Malnutrition in Cirrhosis: Frequent but Overlooked

Kuftinec, Gabriela; Bhamidimarri, Kalyan Ram; Pearlman, Michelle

doi:10.1002/lt.25660

Cited by 10 publications

(14 citation statements)

References 10 publications

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“…However, since malnutrition is common in all hospitalized patients [1], the use of malnutrition screening tools for the general hospital population is recommended [4]. A major challenge is to choose an appropriate screening tool that ideally fits all hospitalized patients and is easy to perform also by non-nutritional specialists.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with liver cirrhosis, hepatic metabolic functions are impaired resulting in a variety of nutritional disorders including protein-energy-malnutrition (PEM) which occurs in 65-90% but is still frequently underestimated [1]. However, up to now, common models to determine the prognosis in patients with liver cirrhosis do not include nutritional screening.…”

Section: Introductionmentioning

confidence: 99%

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Validation of Malnutrition Screening Tools in Liver Cirrhosis

et al. 2020

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Malnutrition in liver cirrhosis is frequently underestimated. To determine if a patient is at risk of malnutrition, several screening tools have been established. However, most of them are not validated for patients with liver cirrhosis. Therefore, we compared the RFH-NPT (Royal Free Hospital Nutritional Prioritizing Tool) as the validated gold standard for malnutrition screening in cirrhosis patients with GMS (Graz Malnutrition Screening), NRS-2002 (Nutritional Risk Screening) and MNA-SF (Mini Nutritional Assessment-Short Form). Based on common validity criteria for screening tools, only the MNA-SF showed fair correlation (12/15 points) with the RFH-NPT, whereas NRS-2002 and GMS performed worse (6/15 points). Taken together, our results suggest that NRS-2002 and GMS are not suitable for screening of malnutrition in cirrhosis patients. A cirrhosis-specific screening tool like RFH-NPT should be used to assess malnutrition and to identify those at risk of malnutrition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of Malnutrition Screening Tools in Liver Cirrhosis

et al. 2020

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“…However, this is a modifiable situation, and early detection and diagnosis are essential for proper treatment. [1][2][3] Despite this, the use of screening tools for malnutrition and nutrition assessment is relatively uncommon in patients with liver cirrhosis. This is due to multiple causes, including the absence of a validated, rapid, and reliable screening tool, as well as the existence of numerous definitions of malnutrition.…”

Section: Introductionmentioning

confidence: 99%

Mini Nutritional Assessment ‐ Short Form Is a Useful Malnutrition Screening Tool in Patients with Liver Cirrhosis, Using the Global Leadership Initiative for Malnutrition Criteria as the Gold Standard

et al. 2021

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Background: The use of nutrition-screening tools in cirrhotic patients is not systematized. Recently, specific tools have been proposed for patients with cirrhosis, but their diagnostic capabilities have been scarcely studied. Methods: This was a prospective study that includes outpatients with liver cirrhosis undergoing follow-up in the hepatology consultations of a tertiary-care university hospital. A trained gastroenterologist applied the screening tools: Liver Disease Universal Screening Tool (LDUST), Royal Free Hospital-Nutrition Prioritizing Tool (RFH-NPT), and Mini Nutritional Assessment-Short Form (MNA-SF). Subsequently, the diagnosis of malnutrition was made according to Global Leadership Initiative for Malnutrition (GLIM) criteria by an endocrinologist, who was blind to the results of the screening tools. Results: Sixty-three patients (38.1% women, mean age 63.1 ± 9.9 years) with cirrhosis (60.3% Child-Pugh A, 34.9% Child-Pugh B, and 4.8% Child-Pugh C) were evaluated. The prevalence of malnutrition was 38.1% (15.9% moderate, 22.2% severe). Advanced stages of cirrhosis were associated with a higher prevalence of malnutrition (P = .021). MNA-SF was the most accurate screening tool, being superior to RFH-NPT and LDUST. It presented better sensitivity than RFH-NPT (88% [0.68-0.97] vs 67% [0.45-0.84], P = .031) and better specificity than both LDUST (97% [0.87-0.99] vs 62% [0.45-0.77], P < .001) and RFH-NPT (97% [0.87-0.99] vs 82% [0.67-0.93], P = .016). Conclusions: According to the GLIM criteria, malnutrition affected 38.1% of patients with cirrhosis, being severe in 22% of the patients. MNA-SF is the most accurate screening test, superior even to tools specifically designed for cirrhotic patients (LDUST).

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“…Another general consideration is that depending on the method used, the percentage of cirrhotic patients that are judged to be malnourished in a sample varies. This is evident in the majority of the published studies and, as in this study, the parameter used to define MN substantially affects the percentage of participants placed in this category [41,42]. Indeed, the patients enrolled in the present study had a prevalence of MN of 79.1%, which was principally of mild-tomoderate severity (55.5%).…”

Section: Discussionmentioning

confidence: 57%

Adipopenia Is the Rapid Screening Tool that Best Predicts Mortality in Patients with Decompensated Cirrhosis: Results of a Prospective Study

Luca¹,

Addario²,

Lombardi³

et al. 2021

JGLD

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Background and Aims: Patients with liver cirrhosis (LC) often have malnutrition (MN), which can be associated with decompensation, infection, and death. The aims were to determine: the prevalence of MN in patients with LC and ascites, its impact on mortality, and the relationship between MN and spontaneous bacterial peritonitis (SBP). Methods: Nutritional status (NS) was analysed in cirrhotic patients, experiencing their first episode of ascites, who were consecutively admitted at two clinical liver centres between November 2014 and October 2016. The participants underwent diagnostic paracentesis and were followed up to assess their outcomes. Results: 110 participants underwent NS assessment in addition to routine clinical procedures. The prevalence of MN was 30.9% according to corrected body mass index, 67.3% according to upper mid-arm muscle area (UMA) and 40% according to upper mid-arm fat area (UFA). The percentages of the participants remaining alive were 68.1% at 3 months, 59.3% at 6 months, 45.1% at 12 months and 24.2% at the end of the study. Univariate analysis showed that SBP, model for end-stage liver disease (MELD), UFA, UMA and age were significantly associated with mortality. Multivariate analysis showed that only SBP, MELD and UFA (hazard ratio 2.2) were independently associated with mortality. There was a correlation between adipopenia, but not sarcopenia, and SBP. Conclusions: Adipopenia, as assessed by UFA, was present in 40% of the cirrhotic patients, and it was independently associated with mortality.

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Malnutrition in Cirrhosis: Frequent but Overlooked

Cited by 10 publications

References 10 publications

Validation of Malnutrition Screening Tools in Liver Cirrhosis

Validation of Malnutrition Screening Tools in Liver Cirrhosis

Mini Nutritional Assessment ‐ Short Form Is a Useful Malnutrition Screening Tool in Patients with Liver Cirrhosis, Using the Global Leadership Initiative for Malnutrition Criteria as the Gold Standard

Adipopenia Is the Rapid Screening Tool that Best Predicts Mortality in Patients with Decompensated Cirrhosis: Results of a Prospective Study

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