Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 21; no. 2; pp. 113 - 117
• Main Authors: Álvares-da-Silva, M.ário Reis, Reverbel da Silveira, Themis
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2005; Elsevier; Elsevier Limited
• Subjects: Adult; Ascites - complications; Ascites - mortality; Biological and medical sciences; Cirrhosis; Clinical outcome; Cross-Sectional Studies; disease diagnosis; dynamometers; Dynamometry; Family medical history; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastrointestinal Diseases - complications; Gastrointestinal Diseases - mortality; Hand Strength - physiology; Handgrip strength; hands; Hepatitis; Humans; Hypertension; Hypertension - complications; Hypertension - mortality; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver diseases; liver function; Liver Transplantation; Male; Malnutrition; Medical sciences; Metabolic diseases; Methods; Middle Aged; Mortality; Nutrition Assessment; Nutritional assessment; Nutritional Status; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); patients; Prevalence; Prognosis; Prospective Studies; Protein-Energy Malnutrition - complications; Protein-Energy Malnutrition - diagnosis; Protein-Energy Malnutrition - epidemiology; Protein-Energy Malnutrition - mortality; Sensitivity and Specificity; Severity of Illness Index; strength (mechanics); symptoms; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Cirrhosis; Nutritional assessment; Clinical outcome; Dynamometry; Handgrip strength; Human; Gripping; Prevalence; Self evaluation; Force; Nutrition disorder; Hepatic disease; Nutritional indicator; At home; Digestive diseases; Malnutrition; Nutritional status
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2004.02.002

This study compared three methods of assessing malnutrition in cirrhotics and correlated nutritional status with clinical outcome.
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.
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.
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.