Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end‐stage liver disease

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.

[1]  M. Elia,et al.  Impact of tuberculosis on the body composition of HIV-infected men in Brazil. , 1999, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[2]  H. Plotkin,et al.  Gender-related differences in the relationship between densitometric values of whole-body bone mineral content and lean body mass in humans between 2 and 87 years of age. , 1998, Bone.

[3]  S. Heymsfield,et al.  The quality of the body cell mass--1996. Are we ready to measure it? , 1998, Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine.

[4]  J. Downs,et al.  Nutritional assessment in the critically ill. , 1998, Current opinion in clinical nutrition and metabolic care.

[5]  B. Lindholm,et al.  Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. , 1998, Kidney international.

[6]  O. Selberg,et al.  Identification of high‐ and low‐risk patients before liver transplantation: A prospective cohort study of nutritional and metabolic parameters in 150 patients , 1997, Hepatology.

[7]  National-Isometric-Muscle-Strength-Database-Consor.  Muscular weakness assessment: use of normal isometric strength data. The National Isometric Muscle Strength (NIMS) Database Consortium. , 1996, Archives of physical medicine and rehabilitation.

[8]  Thomas E. Moritz,et al.  Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment , 1995 .

[9]  U. Süttmann,et al.  Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. , 1995, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[10]  D. Crawford,et al.  Body composition in nonalcoholic cirrhosis: the effect of disease etiology and severity on nutritional compartments. , 1994, Gastroenterology.

[11]  J. Hasse,et al.  Subjective global assessment: alternative nutrition-assessment technique for liver-transplant candidates. , 1993, Nutrition.

[12]  R. Cuneo,et al.  Pathogenesis and assessment of malnutrition in liver disease , 1993, Journal of gastroenterology and hepatology.

[13]  F. Horber,et al.  Impact of hydration status on body composition as measured by dual energy X-ray absorptiometry in normal volunteers and patients on haemodialysis. , 1992, The British journal of radiology.

[14]  H. Lautz,et al.  Energy expenditure and substrate oxidation in patients with cirrhosis: The impact of cause, clinical staging and nutritional state , 1992, Hepatology.

[15]  G. Hill.  Jonathan E. Rhoads Lecture. Body composition research: implications for the practice of clinical nutrition. , 1992, JPEN. Journal of parenteral and enteral nutrition.

[16]  S. Kalhan,et al.  Measurements of total body and extracellular water in cirrhotic patients with and without ascites , 1991, Hepatology.

[17]  Marvin E. Miller,et al.  Bromide space determination using anion-exchange chromatography for measurement of bromide. , 1989, The American journal of clinical nutrition.

[18]  J. Hanley,et al.  Predicting Mortality Based on Body Composition Analysis , 1989, Annals of surgery.

[19]  H C Lukaski,et al.  Methods for the assessment of human body composition: traditional and new. , 1987, The American journal of clinical nutrition.

[20]  K. Jeejeebhoy,et al.  Muscle function and nutrition. , 1986, Gut.

[21]  G. Blackburn,et al.  Nutrition in patients undergoing orthotopic liver transplant. , 1985, JPEN. Journal of parenteral and enteral nutrition.

[22]  T. Starzl,et al.  Influence of Selected Patient Variables and Operative Blood Loss on Six-Month Survival Following Liver Transplantation , 1985, Seminars in liver disease.

[23]  C. Mendenhall,et al.  Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis. , 1984, The American journal of medicine.

[24]  R. N. Macsween,et al.  Assessment of nutritional status and in vivo immune responses in alcoholic liver disease. , 1983, The American journal of clinical nutrition.

[25]  S. Sherlock,et al.  Plasma amino-acid patterns in liver disease. , 1982, Gut.

[26]  A. Czaja,et al.  The nature and prognostic significance of serial amino acid determinations in severe chronic active liver disease. , 1981, Gastroenterology.

[27]  D. Schoeller,et al.  Total body water measurement in humans with 18O and 2H labeled water. , 1980, The American journal of clinical nutrition.

[28]  A M Klidjian,et al.  Relation of anthropometric and dynamometric variables to serious postoperative complications. , 1980, British medical journal.

[29]  Frisancho Ar,et al.  Triceps skin fold and upper arm muscle size norms for assessment of nutritional status , 1974 .

[30]  K. Jeejeebhoy.  Nutritional assessment : General nutritional therapeutic issues , 1998 .

[31]  Thomas E. Moritz,et al.  Protein energy malnutrition in severe alcoholic hepatitis: diagnosis and response to treatment. The VA Cooperative Study Group #275. , 1995, JPEN. Journal of parenteral and enteral nutrition.

[32]  J. Harrison,et al.  Nutritional assessment. , 1994, Blood purification.

[33]  M D Jensen,et al.  Research techniques for body composition assessment. , 1992, Journal of the American Dietetic Association.

[34]  R. Wiesner,et al.  Assessment of nutritional status of patients with end-stage liver disease undergoing liver transplantation. , 1989, Mayo Clinic proceedings.

[35]  G. Spurr,et al.  Body composition in chronic undernutrition. , 1978, The American journal of clinical nutrition.

[36]  A. R. Frisancho,et al.  Triceps skin fold and upper arm muscle size norms for assessment of nutrition status. , 1974, The American journal of clinical nutrition.