title: Nutritional status and the performance of multiple bedside tools for nutrition assessment among patients waiting for liver transplantation: A Canadian experience.
abstract: BACKGROUND
  Malnutrition is an important predictor of morbidity and mortality among cirrhotic patients. Our objectives were to assess protein-calorie malnutrition (PCM) in cirrhotic pre-liver transplant patients and to study the correlation between subjective global assessment (SGA) and other objective measures of malnutrition.
  
  
  METHODS
  We recruited pre-liver transplant adult patients at our center between October 2012 and Oct 2015. Nutrition status was assessed via SGA. PCM was assessed by comparing recommended to actual protein and calorie intake. SGA was correlated with body mass index (BMI), dry BMI, handgrip strength by calibrated dynometer (HGS), and mid-arm circumference (MAC). We used non-parametric statistical methods in our analysis.
  
  
  RESULTS
  Seventy patients were included in this study. Majority were males (n = 46, 66%) with a median age of 58 years (IQR: 50-61). Moderate to severe malnutrition was prevalent in our cohort (SGA-A: n = 15 (21.4%), SGA-B: n = 30 (42.9%) and SGA-C: n = 25 (35.7%). There was a significant difference in the recommended calories consumed between SGA groups (A 98.5% vs. C 79.2%, P = 0.03). A similar trend was observed for the recommended protein consumed (A 85.4%, C 62.5%; P = 0.09). SGA correlated with BMI (A = 26.4, C = 22.4; P<0.01), Dry BMI (A = 25.9, C = 20.4; P<0.01), HGS (A = 67.0, C = 47.0 PSI; P = 0.03), and MAC (A = 29.5 cm, C = 22.0 cm; P<0.01). HGS and MAC were strongly correlated (Spearman correlation 0.49, P<0.01).
  
  
  CONCLUSIONS
  Cirrhotic patients have significant protein-calorie malnutrition. Multiple malnutrition tools including BMI, dry BMI, HGS and MAC were precisely able to assess malnutrition.
authors.affiliation: University of Calgary, Department of Medicine, Canada.
authors.forename: Kaleb J
authors.initials: KJ
authors.lastname: Marr
authors.affiliation: University of Calgary, Department of Medicine, Canada.
authors.forename: Abdel-Aziz
authors.initials: AA
authors.lastname: Shaheen
authors.affiliation: Alberta Health Services, Canada.
authors.forename: Louisa
authors.initials: L
authors.lastname: Lam
authors.affiliation: University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Stapleton
authors.affiliation: University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: Burak
authors.affiliation: University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Canada. Electronic address: mkothand@ucalgary.ca.
authors.forename: Maitreyi
authors.initials: M
authors.lastname: Raman
mesh_terms: D000328:Adult; D000416:Alberta; D000886:Anthropometry; D015992:Body Mass Index; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D018737:Hand Strength; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D015596:Nutrition Assessment; D009752:Nutritional Status; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D064167:Recommended Dietary Allowances; D012307:Risk Factors; D014850:Waiting Lists
chemical_list: D004044:Dietary Proteins
keywords: Cirrhosis; Malnutrition