Abstract :
Background: Malnutrition is common and is a very important prognostic factor among patients with cirrhosis. The best method for assessing nutritional status in patients with cirrhosis is unclear and there are several limitations and controversies regarding the utility of conventional and sophisticated nutritional assessment methods in this population.
Objective: To determine the prevalence of malnutrition in patients with cirrhosis and to compare the performance of various nutritional assessment methods.
Methods: This cross-sectional study was conducted in Rajavithi Hospital between December 2013 and May 2014. Patients with cirrhosis at outpatient clinic were assessed for their nutritional status several methods including subjective global assessment (SGA), anthropometry [body mass index, tricep skinfold thickness (TST) and mid-arm muscle circumference (MAMC)], hand grip strength dynamometry (HGS), and bioelectrical impedance analysis (BIA).
Results: Eighty-five patients were evaluated, 54.1% were male and mean age were 54.41 ± 11.61 years. Etiology of cirrhosis was chronic hepatitis B 35.29%, chronic hepatitis C 27.05%, and alcohol 21.17% of cases. According to the classification of Child-Pugh, 80% were A, 15.29% were B, and 4.71% were C. The prevalence of malnutrition was varied according to the assessment methods used; 44.71% by SGA, 51.76% by MAMC, 36.47% by HGS, and 15.29% by BIA. The results of statistical analysis in different methods of nutritional assessment revealed slightly agreement between SGA-HGS (Kappa = 0.298, p < 0.05) and SGA-BIA (Kappa = 0.291, p < 0.05).
Conclusions: There was a relatively high prevalence of malnutrition (15-51%) in patients with cirrhosis even in those with Child-Pugh class A.The frequency of malnutrition in patients with cirrhosis appears to be varied according to the nutritional assessment method used. MAMC was superior to SGA, HGS and BIA in terms of its simplicity and ability detects malnourished cirrhotic patients, therefore MAMC recommended as a screening tool for malnutrition in cirrhosis.
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file/Thai-Journal-of-gastroenterology-vol-15-no-2-4552273.pdf