Is NRS-2002 a reliable tool in the nutritional assessment of cirrhosis: A comparative study

Gamze Geyik¹, Abdurrahman Sahin², Yildiz Pekcioglu³, Nalan Okuroglu¹, Levent Doganay², Kamil Ozdil²

¹Department of Internal Medicine1, Department of Gastroenterology - ²Department of Nutrition and Dietetics3, Istanbul Umraniye Education and Research Hospital, Istanbul, Turkey

Introduction: Nutritional assessment of cirrhotic patients is a neglected issue. This study compared cirrhotic and non-cirrhotic subjects in terms of nutritional assessment tools and investigated the relationship between nutritional risk screening (NRS)-2002 and subjective global assessment (SGA) with other nutritional assessment parameters.

Materials and methods: Fifty-seven cirrhotic patients (age 59±13 years, 63% male) and 58 control subjects (age 63±11, 52% male) were recruited. Anthropometry, bioelectrical impedance analysis and hand grip strength measurements were recorded. Nutritional status was evaluated by NRS-2002 and SGA. 

Results: While none of the controls had malnutrition, prevalences of malnutrition were 37% by NRS-2002 and 74% by SGA among cirrhotic patients. Dry body mass index (BMI) (28.0±6.2 kg/m2 vs. 30.1±5.1 kg/m2, p=0.04), mid-arm circumference (MAC) (29.1±5.1 cm vs. 30.8±3.0 cm, p=0.03) and triceps skinfold thickness (TST) (19.9±9.6 mm vs. 25.3±8.1 mm, p=0.003) were lower and total body water (TBW) was higher (51.1±8.9% vs. 47.5±6.9%, p= 0.018) in cirrhotic group compared to controls. Malnutrition by NRS-2002 was negatively correlated with dry BMI (r=-0.416 ,p=0.001), MAC (r=-0.515 ,p<0.001) and TST (r=-0.528 ,p<0.001) and positively correlated with TBW (r=0.273, p=0.04). Malnutrition by SGA was correlated only with TST (r=-0.286, p=0.031). The AUROC curves of dry BMI, MAC and TST were 0.75, 0.81 and 0.82 to discriminate the presence or absence of malnutrition by NRS-2002.

Conclusion: Since it is correlated with other nutritional assessment tools, NRS-2002 may be used in the assessment of cirrhotic subjects.