Royal Free Hospital Nutrition Prioritizing Tools (RFH-NPT): Predictor of Malnutrition Risk among Chronic Liver Disease Patients
Article Sidebar
Published
31 January 2024
Keywords:
-
cirrhosis, liver disease, Nutrition Risk Screening 2002 (NRS 2002), nutrition screening, Royal Free Hospital Nutrition Prioritizing Tools (RFH NPT)
Abstract
This study is aimed to investigate the prevalence of malnutrition using Royal Free Hospital Nutrition Prioritizing Tools (RFH-NPT) and the correlation between malnutrition and RFH-NPT with clinical parameters. A total of 80 cirrhosis liver patients without liver cancer were enrolled in this prospective study. This study was conducted at Selayang hospital, which is the national tertiary referral centre for liver disease in Malaysia. We administered the nutrition screening of RFH-NPT to the patients within 24 hours after admission. The utilization of the RFH-NPT resulted in a higher incidence of nutritional risk, at 73%. The RFH-NPT revealed a higher proportion of Child Pugh C patients at risk for malnutrition (46/50 or 92%, p= 0.002) and had superior capability in identifying patients with intermediate and high risk for malnutrition (35/61 or 57.3%, p=0.012) within the subset of patients with Model for End- Stage Liver Disease (MELD) scores below 15. Hence, we propose that the utilization of the RFH-NPT enhances medical professional’s capacity for early-stage prediction of malnutrition risk in patients with cirrhosis predominantly attributed to hepatitis virus infection.
References
Amodio P, Bemeur C, Butterworth R, Cordoba J, Kato A, Montagnese S, Uribe M, Vilstrup H, Morgan MY. 2013. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International society for hepatic encephalopathy and nitrogen metabolism consensus. Hepatol 58(1):325–336. https://doi.org/10.1002/hep.26370
Borhofen SM, Gerner C, Lehmann J, Fimmers R, Görtzen J, Hey B, Geiser F, Strassburg CP, Trebicka J. 2016. The royal free hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 61(6): 1735–1743. https://doi.org/10.1007/s10620-015-4015-z
Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM. 2015. Diagnostic criteria for malnutrition-an ESPEN consensus statement. Clin Nutr 34(3):335–340. https://doi.org/10.1016/j.clnu.2015.03.001
Cheung K, Lee SS, Raman M. 2012. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol 10(2):117–125. https://doi.org/10.1016/j.cgh.2011.08.016
Georgiou A, Papatheodoridis GV, Alexopoulou A, Deutsch M, Vlachogiannakos I, Ioannidou P, Papageorgiou MV, Papadopoulos N, Tsibouris P, Prapa A et al. 2019. Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: The KIRRHOS study. Br J Nutr 122(12):1368–1376. https://doi.org/10.1017/S0007114519002277
Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J et al. 2013. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med 173(9):778–787. https://doi.org/10.1001/jamainternmed.2013.180
Jeejeebhoy KN, Keller H, Gramlich L, Allard JP, Laporte M, Duerksen DR, Payette H, Bernier P, Vesnaver E, Davidson B et al. 2015. Nutritional assessment: Comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission. Am J Clin 101(5):956–965. https://doi.org/10.3945/ajcn.114.098665
Johnson TM, Overgard EB, Cohen AE, DiBaise JK. 2013. Nutrition assessment and management in advanced liver disease. Nutr Clin Pract 28(1):15–29. https://doi.org/10.1177/0884533612469027
Kondrup J, Rasmussen HH, Hamberg OLE, Stanga Z, An ad hoc ESPEN Working Group. 2003. Nutritional Risk Screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin Nutr 22(3):321–336. https://doi.org/10.1016/S0261-5614(02)00214-5
Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Van den Berghe G, Pichard. 2016. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, Definitions and General Topics. Clin Nutr 25(2): 180–186. https://doi.org/10.1016/j.clnu.2006.02.007
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA et al. 2016. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enteral Nutr 40(2):159–211. https://doi.org/10.1177/0148607115621863
Mendenhall C, Roselle GA, Gartside P, Moritz T, Veterans Administration Cooperative Study Groups 119 and 275. 1995. Relationship of protein calorie malnutrition to alcoholic liver disease: A reexamination of data from two veterans administration cooperative studies. Alcohol Clin Exp Res 19(3):635–641. https://doi.org/10.1111/j.1530-0277.1995.tb01560.x
