderate agreement with phase angle of the body and was associated with various clinical and prognostic variables of liver transplantation.

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Serum albumin, subjective global assessment, body mass index and the bioimpedance analysis in the assessment of malnutrition in patients up to 15 years after liver transplantation

Abstract: SGA or BMI calculation alone does not suffice to evaluate the nutritional status. SA seems to play a crucial role in the prediction of severe disease-related malnutrition in this special patient cohort.

Cited by 37 publications

References 20 publications

Nutritional assessment in patients with cirrhosis

Nutritional assessment in patients with cirrhosis

Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission

Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant

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