title: A practical approach to nutritional screening and assessment in cirrhosis.
abstract: Malnutrition is one of the most common complications of cirrhosis, associated with an increased risk of morbidity and mortality. As a potentially modifiable condition, it is of particular importance to identify malnourished patients so that nutritional therapy can be instituted. Nutrition screening and assessment are infrequently performed in patients with cirrhosis. The reasons for this are multifactorial, including the absence of a validated "rapid" screening tool, multiple definitions of what constitutes malnutrition, and challenges with interpreting body composition and laboratory results in the setting of volume overload and liver dysfunction. This article summarizes the clinically relevant evidence and presents key issues, tools, and clinical options that are applicable to patients with cirrhosis. The definition, etiology, and clinically relevant outcomes associated with malnutrition are reviewed. Rapid nutritional screening is differentiated from more detailed nutritional assessment. Nutritional assessment in special populations, including women and the obese, and the role of inflammation are discussed. Multicenter studies using a common nutritional screening/assessment strategy are the next steps to fast-track adoption and implementation of nutrition-related evaluations into routine clinical practice. (Hepatology 2017;65:1044-1057).
authors.affiliation: Cirrhosis Care Clinic and CEGIIR, University of Alberta, Edmonton, AB, Canada.
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Maitreyi
authors.initials: M
authors.lastname: Raman
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Mourtzakis
authors.affiliation: Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
mesh_terms: D001823:Body Composition; D004032:Diet; D002149:Energy Intake; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000178:diet therapy* / Q000209:etiology; D008403:Mass Screening / Q000379:methods*; D018482:Muscle, Skeletal / Q000502:physiology; D015596:Nutrition Assessment; D009752:Nutritional Status; D009929:Organ Size; D011379:Prognosis; D018570:Risk Assessment