Palavras-chave
Avaliação nutricional
Triagem de risco
Como Citar
Copyright © | Todos os direitos reservados.
A revista detém os direitos autorais exclusivos de publicação deste artigo nos termos da lei 9610/98.
Reprodução parcial
É livre o uso de partes do texto, figuras e questionário do artigo, sendo obrigatória a citação dos autores e revista.
Reprodução total
É expressamente proibida, devendo ser autorizada pela revista.
Resumo
Objetivo: Comparar as principais ferramentas de triagem e diagnóstico nutricional utilizadas em pacientes adultos com doença hepática crônica. Métodos: Revisão integrativa da literatura realizada nas bases PubMed, Cochrane Library e SciELO, incluindo estudos originais publicados entre 2016 e 2025, nos idiomas português e inglês. Foram selecionados estudos com pacientes adultos com doença hepática crônica ou cirrose que utilizaram instrumentos de triagem e/ou avaliação nutricional. A seleção ocorreu por títulos, resumos e leitura completa, resultando em 33 estudos incluídos. Os dados extraídos contemplaram delineamento, características da população, ferramentas aplicadas e principais desfechos clínicos. Resultados: A desnutrição apresentou alta prevalência, variando conforme o método empregado. O RFH-NPT demonstrou maior sensibilidade na triagem nutricional. Para diagnóstico, ASG, RFH-GA e critérios GLIM associaram-se consistentemente à gravidade da doença, sarcopenia, mortalidade e tempo de internação. Medidas complementares, como força de preensão palmar, bioimpedância elétrica e tomografia computadorizada, mostraram relevância na avaliação funcional e da composição corporal. Considerações finais: A desnutrição é frequente e subdiagnosticada quando métodos isolados são utilizados. A abordagem multimodal mostrou-se mais eficaz, integrando triagem de risco precoce, diagnóstico nutricional estruturado e avaliação funcional e corporal.
Referências
ALI SH, et al. Nutritional assessment in patients with liver cirrhosis. World Journal of Hepatology, 2022; 14(9): 1694-1703.
ANDRADE CPT, et al. Diminished hand grip strength and cirrhosis: prevalence and associated factors. Arquivos de Gastroenterologia, 2023; 60(4): 431-437.
ARORA S, et al. The development and validation of a nutritional prioritising tool for use in patients with chronic liver disease. Gut, 2012; 61: A90.
BAKER JP, et al. Nutritional assessment: a comparison of clinical judgement and objective measurements. The New England Journal of Medicine, 1982; 306(16): 969-972.
BARTLETT S, et al. Nutritional assessment of patients with liver cirrhosis in the outpatient setting: a narrative review. Nutrition, 2025; 132: 112675.
BENTO JR, TANURI PC. Estado nutricional por diferentes parâmetros e sua associação com a gravidade e complicações clínicas da doença hepática crônica em pacientes hospitalizados. Dissertação (Mestrado em Nutrição) – Universidade Federal da Bahia, Salvador, 2024.
BOULHOSA RS, et al. Comparison between criteria for diagnosing malnutrition in patients with advanced chronic liver disease: GLIM group proposal versus different nutritional screening tools. Journal of Human Nutrition and Dietetics, 2020; 33(6): 862-868.
BOZIC D, et al. Detection of sarcopenia in patients with liver cirrhosis using the bioelectrical impedance analysis. Nutrients, 2023; 15(15): 3335.
CALAPKORUR S, et al. Comparison of the effectiveness of nutritional risk score-2002 and Royal Free Hospital-Nutritional Prioritizing Tool nutrition screening tools in liver cirrhosis. Turkish Journal of Gastroenterology, 2025; 37(1): 121-126.
CEDERHOLM T, et al. GLIM criteria for the diagnosis of malnutrition – a consensus report from the global clinical nutrition community. Clinical Nutrition, 2019; 38(1): 1-9.
CHEEMERLA S, BALAKRISHNAN M. Global epidemiology of chronic liver disease. Clinical Liver Disease, 2021; 17(5): 365-370.
CIOCÎRLAN M, et al. Subjective global assessment and handgrip strength as predictive factors in patients with liver cirrhosis. Pesquisa e Prática em Gastroenterologia, 2017; 2017: 8348390.
