• Mário Reis Alvares-da-Silva and Themis Reverbel da Silveira.
• Hospital de Clinicas de Porto Alegre, Gastroenterology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. mras@terra.com.br
• Nutrition. 2005 Feb 1; 21 (2): 113-7.

ObjectiveThis study compared three methods of assessing malnutrition in cirrhotics and correlated nutritional status with clinical outcome.MethodsThis cross-sectional study evaluated nutritional status by subjective global assessment (SGA), prognostic nutritional index (PNI), and handgrip strength (HG) in outpatients with cirrhosis (n = 50) and two control groups with hypertension (n = 46) and functional gastrointestinal disorders (n = 49). Patients with cirrhosis were followed for 1 y to verify the incidence of major complications, the need for transplantation, and death.ResultsAmong patients with cirrhosis, 88% were Child-Pugh A and only 12% were Child-Pugh B. Among these, prevalences of malnutrition were 28% by SGA, 18.7% by PNI, and 63% by HG (P < 0.05). HG, but not SGA or PNI, predicted a poorer clinical outcome in patients with cirrhosis because major complications such as uncontrolled ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome developed in 65.5% of malnourished patients versus 11.8% of well-nourished ones (P < 0.05). No significant differences by any method were seen between the two groups regarding liver transplantation or death.ConclusionsThere was a high prevalence of malnutrition in cirrhotic outpatients, especially when assessed by HG, which was superior to SGA and PNI in this study. HG was the only technique that predicted a significant incidence of major complications in 1 y in undernourished cirrhotic patients.

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