Validation of Malnutrition Screening Tools in Liver Cirrhosis

Abstract

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.

Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study

“…Percent of body weight change and the Mini Nutritional Assessment (MNA) screening tool served as indicators of nutritional status [ 14 ]. The MNA screening tool was initially developed for detecting undernutrition in the elderly, but it has subsequently been adopted in several clinical settings and patient populations [ 15 – 17 ]. The tool identifies individuals at risk of malnutrition or malnourished based on the presence of reduction in food intake (due to loss of appetite, digestive problems, chewing or swallowing difficulties), disease burden (psychological stress or acute disease in the previous 3 months or presence of neuropsychological problems), weight loss, body mass index or reduced mobility.…”

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

“…19 MNA-SF has shown a sensitivity and specificity in patients with cirrhosis of 83% and 84% in a recent study. 20 Recently, a new screening tool has been developed called Liver Disease Universal Screening Tool (LDUST), which consists of 6 questions that can be self-administered by the patient. 21 For this study, we have evaluated 3 nutrition-screening questionnaires (LDUST, MNA, and RFH-NPT) using GLIM diagnostic criteria as the "criterion standard" to establish the diagnosis of malnutrition.…”

“…Each questionnaire has a sensitivity and specificity above 70% in different populations, but not all of them have been tested in patients with liver cirrhosis 19 . MNA‐SF has shown a sensitivity and specificity in patients with cirrhosis of 83% and 84% in a recent study 20 . Recently, a new screening tool has been developed called Liver Disease Universal Screening Tool (LDUST), which consists of 6 questions that can be self‐administered by the patient 21 …”

Visceral Adiposity Associates With Malnutrition Risk Determined by Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

“…It is tempting to apply targeted interventions with the purpose of ameliorating malnourished status and relevant complications. Given no generalized modality currently exists regarding malnutrition risk screening, a cirrhosis-specific approach, referring to RFH-NPT, has recently been developed, used, and recommended by several hepatology centers and scientific societies ( 4 , 22 – 25 ). Notably, among eight screening tools for detecting the risk of malnutrition in cirrhosis, RFH-NPT represents the most accurate with a high sensitivity of 97.4% and a fair specificity of 73.3% ( 26 ).…”