Original article Nutritional status and the performance of multiple bedside tools for nutrition assessment among patients waiting for liver transplantation: A Canadian experience Kaleb J. Marr a, 1 , Abdel-Aziz Shaheen a, 1 , Louisa Lam b , Melanie Stapleton c , Kelly Burak c , Maitreyi Raman c, * a University of Calgary, Department of Medicine, Canada b Alberta Health Services, Canada c University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, Canada article info Article history: Received 18 January 2016 Accepted 21 October 2016 Keywords: Malnutrition Cirrhosis summary Background: Malnutrition is an important predictor of morbidity and mortality among cirrhotic patients. Our objectives were to assess protein-calorie malnutrition (PCM) in cirrhotic pre-liver transplant patients and to study the correlation between subjective global assessment (SGA) and other objective measures of malnutrition. Methods: We recruited pre-liver transplant adult patients at our center between October 2012 and Oct 2015. Nutrition status was assessed via SGA. PCM was assessed by comparing recommended to actual protein and calorie intake. SGA was correlated with body mass index (BMI), dry BMI, handgrip strength by calibrated dynometer (HGS), and mid-arm circumference (MAC). We used non-parametric statistical methods in our analysis. Results: Seventy patients were included in this study. Majority were males (n ¼ 46, 66%) with a median age of 58 years (IQR: 50-61). Moderate to severe malnutrition was prevalent in our cohort (SGA-A: n ¼ 15 (21.4%), SGA-B: n ¼ 30 (42.9%) and SGA-C: n ¼ 25 (35.7%). There was a significant difference in the recommended calories consumed between SGA groups (A 98.5% vs. C 79.2%, P ¼ 0.03). A similar trend was observed for the recommended protein consumed (A 85.4%, C 62.5%; P ¼ 0.09). SGA correlated with BMI (A ¼ 26.4, C ¼ 22.4; P<0.01), Dry BMI (A ¼ 25.9, C ¼ 20.4; P<0.01), HGS (A ¼ 67.0, C ¼ 47.0 PSI; P ¼ 0.03), and MAC (A ¼ 29.5 cm, C ¼ 22.0 cm; P<0.01). HGS and MAC were strongly correlated (Spearman correlation 0.49, P<0.01). Conclusions: Cirrhotic patients have significant protein-calorie malnutrition. Multiple malnutrition tools including BMI, dry BMI, HGS and MAC were precisely able to assess malnutrition. © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Background More than half of patients with cirrhosis are malnourished [1,2]. Anorexia, malabsorption, and hypermetabolism due to hormonal changes are predisposing factors for malnutrition in cirrhosis [3]. Moreover, alteration of utilization of nutrients and metabolism contribute significantly to malnutrition. Malnutrition is associated with significant morbidity and mor- tality in decompensated cirrhosis. Malnourished cirrhotic patients have higher mortality rates compared to their peers [4,5]. Furthermore, malnutrition has been found to be an independent predictor of mortality for patients awaiting liver transplantation [6]. In addition, malnourished patients have more post-transplant infections, increased length of stay in the ICU, and hospitalization duration [7]. Nutrition assessment in patients with liver disease continues to be challenging due to the lack of rigorously validated objective tools that can be easily applied in the clinical setting. Although a true * Corresponding author. University of Calgary, Department of Medicine, Division of Gastroenterology and Hepatology, 6D26 TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. E-mail address: mkothand@ucalgary.ca (M. Raman). 1 Please note that Dr. Kaleb Marr and Dr. Abdel-Aziz Shaheen equally share in first authorship. Contents lists available at ScienceDirect Clinical Nutrition ESPEN journal homepage: http://www.clinicalnutritionespen.com http://dx.doi.org/10.1016/j.clnesp.2016.10.003 2405-4577/© 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Clinical Nutrition ESPEN xxx (2016) 1e7 Please cite this article in press as: Marr KJ, et al., Nutritional status and the performance of multiple bedside tools for nutrition assessment among patients waiting for liver transplantation: A Canadian experience, Clinical Nutrition ESPEN (2016), http://dx.doi.org/10.1016/ j.clnesp.2016.10.003