Nutritional assessment techniques in patients with liver cirrhosis
| Assessment technique | Considerations |
|---|---|
| The Malnutrition Universal Screening Tool | Although not designed for cirrhotic patients can make allowances for ascites and oedema if the problem is recognised but this may not happen in practice37 |
| Subjective Global Assessment and the Prognostic Nutritional Index | Both have been used to assess nutritional status but tend to underestimate prevalence38,–,40 |
| The Royal Free Hospital Global Assessment | This is reproducible and valid against measures of body composition. It can also help predict survival41 |
| Mid upper arm muscle circumference (MAMC) | This assesses lean tissue status and is little affected by salt and water retention. It is derived from mid upper arm circumference (MAC) and triceps skinfold thickness (TSF) as follows: |
| MAMC = MAC − (3.14 × TSF) | |
| Hand grip strength | Coupled with measures of arm circumference, has been shown to have a sensitivity of 94% and negative predictive value of 97% in identifying depleted body cell mass in cirrhotics.38 Grip strength is also the best modality for predicting major complications at 1 year.39 Nevertheless, it is reliant on patient volition and rarely used in clinical practice |
| Bioelectrical impedance analysis | Recommended as a reliable bedside tool by the European Society for Clinical Nutrition and Metabolism but has considerable limitations in liver disease patients with their abnormal salt and water distribution.42 43 |