Association Between Malnutrition, Nutritional Assessment Tools, Disease-Severity and Health-Related Quality of Life in Cirrhosis
Bibliographic record
Abstract
Introduction: In cirrhosis patients, identifying significant associations between malnutrition, diseaseseverity and health-related quality of life (HRQoL) may help identify important targets for clinical assessment. Methods: The primary aim of this prospective study from 2014-2017 was to explore the influence of (1) nourishment state measured by subjective global assessment (SGA [Figure 1]), mid-arm circumference (MAC) and hand-grip strength (HGS), and; (2) disease-severity using Model of End-Stage Liver Disease score (MELD-Na) on HRQoL. HRQoL was measured with the validated Short-Form (SF) 36 subscales: vitality (V), physical function (PF), bodily pain (BP), general health (GH), physical role (PR), emotional role (ER), social function (SF) and mental health (MH). After identifying correlations ≥ 2, variables were entered into regression analyses controlled for age and gender. If a curvilinear relationship was present the Kruskal-Wallis test was used.823_A Figure 1. Subjective Global Assessment criteria to assess nutritional statusResults: This study included 81 patients with SGA breakdown outlined in Figure 2. After evaluation of correlation matrices, MELD-Na had correlation ≥ 2 with GH; MAC did not have any correlations ≥ 2 with any HRQoL subscale; HGS had correlations ≥ 2 with all subscales excluding SF, and; SGA had correlations ≥ 2 with all subscales. For SGA, PR demonstrated a significant relationship between SGA levels A and B compared to C (chi-squared=0.63, p=0.04); PF worsened as SGA did (Adjusted R2=19%; β=-0.24, p=0.03); V and SF worsened as SGA did (Adjusted R2=8% for both; β=-0.28, p=0.02 and β=-0.32, p<0.01), and; SGA had a borderline nonsignificant relationship with GH (β=-0.23, p=0.08). HGS was only significantly associated with PF (β=0.36, p<0.01). MELD-Na and MAC did not demonstrate any significant relationships with HRQoL. Neither BP nor MH demonstrated any significant relationships with assessment tools.823_B Figure 2. Breakdown of SGA of 81 patientsConclusion: Malnutrition was present in 70% of the study patients and was significantly related to decreased HRQoL for 4 subscales including physical role, physical function, vitality, and social function. Malnutrition measured by SGA was the only significant relationship with HRQoL in most analyses; HGS was significantly related to physical function only. This study identifies SGA as an important clinical tool to measure in cirrhosis patients and moderate to severe malnutrition (SGA B or C) is associated with reduced HRQoL. Future studies should explore if improvements in SGA relate to improved HRQoL.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".