scholarly journals MALNUTRITION IN LIVER CIRRHOSIS

2020 ◽  
Vol 8 (10) ◽  
pp. 445-453
Author(s):  
Akshay Rawat ◽  
◽  
Arti Devi ◽  
Keyword(s):  
Liver Disease ◽  
Global Assessment ◽  
Nutritional Assessment ◽  
Assessment Tools ◽  
Subjective Global Assessment ◽  
Common Complication ◽  
Nutrient Metabolism ◽  
Global Assessment Scale ◽  
Advanced Liver Disease ◽  
Cirrhotic Patients

Malnutrition is a common complication of liver disease and it adversely affects patient outcome. Aetiologic factors include hypermetabolism, malabsorption, altered nutrient metabolism and anorexia. Use of traditional nutritional assessment tools, such as anthropometry along with subjective global assessment scale and biometric measures, should be done to evaluate cirrhotic patients for malnutrition. Improvements in nutritional status can improve outcomes of patients with advanced liver disease.

scholarly journals Clinical measurement properties of malnutrition assessment tools for use with patients in hospitals: a systematic review

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Yue Camille Xu ◽  
Joshua I. Vincent
Keyword(s):  
Global Assessment ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Quality Score ◽  
Assessment Tools ◽  
Measurement Properties ◽  
Subjective Global Assessment ◽  
Clinical Measurement ◽  
Nutritional Care ◽  
Minimum Detectable Change

Abstract Background The use of malnutrition outcome measures (OM) by registered dietitians (RD) with inpatients in hospitals has increased promoting the achievement of nutritional care goals and supporting decision-making for the allocation of nutritional care resources in hospitals. There are 3 commonly used OMs: Subjective Global Assessment (SGA), Patient Generated-Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA). The purpose of this current study was to systematically review the evidence of the clinical measurement properties of malnutrition assessment tools for use with patients admitted in hospitals. Methods MEDLINE, Cinahl, EMBASE, and PubMed were searched for articles published between 2000 and 2019. Research articles were selected if they established reliability, validity, and responsiveness to change properties of the SGA, PG-SGA and MNA tools, were written in English, and used any of these OMs as an outcome measure. Abstracts were not considered. The risk of bias within studies was assessed using the Quality Appraisal for Clinical Measurement Study (QA-CMS). Results Five hundred five studies were identified, of which 34 articles were included in the final review: SGA (n = 8), PG-SGA (n = 13), and MNA (n = 13). Of the 34 studies, 8 had a quality score greater than 75%; 23 had a quality score of 40–75% and 3 studies had a quality score of less than 40%. PG-SGA was found to have excellentdiagnostic accuracy (ROC: 0.92–0.975; Sensitivity: 88.6–98%; Specificity: 82–100%), sufficient internal consistency (Cronbach’s alpha: 0.722–0.73), and strong test-retest reliability (r = 0.866). There was insufficient evidence to suggest adequate diagnostic accuracy and good inter-rater reliability for SGA. Only one study examined the minimum detectable change of MNA (MDC = 2.1). Conclusions The evidence of validity for the existing malnutrition assessment tools supports the use of these tools, but more studies with sound methodological quality are needed to assess the responsiveness of these OMs to detect the change in nutritional status.

scholarly journals Nutritional Status of Out-patient Hemodialysis Patients in a Hospital-based Hemodialysis Centre in Nepal

2018 ◽  
Vol 1 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Ruju Khadka ◽  
Nabin Bahadur Basnet ◽  
Rishi Kumar Kafle
Keyword(s):  
Nutritional Status ◽  
Global Assessment ◽  
Dietary Habits ◽  
Nutritional Assessment ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Anthropometric Measurements ◽  
Assessment Tools ◽  
Subjective Global Assessment ◽  
Biochemical Assessment