DEZA D, et al. Mini Nutritional Assessment - Short Form is a useful malnutrition screening tool in patients with liver cirrhosis, using the Global Leadership Initiative for Malnutrition criteria as the gold standard. PráticaClínica de Nutrição, 2021; 36(5): 1003-1010.
EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER (EASL). EASL clinical practice guidelines on nutrition in chronic liver disease. Journal of Hepatology, 2019; 70(1): 172-193.
EUROPEAN SOCIETY FOR CLINICAL NUTRITION AND METABOLISM (ESPEN). ESPEN practical guideline: clinical nutrition in liver disease. Clinical Nutrition, 2020; 39(12): 3533-3562.
FONSECA ALF, et al. Global Leadership Initiative on Malnutrition criteria for the diagnosis of malnutrition and prediction of mortality in patients awaiting liver transplant: a validation study. Nutrition, 2023; 114: 112093.
FUENTE RA. Nutrition and chronic liver disease. Clinical Drug Investigation, 2022; 42(Suppl 1): S55-S61.
GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 2020; 5(3): 245-266.
GEORGIOU A, et al. Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study. British Journal of Nutrition, 2019; 122(12): 1368-1376.
GLASENAPP JH, et al. Translation and cross-cultural adaptation of the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Arquivos de Gastroenterologia, 2023; 60(1): 84-90.
GREGORINI FR, et al. Avaliação do estado nutricional em pacientes hospitalizados com cirrose hepática. BRASPEN Journal, 2016; 31(4): 299-304.
GUIMARÃES JSF, et al. Burden of liver disease in Brazil, 1996–2022: a retrospective descriptive study of the epidemiology and impact on public healthcare. The Lancet Regional Health – Americas, 2024; 33: 100731.
HE Y, et al. Nutritional screening and assessment tools for patients with cirrhosis based on the Global Leadership Initiative on Malnutrition criteria. Journal of Human Nutrition and Dietetics, 2024; 37(2): 430-439.
JAVAID N, et al. Avaliando o impacto da avaliação e intervenção nutricional precoce em pacientes hospitalizados com cirrose hepática. Arquivos de Gastroenterologia, 2022; 59(1): 22-28.
KALAFATELI M, et al. A desnutrição e a sarcopenia predizem os resultados pós-transplante hepático independentemente da pontuação do Modelo para Doença Hepática Terminal. Journal of Cachexia, Sarcopenia and Muscle, 2017; 8(1): 113-121.
KOULENTAKI M, et al. Nutritional assessment of Greek liver cirrhosis patients: Mini Nutritional Assessment predicts mortality. Healthcare, 2022; 10(5): 859.
LIU Q, et al. Development and external validation of Global Leadership Initiative on Malnutrition-dictated nomograms predicting long-term mortality in hospitalized patients with cirrhosis. Science Progress, 2025; 108(1): 368504251320157.
MAKHIJA S, BAKER J. The Subjective Global Assessment: a review of its use in clinical practice. Nutrition in Clinical Practice, 2008; 23(4): 405-409.
MARR KJ, et al. Nutritional status and the performance of multiple bedside tools for nutrition assessment among patients waiting for liver transplantation: a Canadian experience. Nutrição Clínica ESPEN, 2017; 17: 68-74.
MCFARLANE M, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clinical Nutrition ESPEN, 2018; 23: 156-161.
MIWA T, et al. Usefulness of the Global Leadership Initiative on Malnutrition criteria to predict sarcopenia and mortality in patients with chronic liver disease. Hepatology Research, 2022; 52(11): 928-936.
MOON AM, et al. Contemporary epidemiology of chronic liver disease and cirrhosis. Clinical Gastroenterology and Hepatology, 2020; 18(12): 2650-2666.
MORGAN MY, et al. Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology, 2006; 44(4): 823-835.
NUNES FF, et al. Food consumption of cirrhotic patients, comparison with the nutritional status and disease staging. Arquivos de Gastroenterologia, 2016; 53(4): 250-256.
NUNES G, et al. Outcome and nutritional assessment of chronic liver disease patients using anthropometry and subjective global assessment. Arquivos de Gastroenterologia, 2017; 54(3): 225-231.
