Patient-Generated Subjective Global Assessment and Computed Tomography in the assessment of malnutrition and sarcopenia in patients with cirrhosis: Is there any association?

Abstract

Background & aims: Chronic liver disease often occurs with malnutrition and its primary consequences, loss of strength and muscle mass (sarcopenia) have an impact on worsening quality of life and increased mortality. The objective of this study was to investigate the usefulness of computed tomography (CT) and Patient-Generated Subjective Global Assessment (PG-SGA) in the assessment of sarcopenia and malnutrition and to explore the association between these two conditions in these patients.

Methods: A cross-sectional study was conducted between July 2016 and July 2017 in outpatients with cirrhosis. In the routine consultation, nutritional status and handgrip strength (HGS) were assessed by PG-SGA and dynamometry, respectively. An abdominal CT was performed for hepatocarcinoma screening and muscle mass was assessed at the third lumbar vertebra. Sarcopenia was defined as the combination of low muscle mass (myopenia) and low HGS (dynapenia).

Results: A total of 118 patients with cirrhosis were evaluated; the prevalence of dynapenia, myopenia, sarcopenia, and malnutrition were 50%, 33%, 17% and 35% respectively. Women were more malnourished (55% vs 25% in men, p = 0.07), and men had more myopenia (16.7% vs. 42.1% in men, p < 0.05). Patients with body composition and function abnormalities had higher PG-SGA scores, confirming its usefulness as a nutritional risk assessment tool in these patients.

Conclusions: Malnutrition and sarcopenia were highly prevalent in patients with hepatic cirrhosis and should be assessed routinely in clinical practice. PG-SGA can be considered a good marker of sarcopenia that can be used in clinical practice.

Keywords: Handgrip strength; Liver cirrhosis; Malnutrition; Nutrition assessment; Patient-Generated Subjective Global Assessment; Sarcopenia.