Subjective global nutritional assessment as a nutritional tool in childhood chronic liver disease

Objective of the study was to assess subjective global nutritional assessment (SGNA) in children with chronic liver diseases (CLD). Children aged 3 months to 18 years with CLD were prospectively enrolled (January 2016 to October 2018). SGNA was performed as per validated pro forma for children. Nutritional categories were categorised into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished). Agreement between SGNA and anthropometric measures, prediction of morbidity and death or liver transplantation (LT) at 1-year post-enrolment by SGNA and inter-observer reliability of SGNA were assessed. Ninety-two subjects were enrolled, median age 23 center dot 5 (3-216) months. SGNA classified 47 patients (51 center dot 1 %) in group A, 26 (28 center dot 3 %) in group B and 19 (20 center dot 6 %) in group C. Kendall coefficients disclosed significant association of SGNA with all anthropometric measurements, greatest with weight for age (r = -0 center dot 637), height for age (r = -0 center dot 581) and mid-arm fat area (r = -0 center dot 449). At 12 months follow-up, twenty children died and four received LT. A significantly higher number of children with malnutrition (groups B and C) had poor outcome (OR 6 center dot 74 (95 % CI 2 center dot 21, 20 center dot 55), P = 0 center dot 001), increased risk of hospital readmission (OR 12 center dot 2 (95 % CI 4 center dot 60, 35 center dot 88), P = 0 center dot 001), higher rate of infectious complications (OR 22 center dot 68 (95 % CI 7 center dot 29, 70 center dot 53), P < 0 center dot 0001) and lower median survival with native liver (Log Rank < 0 center dot 001) as compared with group A. Inter-observer agreement in assessment of SGNA was good (90 center dot 2 %). SGNA, in contrast to anthropometric measures, is a better nutritional assessment tool. It is reliable, comprehensive and predicts poor outcome in childhood CLD.

Automated summary

The study aimed to assess subjective global nutritional assessment (SGNA) in children with chronic liver diseases (CLD). The results indicated that SGNA is a more reliable nutritional assessment tool compared to anthropometric measures, and it can predict poor outcomes in children with chronic liver disease.