US EPA

6579139 

Journal Article 

Abstract 

Exploring relationships between handgrip strength, mid-upper arm circumference, subjective global assessment and clinical outcomes in cirrhosis: A prospective cohort study 

Wishart, ED; Taylor, L; Lam, L; Marr, KJ; Fitzgerald, Q; Chiu, E; Stapleton, M; Tandon, P; Raman, M 

2019 

Yes 

Gastroenterology
ISSN: 0016-5085
EISSN: 1528-0012 

156 

6 Suppl. 1 

S474 

English 

10.1016/S0016-5085(19)38045-X 

WOS:000467106001618 

Background: Malnutrition is highly prevalent in cirrhosis and is an independent predictor
of negative clinical outcomes. Nutrition assessment (NA) is often not performed in patients
with cirrhosis and this may result from a lack of clarity surrounding valid bedside tools.
Aims The study aimed to identify relationships between baseline NA measurements and
adverse clinical outcomes in patients with cirrhosis. Methods: A prospective cohort study
was conducted between 2014-2018 at the University of Calgary. Ambulatory pre-liver
transplant patients with cirrhosis were co-assessed by a registered dietitian and a physician
nutrition specialist in a specialized malnutrition clinic, and completed measurements of
subjective global assessment (SGA), handgrip strength (HGS) and mid upper arm circumference (MUAC). Clinical outcomes including frequency of hospitalizations, length of stay,
infections, and hepatic encephalopathy were collected in the 6-12 months following nutrition
assessment. Mortality was examined from baseline to 3 years. T-tests and chi-squared analyses
were used to examine relationships between NA tools and clinical outcomes. Results: This
study included 66 patients, mean age 54 (±10.1) years, and 56% (n=37) male. Baseline
demographic characteristics are summarized in Table 1. Malnourished SGA status (9.5%
(n=2) SGA A vs. 90.5% (n=19) who were SGA B and C) and lower HGS category (23.8%
(n=5) who had a higher HGS vs. 76.2% (n=16) with a lower HGS) both had significantly
higher proportions of mortality (SGA: (x2
(2)=6.6, p<0.05); HGS: (x2
(1)= 15.9, p<0.001),
while MUAC was not significantly related to mortality (x2
(1) =1.9, p=0.17). The probability
of a mortality event was 3.2 times more likely when they were in a lower HGS category.
Higher MELD category was also associated with increased mortality (x2
(1) =4.1, p=0.04). SGA,
HGS and MUAC were not significantly related to the other clinical outcomes. Conclusions
In our study, malnutrition diagnosed by both SGA and HGS is predictive of mortality in
cirrhosis. Incorporating SGA and HGS into routine clinical practice for pre-liver transplant
patients with cirrhosis to identify patients who may benefit form nutrition therapy should
be considered. 

Digestive Disease Week (DDW) 

San Diego, CA 

May 18-21, 2019