Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease

Protein-calorie malnutrition, best measured by body cell mass (BCM) depleti on, has been associated with adverse outcomes in patients with end-stage li ver disease. We prospectively measured BCM and multiple standard nutritiona l parameters in patients with end-stage liver disease to determine which, i f any, of the traditionally measured nutritional parameters correlate with BCM. A detailed nutritional assessment, including BCM analysis, subjective global assessment, anthropometry, handgrip dynamometry, laboratory tests, a nd body composition measured by dual-energy X-ray absorptiometry was perfor med in 69 sequential patients awaiting liver transplantation. The frequency of abnormalities of specific parameters of nutritional status varied betwe en 19% and 99%. Most of the commonly measured parameters of nutritional sta tus correlated poorly with BCM. Patients with depleted BCM (lowest quartile for sex) had midarm circumference (P < .01), arm-muscle circumference (P < .001), handgrip strength (P < .001), blood urea nitrogen (P <.01), and cre atinine (P < .01) values less than those for patients with greater BCM (hig hest 3 quartiles for sex). In multivariate analysis, arm-muscle circumferen ce and handgrip strength were the best predictors of BCM. The combined crit eria of handgrip strength less than 30 kg and arm-muscle circumference less than 23 cm have a sensitivity of 94% and a negative predictive value of 97 % in identifying patients with depleted BCM. Although abnormalities of nutr itional parameters are highly prevalent among patients with end-stage liver disease, most parameters of nutritional status do not correlate with BCM. In patients with end-stage liver disease, arm-muscle circumference and hand grip strength are the most sensitive markers of BCM depletion.