title: Validation of body mass index for the diagnosis of malnutrition in patients with liver cirrhosis.
abstract: OBJECTIVE
  Simple clinical tools are needed to detect malnutrition in cirrhotic patients. We have validated optimal body mass index (BMI) cut-offs for the diagnosis of malnutrition in accordance with the importance of ascites.
  
  
  METHODS
  BMI, mid-arm muscle circumference (MAMC) and triceps skinfold thickness (TST) were measured before paracentesis in study (SP) and validation (VP) populations of 875 and 294 cirrhotic patients, respectively with no ascite (NA), mild (MA), tense ascites (TA) (NA/MA/TA: SP: 327, 270, 278; VP: 111, 69, 114). Preserved nutritional status (SP: 259; VP: 93), malnutrition including severe and moderate malnutrition (SP: 251 and 365; VP: 92 and 109) were defined from MAMC and TST measurements.
  
  
  RESULTS
  Optimal BMI cut-off values were 22, 23 and 25 kg/m2 in NA, MA and TA patients, respectively. In the whole SP and VP, sensitivities of these cut-offs were 86.2% and 89.1%, respectively; the corresponding negative predictive values (NPV) for the diagnosis of severe malnutrition were 92.3% and 93.2%; specificities and positive predictive values (PPV) were 87.7% and 89.9%, 92.7% and 93.6%, respectively for the diagnosis of malnutrition. In the entire VP, peripheral oedema did not change sensitivity and NPV of BMI cut-offs for the diagnosis of severe malnutrition and tended to increase specificity and PPV for the diagnosis of malnutrition. 96.7% of the malnourished TA patients in the VP before paracentesis were correctly identified after removal of ascites.
  
  
  CONCLUSIONS
  BMI is a reliable parameter to detect malnutrition in cirrhotic patients with the above mentioned cut-offs. Peripheral oedema and removal of ascites do not affect its diagnostic performance.
authors.affiliation: Service de Rééducation Digestive, Hôpital Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil. bernard.campillo@ach.ap-hop-paris.fr
authors.forename: Bernard
authors.initials: B
authors.lastname: Campillo
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Richardet
authors.forename: Phuong-Nhi
authors.initials: PN
authors.lastname: Bories
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001201:Ascites / Q000209:etiology / Q000628:therapy; D015992:Body Mass Index; D003627:Data Interpretation, Statistical; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D019152:Paracentesis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012885:Skinfold Thickness; D013997:Time Factors