Nutritional support in chronic liver disease and cirrhotics

Table 1 Anthropometric techniques: Benefits and limitations

Technique	Benefits	Limitations
BMI	Weight (kg)/height (m2) Indicator of choice for chronic undernutrition in adults Probability of misclassifying nutritional status on basis of BMI considered to be very small	Confounded in cirrhotics with ascites and peripheral edema
Mid-arm muscle circumference	Measured in centimeters using flexible measuring tape (halfway between olecranon and acromion process) Less influenced by patient fluid status (upper limbs less commonly edematous) Recognize malnutrition earlier relative to BMI Better at recognizing mild-moderate malnutrition	Possibly significant inter-observer variability Poorly recognizes patients with severe malnutrition
Skinfold thickness (triceps, biceps, subscapular, suprailiac)	Measured in millimeters using skinfold caliper Less influenced by patient fluid status Recognize malnutrition earlier relative to BMI Better at recognizing mild-moderate malnutrition	Possibly significant inter-observer variability Poorly recognizes patients with severe malnutrition
Handgrip strength	Measured in kilogram force, using hydraulic dynamometer adjusted to patient hand size Highly sensitive indicator of functional impairment, reflective of protein-calorie malnutrition Correlates with severity of clinical outcome in different disease states	Requires certain equipment to measure which may not be widely available

BMI: Body mass index.