Introduction: Malnutrition is common among patients on chronic hemodialysis and is a risk factor. Nutritional assessment ensures early recognition and appropriate intervention. Dietary interview, physical and anthropometric measurements, biochemical assessment, bio-impedance, and structured assessment tools like subjective global assessment are modalities for identifying and monitoring of nutritional assessment of hemodialysis patients. This study was conducted to assess the nutritional status of hemodialysis patients and identify various factors related to malnutrition.Materials and Methods: A cross-sectional study of 72 chronic hemodialysis patients at a hemodialysis unit in Lalitpur was done. Detailed dietary and personal interview, anthropometric measurements, biochemical assessment, and subjective global assessment were used to collect the data to determine the prevalence of malnutrition among the hemodialysis patients as well as identify various factors related.Results: Malnutrition was prevalent among the respondents. The respondents were mostly male with average age of 50.2 1.9 years and majority being on hemodialysis for more than two years. Though severe malnutrition was absent among the hemodialysis patients assessed, mild to moderate malnutrition was seen in 52.78%. Most of these patients were female and were of older age group. Patients who had malnutrition had experienced a significant weight loss in previous six months. Anthropometric profile, dietary habits, and biochemical profile did not correlate with occurrence of malnutrition in hemodialysis patients.Conclusions: Malnutrition is fairly prevalent in chronic hemodialysis patients which can be identified by subjective global assessment. Elderly patients and patients who are losing weight are risk factors for mild to moderate malnutrition.Nepalese Medical Journal, vol.1, No. 1, 2018, Page: 12-16

scholarly journals OUTCOME AND NUTRITIONAL ASSESSMENT OF CHRONIC LIVER DISEASE PATIENTS USING ANTHROPOMETRY AND SUBJECTIVE GLOBAL ASSESSMENT

2017 ◽  
Vol 54 (3) ◽  
pp. 225-231 ◽  
Author(s):  
Gonçalo NUNES ◽  
Carla Adriana SANTOS ◽  
Rita BAROSA ◽  
Cristina FONSECA ◽  
Ana Teresa BARATA ◽  
...  
Keyword(s):  
Liver Disease ◽  
Global Assessment ◽  
Nutritional Assessment ◽  
Handgrip Strength ◽  
Subjective Global Assessment ◽  
Upper Arm ◽  
Protein Calorie Malnutrition ◽  
Arm Circumference ◽  
Hospitalised Patients ◽  
Mid Upper Arm Circumference

ABSTRACT BACKGROUND: Protein-calorie malnutrition is common in chronic liver disease (CLD) but adequate clinical tools for nutritional assessment are not defined. OBJECTIVE: In CLD patients, it was aimed: 1. Characterize protein-calorie malnutrition; 2. Compare several clinical, anthropometric and functional tools; 3. Study the association malnutrition/CLD severity and malnutrition/outcome. METHODS: Observational, prospective study. Consecutive CLD ambulatory/hospitalised patients were recruited from 01-03-2012 to 31-08-2012, studied according with age, gender, etiology, alcohol consumption and CLD severity defined by Child-Turcotte-Pugh. Nutritional assessment used subjective global assessment, anthropometry, namely body-mass index (BMI), triceps skinfold, mid upper arm circumference, mid arm muscular circumference and handgrip strength. Patients were followed during two years and survival data was recorded. RESULTS: A total of 130 CLD patients (80 men), aged 22-89 years (mean 60 years) were included. Most suffered from alcoholic cirrhosis (45%). Hospitalised patients presented more severe disease ( P <0.001) and worst nutritional status defined by BMI ( P =0.002), mid upper arm circumference ( P <0.001), mid arm muscular circumference ( P <0.001), triceps skinfold ( P =0.07) and subjective global assessment ( P <0.001). A third presented deficient/low handgrip strength. Alcohol consumption ( P =0.03) and malnutrition detected by BMI ( P =0.03), mid upper arm circumference ( P =0.001), triceps skinfold ( P =0.06), mid arm muscular circumference ( P =0.02) and subjective global assessment ( P <0.001) were associated with CLD severity. From 25 patients deceased during follow-up, 17 patients were severely malnourished according with triceps skinfold. Malnutrition defined by triceps skinfold predicted mortality ( P <0.001). CONCLUSION: Protein-calorie malnutrition is common in CLD patients and alcohol plays an important role. Triceps skinfold is the most efficient anthropometric parameter and is associated with mortality. Nutritional assessment should be considered mandatory in the routine care of CLD patients.

scholarly journals Subjective Global Assessment and Handgrip Strength as Predictive Factors in Patients with Liver Cirrhosis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Maria Ciocîrlan ◽  
Andreea Ruxandra Cazan ◽  
Mihaela Barbu ◽  
Mircea Mănuc ◽  
Mircea Diculescu ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Global Assessment ◽  
Handgrip Strength ◽  
Assessment Tools ◽  
Subjective Global Assessment ◽  
Term Survival ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Short Term Survival

