Sensibility of anthropometric-laboratory markers of protein-energy malnutrition in cirrhotic patients

The prevalence and severity of protein-energy malnutrition (PEM) were investigated through the anthropometric (body mass index, triceps and subescapular skinfolds and upper arm circumferences) and blood measures in 117 cirrhotic patients. The sensitivity and specificity of single or combined PEM markers were tested among Child A (n=18), Child B (n=42) and Child C (n=57) adults (51+/-13y). Were calculated as z score and considered deficient when z< or =-1.28SD according to local standards. The most deficient markers where albumin (93%), hemoglobin (90%), upper arm circumference (61%), triceps (55%) and subescapular (53%) skinfolds. By combining upper arm circumference with triceps or subescapular skinfolds, PEM were detected in 63% of patients varying from 39-44% (Child A) to 64-68% (Child B or C). Thus the pattern of PEM present in cirrhosis is predominantly in their protein compartment and worsened with the severity of hepatocellular insuficiency. Upper arm circumference can be used as sensitive markers of presence and severity of PEM in cirrhotic patients but showing low specificity for discriminate PEM among Child grades (B and C) of hepatocellular dysfunctions.