O’BRIEN A e WILLIAMS R. Nutrition in End-Stage Liver Disease: principles and practice. Gastroenterology, 2008; 134(6): 1729-1740.
OLIVEIRA KS, et al. Malnutrition in cirrhosis: association with etiology and hepatocellular dysfunction. Arquivos de Gastroenterologia, 2020; 57(4): 375-380.
PARKASH OM, et al. Assessment of malnutrition in patients with liver cirrhosis using protein calorie malnutrition (PCM) score versus bio-electrical impedance analysis (BIA). BMC Research Notes, 2018; 11(1): 545.
PELTRON M, et al. Role of nutrition in the management of chronic liver disease. Gastro Hep Advances, 2025; 4(5): 100613.
RAMACHANDRAN G, et al. Effectiveness of different tools for malnutrition in the assessment of patients with cirrhosis. Am J Med Sci. 2024; 368(1):61 67.
SANTOS BC, et al. Different combinations of the GLIM criteria for patients awaiting a liver transplant: poor performance for malnutrition diagnosis but a potentially useful prognostic tool. Clinical Nutrition, 2022; 41(1): 97-104.
SANTOS KMS, et al. Nutritional risk assessment using the Nutritional Prognostic Index predicts mortality in Advanced Chronic Liver Disease patients. Nutrition, 2025; 130: 112612.
SAUERESSIG C. Estado nutricional como preditor de mortalidade em pacientes hospitalizados com cirrose descompensada. Dissertação (Mestrado em Ciências em Gastroenterologia e Hepatologia) – Universidade Federal do Rio Grande do Sul, Porto Alegre, 2018.
SBH - Sociedade Brasileira de Hepatologia. Nota técnica: atualização das recomendações da SBH sobre a Covid-19 na cirrose e no transplante de fígado. São Paulo, 2021.
SHARMA A, NAGALLI S. Chronic Liver Disease. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
SHARMA P, et al. Handgrip strength as an important bed side tool to assess malnutrition in patient with liver disease. Journal of Clinical and Experimental Hepatology, 2017; 7(1): 16-22.
SHASTHRY V, et al. Handgrip strength: best practice for a rapid nutrition screening and risk stratification in male patients with alcoholic liver cirrhosis, a classification and regression tree analysis study. Nutrition in Clinical Practice, 2024; 39(2): 475-484.
TAN JYT, et al. Outpatient screening with the Royal Free Hospital-Nutrition Prioritizing Tool for patients with cirrhosis at risk of malnutrition. Nutrition, 2023; 114: 112139.
TOMIYA MTO, et al. Associação entre o consumo alimentar e o estado nutricional de pacientes com alterações hepáticas. Nutricíon Clínica y Dietética Hospitalaria, 2025; 44(1): 31-38.
TOPAN MM, et al. Comparison of different nutritional assessment tools in detecting malnutrition and sarcopenia among cirrhotic patients. Diagnostics, 2022; 12(4): 893.
TRAUB J, et al. Validation of malnutrition screening tools in liver cirrhosis. Nutrients, 2020; 12(5): 1306.
VEISSETES D, GONZÁLEZ A. Nutritional evaluation of hospitalized patients with hepatic cirrhosis and the impact on the prognosis of the disease: a cross-sectional study. Acta Gastroenterologica Latinoamericana, 2022; 52(3): 367-377.
WANG Z, et al. The Global Leadership Initiative on Malnutrition criteria for the diagnosis of malnutrition in patients with chronic liver diseases: a systematic review and meta-analysis. Frontiers in Nutrition, 2025; 12: 161241.
WU Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002. British Journal of Nutrition, 2020; 124(12): 1293-1302.
YANG D, et al. Malnutrition according to the Global Leadership Initiative on Malnutrition criteria is associated with in-hospital mortality and prolonged length of stay in patients with cirrhosis. Nutrition, 2023; 105: 111860.
YANG W, et al. Comparison of the GLIM criteria with specific screening tool for diagnosing malnutrition in hospitalized patients with cirrhosis: a descriptive cross-sectional study. JPEN Journal of Parenteral and Enteral Nutrition, 2023; 47(2): 310-321.
ZHANG P, et al. Differences in nutritional risk assessment between NRS2002, RFH-NPT and LDUST in cirrhotic patients. Scientific Reports, 2023; 13: 3306.