Ney M, Gramlich L, Mathiesen V, Bailey RJ, Haykowsky M, Ma M, Abraldes JG, Tandon P. 2017. Patient-perceived barriers to lifestyle interventions in cirrhosis. Saudi J Gastroenterol 23(2):97–104. https://doi.org/10.4103/1319-3767.203357
Palmer LB, Kuftinec G, Pearlman M, Green CH. 2019. Nutrition in Cirrhosis. Curr Gastroenterol Rep 21(8):1–10. https://doi.org/10.1007/s11894-019-0706-5
Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Bischoff SC. 2019. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 38(2):485–521. https://doi.org/10.1016/j.clnu.2018.12.022
Poudineh S, Shayesteh F, Kermanchi J, Haghdoost AA, Torabi P, Pasdar Y, Azimi-Nezhad M, Safarian M, Hajifaraji M, Eslami-Hasan-Abadi S et al. 2021. A multi-centre survey on hospital malnutrition: Result of PNSI study. Nutrition Journal BioMed Central 20(1):1–7. https://doi.org/10.1186/s12937-021-00741-1
Purnak T, Yilmaz Y. 2013. Liver disease and malnutrition. Best Pract Res Clin Gastroenterol 27(4):619–629. https://doi.org/10.1016/j.bpg.2013.06.018
Rahman A, Wu T, Bricknell R, Muqtadir Z, Armstrong D. 2015. Malnutrition matters in Canadian hospitalized patients: Malnutrition risk in hospitalized patients in a tertiary care center using the malnutrition universal screening tool. Nutr Clin Pract 30(5):709–713. https://doi.org/10.1177/0884533615598954
Rajab N, Hamid SBA, Said AHM, Isa KAM. 2023. Validation of nutrition screening tool : Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) for chronic liver disease patients. Malaysian Journal of Medicine & Health Sciences 19(3):1–8. https://doi.org/10.47836/mjmhs19.3.x
Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. 2019. Nutritional risk screening and assessment. J Clin Med 8(7):1–19. https://doi.org/10.3390/jcm8071065
Sharma P, Rauf A, Matin A, Agarwal R, Tyagi P, Arora A. 2017. Handgrip strength as an important bed side tool to assess malnutrition in patient with liver disease. J Clin Exp Hepatol 7(1):16–22. https://doi.org/10.1016/j.jceh.2016.10.005
Skladany L, Vnencakova J, Laffers L, Skvarkova B, Hrubá E, Molcan P, Koller, T. 2021. Adherence to oral nutritional supplements after being discharged from the hospital is low but improves outcome in patients with advanced chronic liver disease. Patient Prefer Adherence 14:2559–2572. https://doi.org/10.2147/PPA.S283034
Tandon P, Raman M, Mourtzakis M, Merli M. 2017. A practical approach to nutritional screening and assessment in cirrhosis. Hepatol 65(3):1044–1057. https://doi.org/10.1002/hep.29003
Wu Y, Zhu Y, Feng Y, Wang R, Yao N, Zhang M, Liu X, Liu H, Shi L, Zhu L et al. 2020. Royal free hospital-nutritional prioritizing tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with nutritional risk screening 2002. Bj J Nutr 124(12):1293–1302. https://doi.org/10.1017/s0007114520002366
Borhofen SM, Gerner C, Lehmann J, Fimmers R, Görtzen J, Hey B, Geiser F, Strassburg CP, Trebicka J. 2016. The royal free hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 61(6): 1735–1743. https://doi.org/10.1007/s10620-015-4015-z
Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM. 2015. Diagnostic criteria for malnutrition-an ESPEN consensus statement. Clin Nutr 34(3):335–340. https://doi.org/10.1016/j.clnu.2015.03.001
Cheung K, Lee SS, Raman M. 2012. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol 10(2):117–125. https://doi.org/10.1016/j.cgh.2011.08.016
Georgiou A, Papatheodoridis GV, Alexopoulou A, Deutsch M, Vlachogiannakos I, Ioannidou P, Papageorgiou MV, Papadopoulos N, Tsibouris P, Prapa A et al. 2019. Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: The KIRRHOS study. Br J Nutr 122(12):1368–1376. https://doi.org/10.1017/S0007114519002277
Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J et al. 2013. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med 173(9):778–787. https://doi.org/10.1001/jamainternmed.2013.180
Jeejeebhoy KN, Keller H, Gramlich L, Allard JP, Laporte M, Duerksen DR, Payette H, Bernier P, Vesnaver E, Davidson B et al. 2015. Nutritional assessment: Comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission. Am J Clin 101(5):956–965. https://doi.org/10.3945/ajcn.114.098665
