Subjective Global Assessment And Functional Methods For The Nutritional Diagnosis Of Patients With Chronic Liver Disease

Introduction: Comorbidities emerge late in individuals with liver damage and malnutrition is found in 10 to 100% of such patients.Objective: The aim of the present study was to determine the level of agreement between a subjective global assessment and functional methods for the nutritional evaluation of patients with chronic liver disease.Methods: Across-sectional study was conducted at the Oswaldo Cruz University Hospital in the city of Recife, Brazil, between April and September 2015 involving hospitalized male and female adults and elderly individuals with chronic liver disease. The subjective global assessment was compared to functional methods (grip strength and thumb adductor thickness) using Fisher's exact test, ANOVA and Tukey's test.Results: One hundred one individuals were analyzed (51.5% female; mean age: 59.2 +/- 11 years; 52.5% elderly). The most common etiology was schistosomiasis (47.5%). Mean grip strength and thumb adductor thickness were 18.54 +/- 9.31 kg/F and 15.66 +/- 4.08 mm, respectively, which were lower than reference values for healthy individuals and patients with liver disease in outpatient follow up. Gastrointestinal disorders were found in 92% and ascites was found in 85%. The prevalence of malnutrition was 95%, 89.196 and 13.9% based on the subjective global assessment, grip strength and thumb adductor thickness, respectively. Low levels of agreement were found among the three methods.Conclusion: Divergences were found among the methods employed for a nutritional evaluation. The detection of malnutrition was higher when using the subjective global assessment rather than grip strength and thumb adductor thickness. Thus, the subjective global assessment can be used in the hospital setting for the evaluation of nutritional status in patients with chronic liver disease.