Utility of Standard Nutritional Parameters in Detecting Body Cell Mass Depletion in Patients With End-Stage Liver Disease

• Published in: Liver transplantation Vol. 6; no. 5; pp. 575 - 581
• Main Authors: Figueiredo, Fatima A., Dickson, E.Rolland, Pasha, Tousif M., Porayko, Michael K., Therneau, Terry M., Malinchoc, Michael, DiCecco, Sara R., Francisco-Ziller, Nickie M., Kasparova, Pavla, Charlton, Michael R.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-09-2000; W.B. Saunders
• Subjects: Absorptiometry, Photon; Anthropometry; Cell Size; Hand Strength; Humans; Liver Failure - diagnostic imaging; Liver Failure - metabolism; Liver Failure - pathology; Liver Failure - physiopathology; Multivariate Analysis; Nutrition Assessment; Nutritional Status; Prospective Studies
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1053/jlts.2000.9736

Protein-calorie malnutrition, best measured by body cell mass (BCM) depletion, has been associated with adverse outcomes in patients with end-stage liver disease. We prospectively measured BCM and multiple standard nutritional parameters in patients with end-stage liver disease to determine which, if any, of the traditionally measured nutritional parameters correlate with BCM. A detailed nutritional assessment, including BCM analysis, subjective global assessment, anthropometry, handgrip dynamometry, laboratory tests, and body composition measured by dual-energy X-ray absorptiometry was performed in 69 sequential patients awaiting liver transplantation. The frequency of abnormalities of specific parameters of nutritional status varied between 19% and 99%. Most of the commonly measured parameters of nutritional status correlated poorly with BCM. Patients with depleted BCM (lowest quartile for sex) had midarm circumference (P < .01), arm-muscle circumference (P < .001), handgrip strength (P < .001), blood urea nitrogen (P < .01), and creatinine (P < .01) values less than those for patients with greater BCM (highest 3 quartiles for sex). In multivariate analysis, arm-muscle circumference and handgrip strength were the best predictors of BCM. The combined criteria of handgrip strength less than 30 kg and arm-muscle circumference less than 23 cm have a sensitivity of 94% and a negative predictive value of 97% in identifying patients with depleted BCM. Although abnormalities of nutritional parameters are highly prevalent among patients with end-stage liver disease, most parameters of nutritional status do not correlate with BCM. In patients with end-stage liver disease, arm-muscle circumference and handgrip strength are the most sensitive markers of BCM depletion. (Liver Transpl 2000;6:575-581.)