Avaliação nutricional do paciente cirrótico: comparação entre diversos métodos Nutritional evaluation of cirrhotic patients: comparison between several methods

Aims: To compare the differents methods of nutritional assessment for classification of malnutrition in cirrhotic patients. Methods: Cirrhotic patients were studied in the Complexo Hospitalar da Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil. The methods used for nutritional assessment were anthropometry, body mass index, triceps skinfold thickness, mid-upper arm circumference and mid-arm muscle circumference, subjective global assessment, hand grip strength dynamometer measurement and adductor pollicis muscle thickness. Results: We studied 119 adult outpatients with an average age of 56.3±12.0 years, of whom 67 (56.3%) were men. The most frequent etiologies of cirrhosis were: hepatitis C (42%) and alcohol (25.2%). According the severity of the disease classified by Child-Pugh score, 72 patients (60.5%) were A, 43 (36.1%) were B, and 4 (3.4%) were C. The method of nutritional assessment that identified more malnourished patients was the hand-grip strength dynamometer measurement (58.8%), followed by triceps skinfold thickness (34.5%), mid-upper arm circumference (31.1%), mid-arm muscle circumference (29.4%), adductor pollicis muscle thickness (14.3 %), subjective global assessment (6.7%) and body mass index (5.9%). No method detected the association of malnutrition with the severity of disease assessed by Child-Pugh score. Conclusions: Nutritional assessment in cirrhotic patients had a wide variation between the different methods, and the hand grip strength dynamometer measurement was the method that best identified malnutrition. A method of nutritional assessment considered the gold standard for these patients still does not exist. We suggest the combined use of methods of nutritional assessment associated with functional assessment for patients with cirrhosis.