Background and Aims. Malnutrition is common in patients with chronic liver disease. We aimed to evaluate malnutrition assessment tools in predicting severity and survival of patients with liver cirrhosis. Material and Methods. We examined patients with liver cirrhosis. Nutritional evaluation was performed on admission, using subjective global assessment (SGA), handgrip strength (HGS), and anthropometry. Patients were followed up for 6 months. Results. We included 100 patients, 72 men, with mean age of 59.2 years. According to disease severity, patients were 23% Child-Pugh A, 46% Child-Pugh B, and 31% Child-Pugh C. SGA and HGS significantly correlated with Child-Pugh, MELD, and MELD-Na scores on admission. At 6 months follow-up, 80.4% (78 of 97) of patients survived, while 3 patients were lost from observation. Survival was predicted by SGA (1 death in 32 patients SGA A, 8 deaths in 46 patients SGA B, and 9 deaths in 19 patients SGA C, p=0.001) and HGS (25.1 ± 8.5 in deceased versus 30.6 ± 10.9 in survivors, p=0.046). The mean BMI and MAMC values did not significantly differ between patients who survived or were deceased at 6 months. Conclusion. HGS and SGA may predict severity and short-term survival in cirrhotic patients.

Comparison of the Performance of Existing Nutritional Screening Tools against Subjective Global Assessment in Cirrhotic Patients

2021 ◽  
Vol 104 (8) ◽  
pp. 1301-1308
Keyword(s):  
Nutritional Status ◽  
Global Assessment ◽  
Screening Tool ◽  
Risk Index ◽  
Assessment Tools ◽  
Screening Tools ◽  
Subjective Global Assessment ◽  
Nutritional Screening ◽  
Nutritional Risk Index ◽  
Cirrhotic Patients

Background: Malnutrition in cirrhosis has a significant negative impact on morbidity and mortality. There is no agreed gold standard of the screening tool. Study comparing the diagnostic properties of nutritional assessment tools in cirrhotic patients is limited. The Subjective Global Assessment (SGA) is one of the global assessment tools. It is used to assess nutritional status in different patient populations. Objective: To evaluate the diagnostic properties of different nutritional screening tools compared with SGA in cirrhotic patients. Materials and Methods: A cross-sectional study was conducted at the HRH Princess Maha Chakri Sirindhorn Medical Center. All cirrhotic patients were enrolled. The nutritional status was evaluated by the SGA, the Royal Free Hospital Subjective Global Assessment (RFH-SGA), the Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT), the Liver Disease Undernutrition Screening Tool (LDUST), the Malnutrition Universal Screening Tool (MUST), the Prognostic Nutritional Index (PNI-O), the Nutritional Risk Index (NRI), the Spanish Society of Parenteral, the Enteral Nutrition (SENPE), and the Controlling Nutritional Status (CONUT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate RFH-SGA, RFH-NPT, LDUST, MUST, PNI-O, NRI, SENPE, and CONUT compared with SGA. Results: Ninety-four cirrhotic patients were included. The mean age was 60.82 (SD 10.11) years. Patients with cirrhosis Child Turcotte Pugh (CTP) A, B, and C were 62, 21, and 11, respectively. Twenty-five patients (28.7%) were malnourished according to SGA, five with CTP A cirrhosis, twelve with CTP B cirrhosis, and ten with CTP C cirrhosis. The present study also showed that NRI had the highest sensitivity (100%) and LDUST had the highest specificity (94%). Conclusion: NRI is an effective tool with high sensitivity for identifying malnutrition in early stage of cirrhosis. Keywords: Nutritional screening; Cirrhosis; Subjective Global Assessment; SGA; Nutritional Risk Index; NRI

scholarly journals Patterns of dendritic cell and monocyte subsets are associated with disease severity and mortality in liver cirrhosis patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chandra Chiappin Cardoso ◽  
Camila Matiollo ◽  
Carolina Hilgert Jacobsen Pereira ◽  
Janaina Santana Fonseca ◽  
Helder Emmanuel Leite Alves ◽  
...  
Keyword(s):  
Dendritic Cells ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Dendritic Cell ◽  
Disease Severity ◽  
Advanced Liver Disease ◽  
Hla Dr ◽  
Acute Decompensation ◽  
Cirrhotic Patients ◽  
Classical Monocytes