Johnson TM, Overgard EB, Cohen AE, DiBaise JK. 2013. Nutrition assessment and management in advanced liver disease. Nutr Clin Pract 28(1):15–29. https://doi.org/10.1177/0884533612469027
Kondrup J, Rasmussen HH, Hamberg OLE, Stanga Z, An ad hoc ESPEN Working Group. 2003. Nutritional Risk Screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin Nutr 22(3):321–336. https://doi.org/10.1016/S0261-5614(02)00214-5
Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Van den Berghe G, Pichard. 2016. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, Definitions and General Topics. Clin Nutr 25(2): 180–186. https://doi.org/10.1016/j.clnu.2006.02.007
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA et al. 2016. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enteral Nutr 40(2):159–211. https://doi.org/10.1177/0148607115621863
Mendenhall C, Roselle GA, Gartside P, Moritz T, Veterans Administration Cooperative Study Groups 119 and 275. 1995. Relationship of protein calorie malnutrition to alcoholic liver disease: A reexamination of data from two veterans administration cooperative studies. Alcohol Clin Exp Res 19(3):635–641. https://doi.org/10.1111/j.1530-0277.1995.tb01560.x
Ney M, Gramlich L, Mathiesen V, Bailey RJ, Haykowsky M, Ma M, Abraldes JG, Tandon P. 2017. Patient-perceived barriers to lifestyle interventions in cirrhosis. Saudi J Gastroenterol 23(2):97–104. https://doi.org/10.4103/1319-3767.203357
Palmer LB, Kuftinec G, Pearlman M, Green CH. 2019. Nutrition in Cirrhosis. Curr Gastroenterol Rep 21(8):1–10. https://doi.org/10.1007/s11894-019-0706-5
Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Bischoff SC. 2019. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 38(2):485–521. https://doi.org/10.1016/j.clnu.2018.12.022
Poudineh S, Shayesteh F, Kermanchi J, Haghdoost AA, Torabi P, Pasdar Y, Azimi-Nezhad M, Safarian M, Hajifaraji M, Eslami-Hasan-Abadi S et al. 2021. A multi-centre survey on hospital malnutrition: Result of PNSI study. Nutrition Journal BioMed Central 20(1):1–7. https://doi.org/10.1186/s12937-021-00741-1
Purnak T, Yilmaz Y. 2013. Liver disease and malnutrition. Best Pract Res Clin Gastroenterol 27(4):619–629. https://doi.org/10.1016/j.bpg.2013.06.018
Rahman A, Wu T, Bricknell R, Muqtadir Z, Armstrong D. 2015. Malnutrition matters in Canadian hospitalized patients: Malnutrition risk in hospitalized patients in a tertiary care center using the malnutrition universal screening tool. Nutr Clin Pract 30(5):709–713. https://doi.org/10.1177/0884533615598954
Rajab N, Hamid SBA, Said AHM, Isa KAM. 2023. Validation of nutrition screening tool : Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) for chronic liver disease patients. Malaysian Journal of Medicine & Health Sciences 19(3):1–8. https://doi.org/10.47836/mjmhs19.3.x
Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. 2019. Nutritional risk screening and assessment. J Clin Med 8(7):1–19. https://doi.org/10.3390/jcm8071065
Sharma P, Rauf A, Matin A, Agarwal R, Tyagi P, Arora A. 2017. Handgrip strength as an important bed side tool to assess malnutrition in patient with liver disease. J Clin Exp Hepatol 7(1):16–22. https://doi.org/10.1016/j.jceh.2016.10.005
Skladany L, Vnencakova J, Laffers L, Skvarkova B, Hrubá E, Molcan P, Koller, T. 2021. Adherence to oral nutritional supplements after being discharged from the hospital is low but improves outcome in patients with advanced chronic liver disease. Patient Prefer Adherence 14:2559–2572. https://doi.org/10.2147/PPA.S283034
Tandon P, Raman M, Mourtzakis M, Merli M. 2017. A practical approach to nutritional screening and assessment in cirrhosis. Hepatol 65(3):1044–1057. https://doi.org/10.1002/hep.29003
Wu Y, Zhu Y, Feng Y, Wang R, Yao N, Zhang M, Liu X, Liu H, Shi L, Zhu L et al. 2020. Royal free hospital-nutritional prioritizing tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with nutritional risk screening 2002. Bj J Nutr 124(12):1293–1302. https://doi.org/10.1017/s0007114520002366
Authors
RajabN., & Abdul HamidS. B. (2024). Royal Free Hospital Nutrition Prioritizing Tools (RFH-NPT): Predictor of Malnutrition Risk among Chronic Liver Disease Patients. Jurnal Gizi Dan Pangan, 19(Supp.1), 1-8. https://doi.org/10.25182/jgp.2024.19.Supp.1.1-8
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Article Details
