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Liver Failure and Liver Disease
Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis†
Article first published online: 27 SEP 2006
Copyright © 2006 American Association for the Study of Liver Diseases
Volume 44, Issue 4, pages 823–835, October 2006
How to Cite
Morgan, M. Y., Madden, A. M., Soulsby, C. T. and Morris, R. W. (2006), Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology, 44: 823–835. doi: 10.1002/hep.21358
Potential conflict of interest: Nothing to report.
- Issue published online: 27 SEP 2006
- Article first published online: 27 SEP 2006
- Manuscript Accepted: 23 JUL 2006
- Manuscript Received: 30 JAN 2006
Accurate assessments of nutritional status are difficult to obtain in patients with cirrhosis. The aim of this study was to devise and validate a global nutritional assessment scheme for use in this patient population. Measures of body mass index (BMI) and mid-arm muscle circumference (MAMC) were combined with details of dietary intake in a semistructured, algorithmic construct to provide a nutritional assessment scheme for use in patients with cirrhosis; evaluated individuals were classified as adequately nourished, moderately malnourished (or suspected to be), or severely malnourished. There was good interobserver agreement in the nutritional categorization of 50 patients with cirrhosis (34 men, 16 women) using this scheme (κ = 0.79) and significant associations with the contributing objective variables—namely, BMI (Spearman's correlation r = −0.78; P < .001) and relative MAMC (r = −0.69; P < .001)—confirming its internal validity. There was a significant association between nutritional categorization in 20 patients with cirrhosis (10 men, 10 women) and estimates of total body protein obtained using a four-component model (r = −0.45; P = .046), confirming the external validity of the scheme. Finally, a significant association was found between poor nutritional status in 116 patients with cirrhosis (65 men, 51 women), followed for 14 to 52 months, and shorter subsequent survival (P = .0005), confirming the scheme's predictive validity. In conclusion, a global assessment scheme has been devised that provides a simple, reproducible, valid, and predictive method of assessing nutritional status in patients with cirrhosis. (HEPATOLOGY 2006;44:823–835.)