AbstractLiver cirrhosis is often complicated by an immunological imbalance known as cirrhosis-associated immune dysfunction. This study aimed to investigate disturbances in circulating monocytes and dendritic cells in patients with acute decompensation (AD) of cirrhosis. The sample included 39 adult cirrhotic patients hospitalized for AD, 29 patients with stable cirrhosis (SC), and 30 healthy controls (CTR). Flow cytometry was used to analyze monocyte and dendritic cell subsets in whole blood and quantify cytokines in plasma samples. Cirrhotic groups showed higher frequencies of intermediate monocytes (iMo) than CTR. AD patients had lower percentages of nonclassical monocytes than CTR and SC. Cirrhotic patients had a profound reduction in absolute and relative dendritic cell numbers compared with CTR and showed higher plasmacytoid/classical dendritic cell ratios. Increased plasma levels of IL-6, IL-10, and IL-17A, elevated percentages of CD62L+ monocytes, and reduced HLA-DR expression on classical monocytes (cMo) were also observed in cirrhotic patients. Patients with more advanced liver disease showed increased cMo and reduced tissue macrophages (TiMas) frequencies. It was found that cMo percentages greater than 90.0% within the monocyte compartment and iMo and TiMas percentages lower than 5.7% and 8.6%, respectively, were associated with increased 90-day mortality. Monocytes and dendritic cells are deeply altered in cirrhotic patients, and subset profiles differ between stable and advanced liver disease. High cMo and low TiMas frequencies may be useful biomarkers of disease severity and mortality in liver cirrhosis.

scholarly journals The importance of dysphagia screening and nutritional assessment in hospitalized patients

2018 ◽  
Vol 16 (2) ◽  
Author(s):  
Patrícia Amaro Andrade ◽  
Carolina Araújo dos Santos ◽  
Heloísa Helena Firmino ◽  
Carla de Oliveira Barbosa Rosa
Keyword(s):  
Nutritional Status ◽  
Global Assessment ◽  
Assessment Tool ◽  
Nutritional Assessment ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
The Body ◽  
Subjective Global Assessment ◽  
Cross Sectional ◽  
Knee Height

ABSTRACT Objective: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). Methods: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson’s χ2 and Spearman’s correlation were used to verify differences between the groups. Results: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. Conclusion: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people.

scholarly journals Assessment of Malnutrition in Cirrhotic Patients

2016 ◽  
Vol 15 (2) ◽  
pp. 189-194 ◽  
Author(s):  
Mushtaque Ahmad Rana ◽  
Mohammad Abu Faisal ◽  
Mohammad Enamul Karim ◽  
Abu Raihan Siddique ◽  
Dewan Saifuddin Ahmed ◽  
...  
Keyword(s):  
Liver Disease ◽  
Nutritional Status ◽  
Medical Science ◽  
Assessment Tools ◽  
Severe Malnutrition ◽  
Group A ◽  
Malnourished Patient ◽  
Study Population ◽  
Cirrhotic Patients ◽  
Anthropometric Assessment

Malnutrition is a common but frequently overlooked problem among patients with cirrhosis of liver. Malnourished cirrhotic patients have a higher rate of complications and an overall increased mortality. Identifying these patients is of great clinical importance. This study was carried out to assess nutritional status of cirrhotic patients to identify those who are malnourished and to see the relationship between severity of liver disease and malnutrition. 105 patients were selected by purposive type sampling. Nutritional status was assessed by 3 anthropometric assessment tools- body mass index (BMI), mid upper arm muscle circumference (MAMC) and triceps skin fold thickness (TST). Severity of liver disease was assessed by Child-Pugh (CP) score. Severe malnutrition was defined as MAMC and TST <5th percentile, calculated from standard tables, and as BMI <16. Among 105 patients 18, 49 and 38 were of Child-Pugh group (CP group) A, B and C respectively. Anthropometric assessment revealed that, when assessed by MAMC 63% of the study population were severely malnourished. Based on MAMC, severe malnutrition was present in 39%, 63% and 73% patients in CP group A, B and C, respectively (P<0.05). So, percentage of severely malnourished patient increased with the increase in severity of liver disease. Based on TST, 28%, 34% and 50% patients were severely malnourished in CP-A, CP-B and in CP-C (p>0.05) respectively which showed a trend similar to that by MAMC. Whereas, based on BMI, 0%, 8% and 2% patients were severely malnourished respectively (p>0.05). It showed a decrease in the percentage of severely malnourished patient in CP group C than in CP group B. In this study, nutritional assessment by TST and MAMC revealed that severe malnutrition was common in our study population and assessment by MAMC showed a statistically significant association of severity of liver disease with severe malnutrition.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.189-194

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