title: Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients.
abstract: OBJECTIVE
  This study compared three methods of assessing malnutrition in cirrhotics and correlated nutritional status with clinical outcome.
  
  
  METHODS
  This cross-sectional study evaluated nutritional status by subjective global assessment (SGA), prognostic nutritional index (PNI), and handgrip strength (HG) in outpatients with cirrhosis (n = 50) and two control groups with hypertension (n = 46) and functional gastrointestinal disorders (n = 49). Patients with cirrhosis were followed for 1 y to verify the incidence of major complications, the need for transplantation, and death.
  
  
  RESULTS
  Among patients with cirrhosis, 88% were Child-Pugh A and only 12% were Child-Pugh B. Among these, prevalences of malnutrition were 28% by SGA, 18.7% by PNI, and 63% by HG (P < 0.05). HG, but not SGA or PNI, predicted a poorer clinical outcome in patients with cirrhosis because major complications such as uncontrolled ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome developed in 65.5% of malnourished patients versus 11.8% of well-nourished ones (P < 0.05). No significant differences by any method were seen between the two groups regarding liver transplantation or death.
  
  
  CONCLUSIONS
  There was a high prevalence of malnutrition in cirrhotic outpatients, especially when assessed by HG, which was superior to SGA and PNI in this study. HG was the only technique that predicted a significant incidence of major complications in 1 y in undernourished cirrhotic patients.
authors.affiliation: Hospital de Clinicas de Porto Alegre, Gastroenterology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. mras@terra.com.br
authors.forename: Mário Reis
authors.initials: MR
authors.lastname: Alvares-da-Silva
authors.forename: Themis
authors.initials: T
authors.lastname: Reverbel da Silveira
mesh_terms: D000328:Adult; D001201:Ascites / Q000150:complications / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000401:mortality; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome